Tracheostomy Management: NDIS High Intensity Daily Personal Activities
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Updated 05 Aug 2021
Workers employed by National Disability Insurance Scheme (NDIS) providers, who deliver supports to NDIS participants with a tracheostomy tube in situ, must be able to provide appropriate care.
What is a Tracheostomy?
A tracheostomy is a surgical procedure that involves making an incision (stoma) into the trachea through the front of the neck. A tube is then inserted into the incision, creating an air passage that allows the patient to breathe directly through their trachea while avoiding their upper airway. This may be a temporary or permanent intervention (Healthdirect 2018; Mayo Clinic 2019).
It is vital to ensure you care for a tracheostomy tube carefully and thoroughly, as an adverse event such as respiratory distress may develop if the tracheostomy is not managed properly.
A tracheostomy is a surgical procedure that involves making an incision (stoma) into the trachea through the front of the neck.
Tracheostomy Management in the NDIS Practice Standards
Tracheostomy Management is set out in the NDIS Practice Standards under the High Intensity Daily Personal Activities Module.
This Practice Standard aims to ensure that NDIS participants with a tracheostomy tube in situ receive appropriate suctioning and management that is relevant and proportionate to their individual needs (NDIS 2020).
Under these standards, NDIS providers must meet the following quality indicators:
Participants are enabled to engage in the assessment and development of a tracheostomy management plan. This plan identifies possible risks, incidents and emergencies, and what actions need to be taken to manage these situations, including an escalation of care, if necessary. The participant’s health status is reviewed regularly (with their consent)
Workers who provide tracheostomy care are informed by appropriate policies, procedures and training plans. These relate to the supports being provided to each participant
Workers who provide tracheostomy care have received all necessary training that relates to each specific participant, either from a qualified health practitioner or another appropriately qualified individual.
(NDIS 2020)
Caring for a Tracheostomy Tube
Tracheostomy care under the NDIS should include:
Adhering to personal hygiene and infection control procedures, and wearing appropriate PPE
Monitoring the patient’s skin condition, maintaining the cleanliness of the incision (stoma) area and changing dressings
Performing routine suctioning to ensure the patient’s airways remain patent
Monitoring and reporting abnormal secretions
Cleaning and maintaining suctioning equipment
Supporting routine tube tie changes
Keeping appropriate charts and records
Identifying and responding to the signs of airway obstruction
Implementing emergency procedures related to patient deterioration or infection
Ensuring that an emergency tracheostomy kit is present at all times.
(NDIS 2018)
Staff Knowledge
NDIS workers who provide tracheostomy tube care are required to have knowledge of:
The basic anatomy of the eliminatory system
Skin and stoma care
The types, components and functions of equipment, including speaking valves
Risks and indicators of malfunction
Indications that suctioning is required
Requirements for monitoring and recording
Common complications and how to manage them
When to escalate care to a health practitioner
Signs of infection (both in the respiratory system and the stoma site).
(NDIS 2018)
Potential Complications
Complications become more likely the longer the tracheostomy tube is kept in situ. Those who are critically ill or have comorbidities are more at risk (Fernandez-Bussy et al. 2015). Possible complications include:
Tube obstruction
Tube dislodgement
Fistulae
Infection
Aspiration
Tracheal damage or erosion
Tracheal stenosis
Formation of stomal or tracheal granulation tissue.
(Doyle & McCutcheon 2015; RCHM 2018)
Recognising Deterioration in Participants With Tracheostomy
Being able to identify the following signs of respiratory distress is crucial in promptly and appropriately addressing an emergency situation.
Signs of Respiratory Distress
Possible Causes of Respiratory Distress
Increased work of breathing
Decreased or gurgling breath sounds
High inspiratory airway pressure (or low tidal volume if the patient is mechanically ventilated)
Oxygen desaturation
Lack of breath sounds when auscultating the lung fields
Inability to pass the suction catheter or inner cannula
Agitation
Clammy skin
Cyanosis (turning blue due to decreased oxygen supply)
Partial or complete airway obstruction due to blockage
Tracheostomy tube dislodgement
Persistent cuff leak
Faulty oxygen source or ventilation device
Ineffective humidification
Tracheostomy in a false passage
Other causes (non-tracheostomy related)
(Adapted from NSW DoH 2015)
Conclusion
Knowing how to provide appropriate care to NDIS participants with a tracheostomy tube in situ is essential in preventing adverse consequences.
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