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  • Print publication year: 2015
  • Online publication date: July 2015

67 - Examination of a tracheostomy

from Section 12 - Airway, trauma and critical care

Summary

Checklist

WIPER

• Gloves/eye protection if handling the airway

Physiological parameters

Look

• Agitation

• Cyanosis/desaturation

• Respiratory rate

• Tube position

• Chest movement

Listen

• Air entry into chest

• Air leak around cuff

Feel

• Surgical emphysema

• Suction catheter passage

Examination notes

What do you look for in the initial observation of a tracheostomy?

• See-sawing chest movements are a sign of airway obstruction.

• Agitation, hypertension and tachycardia may be the first indicators that there could be a problem with the tracheostomy.

• Cyanosis and desaturation are late signs, and should not be relied on as the sole means of indicating a problem.

• Examine the tracheostomy tubing more carefully: most of the tube should be within the trachea via the stoma.

What are the various types of tracheostomy?

There are two ways of performing a tracheostomy:

Percutaneous – performed in ITU by intensivists/anaesthetists using the Seldinger technique with progressive dilatation over a guidewire.

Surgical – performed in the operating theatre under direct vision.

How do you assess whether a tracheostomy has become misplaced?

Observe the patient and auscultate the chest to hear any signs of air entry. If there is a leak around the tracheostomy cuff or stoma then this would normally be heard as a ‘gurgling’ sound or slow release of air when applying positive-pressure ventilation. If there is no air entry into the chest you should suspect that the tracheostomy has become displaced.