Tracheostomy Care

More than 30 years ago, Kindred Healthcare pioneered the first hospitals to specialize in pulmonary care. Patients and families today often choose Kindred for our expertise in providing effective care plans for respiratory patients, including those who have a tracheostomy. Our hospitals offer the compassionate care and clinical expertise needed to free trach patients from assisted breathing devices and advance their recovery.

“When it comes to respiratory care – and caring for trach patients and vent patients in general – Kindred Hospitals set the standard in post-acute care,” says Dr. Sean Muldoon, Senior Vice President and Chief Medical Officer for Kindred Healthcare’s Hospital Division. “Our approach to caring for vent patients is often modeled as a best practice in the industry.”

What is a tracheostomy?

Certain conditions – such as a severe lung disorder, neurological problem, or infection – can make it impossible to breathe effectively. If you are in this situation, your physician may need to insert a tracheostomy to help you breathe.

During a tracheostomy insertion, a surgeon will create a hole in the neck in order to accommodate a breathing tube. The tube, placed inside the trachea (also known as the windpipe), allows air to enter the lungs. The tracheostomy is often combined with mechanical ventilation for breathing assistance.

In fact, the majority of tracheostomies are required because a patient needs prolonged mechanical ventilation to help them breathe. On rare occasions, an emergency tracheostomy is created to help someone whose airway has become blocked suddenly, usually by a traumatic injury to the neck or face.

Why would someone need a tracheostomy?

There are many reasons why a patient might need to have a tracheostomy.

A few of the conditions associated with this procedure are:

  • Bronchopulmonary dysplasia (BPD)
  • Chronic pulmonary disease (COPD)
  • Diaphragm dysfunction
  • Spinal cord injury
  • Coma
  • Chest wall injury
  • Neurological problems
  • Stroke
  • Disorders of respiratory control
  • Prolonged respiratory support
  • Heart attack

Besides injuries, respiratory failure is another emergency tracheostomy indication. Respiratory failure happens when oxygen is not passing from the lungs into the bloodstream, or the patient’s organs are damaged by too much carbon dioxide in the blood, or a combination of both occurs.

What are the possible complications from having a tracheostomy?

Early complications can happen soon after the tracheostomy insertion is performed.

A few early complications include:

  • Bleeding
  • Air leakage around the lungs (pneumothorax)
  • Air trapped in the deeper layers of the chest (pneumomediastinum)
  • Air trapped underneath the skin around the tracheostomy (subcutaneous emphysema)
  • Damage to the esophagus
  • Injury to the vocal cords
  • Collapsed lung

Blockages are another tracheostomy complication. Tracheostomy tubes can be blocked by blood clots, mucus or the pressure of the airway walls. However, blockages can be prevented by tracheostomy suctioning, humidifying the air and selecting the appropriately sized tracheostomy tube.

Other breathing tube complications can occur later on while the tracheostomy tube is in place, such as accidental removal and infections in the trachea or around the tracheostomy tube. The windpipe itself may also become damaged for a number of reasons, including pressure from the tube, bacteria causing infections, scar tissue or friction from a tube that moves too much.

The interdisciplinary care team at Kindred provides the care patients need to prevent serious complications, like infection or bleeding, associated with surgical procedures. We work with you and your loved ones to begin rehabilitation, so you can learn to breathe independently as quickly as your recovery will allow.

Tracheostomy outcomes and successes

A patient with a tracheostomy must be cared for to prevent infections, bleeding and other complications. Frequent tube replacement and tracheostomy suctioning of mucus are important parts of the care plan to help avoid infection. At Kindred Hospitals, we offer tracheostomy care steps tailored to each patient’s individual needs through an interdisciplinary team. The team can include physicians, nurses, respiratory therapists, occupational therapists, physical therapists, nutritionists and other specialists, depending on your medical condition.

As a patient recovers from their underlying illness, the amount of support they require from the breathing machine is gradually reduced. This process is commonly called ventilator weaning or ventilator liberation. Kindred Hospitals have been an innovator in mechanical ventilation weaning for decades, with a ventilator weaning success rate that exceeds national averages.

“Assisting trach patients on their road to recovery is part of our everyday mission at Kindred Healthcare,” says Dr. Muldoon. “We pride ourselves on not only being pioneers in this field decades ago, but being the best at it today.”


Success Spotlight: Mr. Katz' Story

When he was 62 years old, Mr. Katz was involved in a motorcycle accident. The injuries he suffered included a laceration of his spleen and liver, multiple rib fractures, and clavicle and scapular fractures. He also suffered from respiratory failure, which required a tracheostomy and mechanical ventilation. After he was stabilized at Ocala Regional Medical Center’s Trauma Center, he was transferred to Kindred Hospital.

When Mr. Katz arrived at Kindred, he had multiple complications, including gastrointestinal bleeding and pain from his fractures. His care plan included liberation from the ventilator, but it was touch and go at first. With care from a multidisciplinary team – including respiratory therapy, dietary assistance, skilled nursing and rehabilitation – limitations were identified, goals were set, and a care plan created.

After two months at Kindred, Mr. Katz was weaned off the ventilator. He had a successful tracheostomy tube removal, meaning that his breathing tube was removed.

The nursing team focused on his wound care and pain management, while the physical therapy team worked on his strength and mobility. Before long, he was able to walk more than 250 feet with only standby assistance. The occupational therapy team then began working with him on living skills, which he was able to perform in no time with minimal assistance.

Congratulations to Mr. Katz on his recovery.

 


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