A tracheostomy is a surgical opening through the neck and into the trachea, usually necessary after trauma, disease or surgery. As a result, a permanent hole, or stoma, remains as the orifice through which the person breathes. A tracheostomy tube fits inside the stoma and is secured to the patient’s neck with a tube harness, and may be used by some patients who have trouble with secretion build-up in the trachea. If needed, oxygen therapy can be delivered directly through the stoma or tracheostomy tube.
A person with a tracheostomy no longer breathes through his nose and mouth. All air exchange takes place through the stoma, and steps need to be taken to ensure needed oxygen therapy is delivered correctly. Medical facilities, including ambulance services, first responder units and hospitals, have guidelines in place for providing oxygen to tracheostomy patients.
Providing oxygen to a tracheostomy patient is usually done with a tracheostomy mask, which are specially designed to fit over the stoma and secure to the neck. Use a tracheostomy mask by attaching the tubing to the oxygen tank and turning the oxygen level to the desired amount. Allow the reservoir bag to fill, if applicable. Loop the mask strap around the patient’s head, then place the mask against to stoma, or stoma with tube. Ensure the mask is not obscuring the tube, if applicable, before gently securing the strap around the patient’s neck to keep the mask in place.
Emergency situations may not allow the availability of a tracheostomy mask, and using a standard oxygen mask may be necessary. This will result in the blow-by technique, which provides oxygen around the stoma, but not directly into it, as standard oxygen masks do not fit a stoma correctly for direct oxygen delivery.
Consider using a standard pediatric-size face mask to deliver oxygen to either an adult or child. Using a pediatric size allows the mask to fit more easily over the small stoma, and creates a better seal for oxygen delivery. Loop the mask strap around the patient’s head and place the oxygen mask over the stoma in a sideways position, which may allow a better fit. The standard oxygen mask has a small rise intended to fit over the nose. Pad this rise with gauze four-by-fours as you place the mask against the patient’s neck. Add additional padding any where you see fit to create a seal, and secure the mask as snugly as possible by tightening the mask strap.
If placing the oxygen mask to a stoma with a tube, hold the mask slightly above the tube to prevent obstructing it with the mask. If there is room, place the oxygen mask over the tube, but watch that it does not become occluded by the mask.