Tracheostomy information for patients and relatives

Transcription

1 Tracheostomy information for patients and relatives What is a tracheostomy? A tracheostomy is when a small opening is made in the windpipe to help you breath more easily or to help you cough up phlegm. When patients need help with their breathing, suctioning is often required (see below). A tracheostomy can make breathing support and suctioning easier and more effective in patients who need help with their breathing for more than just a few days. What are the alternatives? In the short-term, help with breathing or clearing secretions may be done through a tube passed through the mouth or nose into the windpipe. However, these are more uncomfortable for the patient, so the specialists will often recommend a tracheostomy if you are still needing breathing support and suctioning after a few days. Consent If you need a tracheostomy, the decision is made by the Anaesthetic Consultants (in conjunction with your regular specialist where appropriate), either in the ENT department or in Critical Care. This will be discussed with you fully. In Critical Care, patients may be too unwell to give consent, or may be under sedation while they receive assistance with their breathing. In these cases written consent is not required. The consultant Critical Care doctors looking after you are able to make decisions on behalf of patients who are unable to give their own consent where this is deemed to be in your best East Sussex Healthcare NHS Trust Page 1 of 5

2 interests. Wherever possible, these decisions are taken after discussion with the next of kin or available family. If you are well enough to give consent for the procedure, you may be asked to sign a consent form. Consent Although you consent for this treatment, you may at any time after that withdraw such consent. Please discuss this with your medical team. What are the potential risks and side effects? As with any surgical procedure, the potential risks are Bleeding from in or around the tracheostomy site (this small hole is called a stoma). Infection after the procedure. Trauma to the airway or soft tissues around or inside the stoma. Complications around the stoma once it has been removed: e.g. pain, difficulties in healing (that may need to be seen by a specialist for further interventions) A gruff voice This will be discussed with you fully. What are the expected benefits of treatment? The tube helps you to breathe by providing a direct and easy route for air into the lungs. It also provides direct access for suctioning secretions (phlegm) from the lungs. Why is suctioning necessary? Suctioning helps in the treatment and prevention of chest infections. You may not have the strength to cough out their secretions. Suctioning helps to clear out phlegm and other secretions from the lungs. This process may make the patient cough. It can be unpleasant but it is vital to help breathing and allow the lungs to work efficiently. It will only be carried out when necessary. Patients have said that hearing phlegm rattle around in their chest is very noisy and suctioning helps with this. What should I do before I come into hospital? It can not be predicted if you will need a tracheostomy whilst in Critical Care so no preparations can be made before you come into hospital. Will I have an anaesthetic? This procedure is mainly done using a local anaesthetic. When a tracheostomy is carried out in a patient who is already receiving breathing assistance, the patient will normally already be receiving sedative and pain-relieving drugs. How will I feel afterwards? You may experience some pain around the incision site. Painkillers will be provided. The nursing staff will be monitoring you and can discuss your needs with you. East Sussex Healthcare NHS Trust Page 2 of 5

