Long-term care of the patient with a tracheostomy.

An increasing number of technology-dependent patients are sent home for long-term home-management of stable chronic illness. With a patient who is going to undergo tracheotomy, patient-education (for the patient and his/her caregivers) should begin early (before the tracheostomy, if possible), should be individualized to the patient, and should include basic airway anatomy, medical justification for the tracheostomy, tube description and operation, signs and symptoms of respiratory and upper-airway distress, signs and symptoms of aspiration, suctioning technique, tracheostomy tube-cleaning and maintenance, stoma-site assessment and cleaning, cardiopulmonary resuscitation, emergency decannulation and reinsertion procedures, tube-change procedure, equipment-and-supply use and ordering procedures, and financial issues. There should be a scheduled follow-up plan with the attending physician. A combination of process-validation, through additional research, and expert consensus may be needed to standardize the long-term care of patients who undergo tracheostomy.