Examination notes

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

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

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

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

4. • 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:

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

2. 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.