Caring for the patient with a tracheostomy (PDF, 250K, 36secs)
About this Best Practice Statement
This statement is designed primarily for the non-specialist practitioner, as an introductory statement and as a guide to best practice and what support should be available locally. It is not designed as a ‘how to’ document, but where professional consensus exists on particular procedures, this is recorded in the statement.
The statement will support local policies and procedures. It is the hope of the Practice Development Unit that, in time, the best practice statements will stimulate research and the development of a more formal evidence base; the statements are targeted at areas of clinical practice where the formal evidence base is still in the process of being developed and where there is a variation in practice across Scotland.
This statement was first published in 2003, and was then revised and republished in March 2007.
About Tracheostomy
A tracheostomy is an opening in the front of the trachea that can be temporary or permanent. Temporary ones usually have a tracheostomy tube in place to keep them open. Indications for the formation of a tracheostomy will include protection from aspiration in cases of swallowing impairment, to facilitate breathing and weaning from artificial ventilation and to facilitate clearance of secretions. Examples of patients who may have a tracheostomy are those with neuromuscular disorders who have impaired swallowing and coughing, those who have a poor cough or gag reflex after a head injury or a protracted critical illness and patients who have had their larynx removed surgically. As with the original, this revised statement does not refer to care of patients with a laryngectomy.
The different nature of the situations in which a tracheostomy could be employed means that it is difficult to track the epidemiology of this procedure. Due to the increasing sophistication of medical technology and higher survival rates from diseases such as motor neurone disease, the incidence of tracheostomy in general wards and in the community is increasing. In Scotland, the volume of tracheostomy operations over the last decade has increased (Appendix 1). In 2002, the Ear, Nose and Throat (ENT) Nursing network from the Nursing and Midwifery Practice Development Unit, which subsequently merged with other organisations to become NHS QIS, identified this topic as one where guidance and support in the form of professional consensus would help promote consistent practice across Scotland.
