The nurse is caring for a client with a new tracheostomy. Which assessment finding requires the nurse's immediate action?
a. Cuff pressure readings consistently between 14 and 20 mm Hg.
b. Need to change Velcro tube holders three times in 1 day.
c. Crackling sensation around the neck when skin is palpated.
d. Small amount of bleeding around the incision for the first few days.
C
Subcutaneous emphysema occurs when an opening or tear occurs in the trachea and air escapes into fresh tissue planes of the neck. Air can also progress through the chest and other tissues into the face. Inspect and palpate for air under the skin around the new tracheostomy. If the skin is puffy and you can feel a crackling sensation, notify the physician immediately. Cuff pressures should be maintained between 14 and 20 mm Hg or between 20 and 28 cm H2O. Tracheostomy ties need to be changed at least once a day or whenever soiled. It is not uncommon for a client with a new tracheostomy to have heavy secretions that would necessitate changing them. It is not unusual to have a small amount of bleeding around the incision for the first few days after surgical placement.
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