Care of adult patients in acute care facilities with a tracheostomy

This clinical practice guide can be used to support NSW local health districts (LHDs) and hospitals to develop local procedures for the care of patients who have a tracheostomy.

Tracheotomy or tracheostomy refers to an artificial opening into the trachea, which may be temporary or permanent. Most patients with a tracheostomy tube will have healthcare needs that cover several healthcare disciplines. This mean an experienced clinician or team is needed to coordinate care for these patients.

This guide includes recommendations for patient-centred, time-sensitive care for patients in acute care facilities with a tracheostomy. These include how to create a safe environment and system of care.

At a glance

The clinical practice guide covers recommendations for:

  • a system of care
  • clinical practice
  • emergency care
  • nutrition
  • communication.

Toolkit

A suite of tools and resources is available to support implementation of this guide. Tools are available to assist with:

  • creating a safe environment for care of adult patients with a tracheostomy
  • ensuring appropriate bedside and emergency equipment is on hand
  • education and training for clinicians
  • weaning to decannulation
  • emergency care of adult patients with a tracheostomy and/or laryngectomy
  • nutrition screening.

Background

This is an update to the Clinical practice guideline: Care of adult patients in acute care facilities with a tracheostomy, published in 2013.

The updated guide has been reviewed by a working group, including expert medical, nursing and allied health representatives from LHDs across NSW.

Resources

Head of the bed signage - tracheostomy

Head of bed signage providing information to have readily available at the bedspace of a patient with a tracheostomy. Facilities may have their own signage and more detailed and provide specific pathways to be followed should complications arise specific to individual patient needs and the clinical environment.

Source: Adapted from the UK national tracheostomy project

Head of the bed signage - laryngectomy

Head of bed signage providing information to have readily available at the bedspace of a patient with a laryngectomy. Facilities may have their own signage and more detailed and provide specific pathways to be followed should complications arise specific to individual patient needs and the clinical environment.

Source: Adapted from the UK national tracheostomy project

Bedside equipment for patient with tracheostomy

The list of recommended bedside tracheostomy equipment was developed by the clinicians who contributed to the clinical practice guide. The actual equipment required at the bedside may vary according to local health district and unit guidelines.

Source: ACI

Emergency equipment for patient with tracheostomy

The list of recommended emergency tracheostomy equipment was developed by the clinicians who contributed to the clinical practice guide. Emergency equipment should be securely kept in a self-contained box, bag or pack to ensure all equipment is available for emergency management and checked each shift.

Source: ACI

12 essential elements of tracheostomy care poster

Poster released in 2013 outlining the essentail elements of care for adult patients with a tracheostomy.

Source: ACI

Transport checklist for patient with a tracheostomy

An example of a transport safety checklist that should be completed prior to transport if the unit requires one. Ensure emergency Tracheostomy equipment is taken on transport.

Source: ACI

Tracheostomy emergency management plan (flow chart)

Algorithm providing an example of an emergency tracheostomy management plan for a patient with a patent upper airway. It was adapted from the UK National Tracheostomy Safety Project.

Source: Adapted from the UK national tracheostomy project

Laryngectomy emergency management plan (flow chart)

The following algorithm is an example of an emergency laryngectomy management plan for a patient with a patent upper airway. It was adapted from the UK National Tracheostomy safety project.

Source: Adapted from the UK national tracheostomy project

Weaning and decannulation flow chart

Adapted from the Northern Sydney LHD guideline. This pathway provides guidance for weaning to decannulation and required observations during this process.

Source: Northern Sydney LHD

Malnutrition screening tool (MST)

An easy to use screening tool with two questions for health care clinicans to identify patients at risk of malnutrition and initate a referal to a dietitian.

Source: Metro North Hospital and health Service and Royal Brisbane and Women's Hospital

Malnutrition universal screening tool

Used for rapid, simple and general procedures by medical, nursing and other staff to identify adults who maybe malnourshised, at risk of malnutrition or obese. It provides guidelines for clinicans to mange these patients.

Source: BAPEN (UK)

Nutrition risk screening tool

The nutrition risk screening tool can be accessed on page 420 of the ESPEN Guidelines for Nutrition Screening. The tool assists clinicians to predict the risk of malnutrition and then the need for a nutritional assessment and intervention.

Source: Kondrup JE, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. Clinical nutrition. 2003 Aug 1;22(4):415-21.

Espen guidelines

The 2019 European Society for Parenteral and Enteral Nutrition Guidelines provide the most recent consensus statements on nutrition in the intensive care patient.

Source: Singer P, Blaser AR, Berger MM, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clinical Nutrition. 2019 Feb 1;38(1):48-79.

Continuing professional development toolkit

This toolkit can be used as a guide by LHDs to develop tracheostomy competencies for different members of the multidisciplinary team. The descriptor specifies the competency, expected performance criteria and the members of the multidisciplinary team.

Source: ACI

Critical care airway management course

A 2-day, practical, hands-on course covering advanced airway management when the going gets tough. CCAM is not about the routine patient in the anaesthetic room, this course will teach you the skills and mindset for when the airway is difficult, the patient sick, the environment challenging, or all of the above.

Source: Critical Care Airway Management

National tracheostomy safety project e-learning modules

Four self-directed modules developed in collaboration between the NHS e-Learning for Healthcare (eLfH) and the Royal College of Anaesthetists e-Learning in Anaesthesia project (eLA)

Source: National tracheostomy safety project (UK)

Disclaimer

The information on this page is general in nature and cannot reflect individual patient variation. It reflects Australian intensive care practice, which may differ from that in other countries. It is intended as a supplement to the more specific information provided by the doctors and nurses caring for your loved one. ICNSW attests to the accuracy of the information contained here but takes no responsibility for how it may apply to an individual patient. Please refer to the full disclaimer.