Essential Guide to Respiratory Care for COPD Patients After Tracheostomy

I want to find a respiratory care center?

Hello Dr.
Lee,
I would like to ask you a few questions and would appreciate your explanations:
1.
My grandfather has chronic obstructive pulmonary disease (COPD) and underwent a tracheostomy over a month ago.
He has a lot of sputum, so he requires frequent suctioning.
Doctor, could you please clarify:
(1) Does continuous suctioning have any negative effects on my grandfather's lungs?
(2) Will turning him and performing chest percussion affect the tracheostomy tube?
(3) Since my grandfather is still in the process of respiratory training and spends most of his time lying in bed, he is not getting enough physical activity, which has led to abdominal distension.
Are there any methods to improve this?
(4) If my grandfather urgently needs suctioning and there are no professional staff available, are there any supportive actions we can take? As we are not trained nurses, can we learn how to perform suctioning?
(5) How can I find a respiratory care center, and what should we do regarding my grandfather's medical care after discharge?
Thank you for your explanations, Dr.
Lee.

Liangliang, 20~29 year old female. Ask Date: 2002/06/10

Dr. Li Yanxian reply Pulmonology

1.
Excessive sputum production is a common issue in patients with chronic obstructive pulmonary disease (COPD).
If the force of coughing is insufficient and external assistance is frequently needed, such as suctioning, chest percussion, or postural drainage, these interventions should be avoided only if contraindications exist (e.g., massive hemoptysis).
As long as the procedures are performed with caution (for example, suctioning should not be prolonged), there should be no significant complications.
Suctioning techniques are not difficult and can be learned by the general public.
2.
For abdominal bloating, correctable factors (such as bowel obstruction or electrolyte imbalances) should be ruled out first, followed by the use of medications or even dietary changes, which should help improve the condition.
3.
I am unsure if the respiratory care center you mentioned is specifically for patients who are dependent on ventilators.
If the patient does not require a ventilator, in addition to home care, nursing homes affiliated with various public and private hospitals can also be considered.

Reply Date: 2002/06/10

More Info

Caring for a patient with Chronic Obstructive Pulmonary Disease (COPD) who has undergone a tracheostomy can be quite challenging, especially when considering the complexities of respiratory care. Here’s a comprehensive guide addressing your concerns and providing essential information for managing your grandfather's condition effectively.

1. Frequent Suctioning and Its Effects
Suctioning is often necessary for patients with COPD and a tracheostomy due to excessive secretions. While suctioning is essential for maintaining airway patency and preventing infections, excessive or improper suctioning can lead to complications such as airway trauma, hypoxia, and increased anxiety for the patient. It is crucial to ensure that suctioning is performed using sterile techniques and only when necessary—typically when the patient exhibits signs of respiratory distress or has audible secretions.

2. Positioning and Mobility
Turning and repositioning your grandfather is vital for preventing complications such as pressure ulcers and promoting lung expansion. However, care should be taken to ensure that the tracheostomy tube remains secure during these movements. Gentle handling is essential, and you may consider using a soft neck strap to stabilize the tube. Additionally, encourage him to engage in passive range-of-motion exercises if he is unable to move independently, as this can help reduce discomfort and improve circulation.

3. Addressing Abdominal Distension
Abdominal distension can occur due to a lack of mobility and can be uncomfortable for your grandfather. To alleviate this, consider implementing a few strategies:
- Encourage Position Changes: Even slight changes in position can help relieve gas buildup.

- Gentle Abdominal Massage: This can stimulate bowel activity and help reduce bloating.

- Dietary Adjustments: If possible, consult with a dietitian to modify his diet to reduce gas-producing foods.

- Physical Therapy: If feasible, a physical therapist can provide tailored exercises to improve mobility and reduce distension.

4. Learning to Suction
If professional help is not immediately available, family members can be trained to perform suctioning safely. It is crucial to receive proper instruction from healthcare professionals before attempting this. They can demonstrate the correct technique, including how to use the suction catheter, how to maintain sterility, and how to monitor the patient for signs of distress during the procedure.

5. Finding a Respiratory Care Center
To find a suitable respiratory care center, you can start by consulting with your grandfather's healthcare provider for recommendations. They can refer you to facilities that specialize in respiratory care and have experience with tracheostomy patients. Additionally, you can search online for local rehabilitation centers or hospitals that offer respiratory therapy services.

Additional Considerations
- Monitoring for Complications: Regularly check for signs of infection at the tracheostomy site, such as redness, swelling, or discharge. Also, monitor his oxygen saturation levels and respiratory rate.

- Emotional Support: Patients with COPD often experience anxiety related to breathing difficulties. Providing emotional support and reassurance can help alleviate some of this anxiety.

- Education: Educate yourself and your family about COPD and tracheostomy care. Understanding the condition can empower you to provide better care and recognize when to seek medical assistance.

In conclusion, managing a COPD patient with a tracheostomy requires a multifaceted approach that includes regular suctioning, careful positioning, addressing mobility issues, and ensuring proper training for family members involved in care. By following these guidelines and maintaining open communication with healthcare providers, you can significantly improve your grandfather's quality of life and respiratory health.

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