3 Will I be able to eat? The tracheostomy tube may make swallowing difficult. The swallow will need to be checked to ensure that food and drink are swallowed safely. You may be placed on Nil By Mouth if the swallow is unsafe or if you are on artificial ventilation. Sometimes you may be started on very small amounts of food. You may be assessed by a Speech and Language Therapist who can see if you can swallow safely. Will I be able to talk? When the cuff of the tracheostomy tube is inflated, air cannot pass over the voice box. You will not therefore be able to speak. A Speech and Language Therapist may assess the speech by deflating the cuff and using a speaking valve. What is a speaking valve? The speaking valve helps to direct air into your voice box. You may be able to use the speaking valve for periods of time each day. This will be monitored regularly throughout your stay in hospital and is individual to each patient. A speaking valve can be put on at different stages for each patient s care and this will be discussed with you in more detail. When will the tube be removed? Normally the tracheostomy tube will be removed once you are able to breathe without the aid of artificial ventilation. A small filter is placed over the tracheostomy tube so you become used to breathing through your nose and mouth again The tube is then removed and a dressing is placed over the stoma (hole) The stoma (hole) will close and should heal up within a few days How long will I be in hospital? This really depends on the condition that you are receiving treatment for. A tracheostomy is just a part of this treatment. In most cases, the tracheostomy can be removed once you no longer require help with your breathing, so it is removed before you go home. In exceptional cases you could go home with a tracheostomy but this is very rare. What should I do when I go home? If the tracheostomy has been removed, the stoma (hole) will normally close up unaided. Very few stomas need any surgical intervention (stitches or any further interventions) to heal them. You will be provided with a dressing for the stoma should you need one. If you need visits from the district nurses or to go to your practice nurse, this can be discussed with you. How soon will I be able to resume normal activities? Once a tracheostomy has been removed, your voice will return but occasionally patients find their voices a little hoarse to start with. You will be allowed to eat and drink but sometimes you may need to see a speech and swallowing specialist beforehand. Any problems with any aspects of talking, eating or drinking, pain or breathing, please feel free to contact the relevant department for advice or the department that put in the tracheostomy. East Sussex Healthcare NHS Trust Page 3 of 5

4 Will I have to come back to hospital? If you need fresh dressings applied to the stoma where the tracheostomy was removed from, we will make arrangements with your GP or district nurse for you. When can I return to work? When you are discharged from hospital, you will be notified when you should be able to go back to work or if there are any limits/restrictions to your life style that you need to consider. This will depend mainly on the condition you were being treated for, rather than you having had a tracheostomy. Sources of information at Conquest Hospital Ear Nose and Throat nurse specialist: Tel: Critical Care staff: Tel: Outreach staff: Tel: Physiotherapy staff: Tel: Speech and Language staff. (S.A.L.T): Tel: Sources of information at Eastbourne DGH Ear Nose and Throat nurse specialist: Tel: Critical Care staff: Tel: ex4155 Out reach staff: Tel: (bleep via switch board) Physiotherapy staff: Tel: Speech and Language staff (S.A.L.T): Tel: ex4793 This leaflet is adapted from information developed by University College Hospital, London, who has given their permission for it to be reproduced. Important information Please remember that this leaflet is intended as general information only. It is not definitive. We aim to make the information as up to date and accurate as possible, but please be warned that it is always subject to change. Please, therefore, always check specific advice on the procedure or any concerns you may have with your doctor. Hand hygiene In the interests of our patients the trust is committed to maintaining a clean, safe environment. Hand hygiene is a very important factor in controlling infection. Alcohol gel is widely available throughout our hospitals at the patient bedside for staff to use and also at the entrance of each clinical area for visitors to clean their hands before and after entering. Other formats This information is available in alternative formats such as large print or electronically on request. Interpreters can also be booked. Please contact the Patient Advice and Liaison Service (PALS) offices, found in the main reception areas: East Sussex Healthcare NHS Trust Page 4 of 5

5 Conquest Hospital - Telephone: Eastbourne District General Hospital - Telephone: After reading this information are there any questions you would like to ask? Please list below and ask your nurse or doctor. Reference The following clinicians have been consulted and agreed this patient information: Anaesthetic consultants: Nick McNeillis, Kate Murray, Chris Scanlan, Frazer Wiggins, Bill Doherty, Ian Hicks, Nick Watson, Rhian Edwards. Sisters: Sophie Horton, Rosemary Hodges, Harriet Wilkinson, Pauline Simes, Simon Speed, Senior Physiotherapist: Alex Wheeler. Senior Speech and Language specialist: Murray Seivewright. ENT Specialist nurse: Chin Barton. Practice Educator: Fiona Stedman, Critical care. Carl Wilkinson, Charge Nurse, Senior Outreach Nurse Critical Care Jackie Dawson. The directorate groups that have agreed this patient information leaflet: Anaesthetics, ENT, Physiotherapy and Speech and Language Department. Date agreed: December 2011 Review date: December 2013 Responsible clinician/author: Sophie Horton East Sussex Healthcare NHS Trust Page 5 of 5