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Create your own tracheostomy and laryngectomy teaching aids

Zeien, Jennifer BSN, RN, ACNS-BC

doi: 10.1097/01.NURSE.0000392976.91901.4f
Department: INSPIRING CHANGE
Free

Jennifer Zeien is an otolaryngology clinical nurse specialist at University of Oklahoma Medical Center in Oklahoma City, Okla.

OBTAINING EFFECTIVE yet inexpensive teaching tools for healthcare staff and patients can be challenging. Teaching aids to demonstrate tracheostomy tube and stoma site care are no exception. Some educational polyurethane manikin heads are available, but most cost between $200 and $500. These manikin heads are not only expensive, but also heavy and clinically inaccurate. For instance, the stoma site isn't anatomically correct and the tracheostomy is simply a hole without a tracheostomy track. When showing a patient how to care for a tracheostomy tube or stoma site, you need more accurate teaching aids.

How can you find a cost-effective tool to help educate both staff and patients about these procedures? Just use your head and create one. This article will tell you how to make a model and how to use it for teaching.

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Getting a head

Effective teaching draws on various methods and approaches to increase understanding. Printed handouts and brochures and various audio-visual aids can help, but nothing beats demonstration and return-demonstration for teaching your patients and their families how to perform a new skill in a safe learning environment and helping them become active participants in patient care.

I created models from foam heads because they're lightweight and can be purchased from any beauty supply store for about $4.00, making them a very inexpensive option. The foam models can be used for teaching about tracheostomies as well as for other types of head and neck surgical procedures, such as laryngectomies. They can also be easily cleaned with germicidal wipes between uses.

To make your own foam model showing the cross section of a head, first cut it in half. Using an electric knife can help with this step, but be careful! Create a pattern or write to me, at jennifer.zeien@healthonecares.com, for a full-size pattern. Trace the pattern on the foam, then cut with a utility knife and carve with a spoon. Use a small metal file or grater to smooth the edges.

Painting allows for creativity. Use craft acrylic paint, allowing it to dry overnight. You may need to apply more than one coat. If necessary, you can apply liquid latex to create a barrier that can also be cleaned. Use caution if you or your patient may be allergic to latex.

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Demonstrating tracheostomy care

Having a tracheostomy, which can be very frightening for patients, requires a new way of breathing as well as a new set of skills. Some patients can't look in the mirror for a while after their tracheostomy. The foam model can be used to provide education on a manikin-like form until the patient is emotionally ready for self-care. All tracheostomy care skills can be taught using the foam model, including peristomal skin care; changing tracheostomy dressings; changing disposable inner cannulas; removing, cleaning, and replacing a nondisposable inner cannula (if applicable); suctioning; changing tracheostomy tube securement devices; and even changing the entire tracheostomy tube.

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To provide peristomal skin care, teach the patient or family member to remove the old dressing and use normal saline-moistened cotton-tipped swabs to clean the skin around the tube and under the tracheostomy faceplate. (See Trach in place.) The foam heads also let new nurses review and practice all aspects of tracheostomy care.

Removing the inner cannula can be difficult for patients who lack manual dexterity. Helping patients practice removing the inner cannula from the foam model can ease the transition to self-care. The model lets patients practice changing the tracheostomy securement device (for example, twill ties) by first placing the new tracheostomy ties in place before removing the old ties to prevent accidental extubation. Patients can also practice cleaning and replacing a reusable inner cannula.

Changing the tracheostomy tube itself can be one of the most frightening procedures for patients. The foam model has helped my patients learn this skill. I've painted the inner tracheostomy tract on a foam head so patients can see it. This visualization helps patients feel comfortable with learning how to insert a new tracheostomy tube. It also shows patients what a mature tracheostomy tract looks like and the difficulties that can occur if the tracheostomy tube is placed in a false tracheostomy tract.

Because the tracheostomy tract extends to the base of the manikin head, you can place your finger in the bottom portion of the base so the patient and family members can feel the resistance that they may encounter when changing a tracheostomy tube. As the instructor, you can also feel whether the patient is using too much pressure when inserting the tracheostomy tube with the obturator.

Patients using cuffed tracheostomy tubes need to know the purpose of the cuffs and possible complications. When inflating the cuff of a tracheostomy tube using a foam model, patients can see how the cuff makes a tight seal against the tracheal wall.

I've also learned that many patients don't understand basic anatomy and physiology of the upper and lower airway and have many questions about eating and swallowing with a tracheostomy. I've shown them diagrams, but only when they see the cross section of the foam model with the tracheostomy tube in place do they understand that they don't need to be afraid of choking. (See Tracheostomy, cross section.)

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Understanding laryngectomy

Patients who've had a total laryngectomy also need to understand basic airway anatomy and physiology because the connection between the upper airway and the lower airway is no longer present after surgery. (See Laryngectomy, cross section.) The only way a person who's had a total laryngectomy can breathe is through the laryngectomy stoma. If a patient experiences respiratory arrest, effective ventilation can be delivered only through the stoma.

Laryngectomy education can be challenging. The model illustrated below shows a patient who's had a laryngectomy with a tissue flap. The red rubber catheter is placed to maintain the tracheoesophageal fistula for a future voice prosthesis.

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Figure

Figure

Figure

Surgical closure depends on the size and location of the tumor removed. A tissue flap may be used if the tumor was too large for complete surgical closure. Each flap is different because it's based on the size and stage of the tumor that was removed.

By lifting up the flap area on the foam model, you can show your patient normal anatomy and explain where the tumor was located. You can also use the model to explain a tracheoesophageal fistula and show the patient where drains are located. Surgeons can use this anatomical foam model to explain the surgical procedures.

Patients undergoing laryngectomies have questions about stoma covers and vents. You can use a foam head to show how they're applied.

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Models with benefits

With cost always being a concern in healthcare, a $4.00 foam head that helps patients through the transition to self-care is a great benefit. Please note, use good judgment and clean them frequently.

These models can make anyone who comes in contact with patients with tracheostomies or laryngectomies feel more comfortable with care and education. A medical–surgical unit can keep a foam model available for patients and staff. Home care companies could use this foam model to assist with education and reinforce teaching provided during hospitalization. Nursing students have reinforced their learning by using the foam models.

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RESOURCES

Morris LL, Afifi SM. Tracheostomies: The Complete Guide. New York, NY: Springer Publishing; 2010.
    Roberts AM. The Complete Human Body: The Definitive Visual Guide. New York, NY: DK Publishing; 2010.
      © 2011 Lippincott Williams & Wilkins, Inc.