# ENT Nursing Care > Nursing care in ENT: tracheostomy care protocol, suction pressures, epistaxis first aid, tonsillectomy haemorrhage recognition and mastoidectomy aftercare. - Canonical URL: https://prepelephant.com/topics/allied/nursing/ent-nursing-care - Exam / course: Allied Health · Subject: Nursing - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "ENT Nursing Care", PrepElephant, https://prepelephant.com/topics/allied/nursing/ent-nursing-care ## Direct answer ENT nursing is airway-first nursing: tracheostomy care — inner cannula cleaning, humidification, controlled suction and stoma hygiene — is the skill on which the specialty rests, because a blocked tube kills in minutes. Around it sit the emergencies and postoperative patterns: epistaxis controlled first with sustained anterior pinching for ten to fifteen minutes, patient leaning forward, tonsillectomy bleeding divided into reactionary (within 24 hours) and secondary (roughly day 5-10 with slough separation), and mastoidectomy aftercare protecting the graft while watching facial nerve function and vertigo. The common thread is close observation of the airway, the bleeding and the swallow. ## What you must remember - **Tracheostomy tube anatomy:** outer cannula stays in place, inner cannula is the removable cleaning element, obturator used only for insertion; cuff pressure kept roughly below 25 cm water to protect against tracheal necrosis. - **Suction discipline:** pressure roughly 80-120 mmHg for adults, pre-oxygenation, insertion without suction, withdrawal with rotating suction under 10 seconds per pass. - **Humidification is not optional:** a bypassed upper airway no longer warms or moistens air — cold dry air thickens secretions until they occlude the tube; heated humidification or saline nebulisers prevent the plug. - **Epistaxis first aid:** sit the patient leaning forward, pinch the soft nose firmly for 10-15 minutes without early release, ice pack — anterior bleeds (Little's area) are the great majority; posterior bleeds (blood in the pharynx) need posterior packing and admission. - **Tonsillectomy haemorrhage timing:** reactionary within about 24 hours (open vessel), secondary around day 5-10 from slough separation with infection; frequent swallowing in a quiet or sleeping child is the classic early sign of a bleeding tonsillar bed. - **Post-tonsillectomy care:** lateral positioning in recovery, no straws or hard foods, soft cool diet, and observation of the swallow-and-spit pattern rather than reliance on reported pain. - **Mastoidectomy aftercare:** keep the ear dry, watch facial symmetry, vertigo, nystagmus and discharge; avoid nose blowing and sneeze with the mouth open. ## Two postoperative nights that test the specialty A child returns from tonsillectomy at four in the evening, positioned lateral with the head slightly down until awake, and the nurse sets the pattern that matters: pulse, spit-bucket inspection, and swallowing counted. Frequent swallowing is the sign taught for one reason — blood trickling down the pharynx is swallowed before it is spat, so the child who swallows every few seconds in silence is bleeding while the ward sleeps. That first night covers the reactionary window: fresh bleeding means pressure, ice packs, intravenous access and the surgeon now. On day seven the same child returns with a spike of bleeding — secondary haemorrhage from an infected, sloughing bed — managed with the same urgency plus antibiotic cover. Down the corridor, a man with a week-old tracheostomy tests the other discipline. His breath sounds coarse: the inner cannula is removed and cleaned, humidification checked, and suction performed to standard — catheter half the tube's inner diameter, no suction on insertion, withdrawal under 10 seconds. The stoma is cleaned with saline and dressed with a pre-cut absorbent dressing (a square notch, never a circle that can drop into the stoma). His bedside carries the emergency kit that never leaves it: spare tube of the same size and one smaller, obturator, blunt-ended scissors, wall suction, and a self-inflating bag — because when a tracheostomy obstructs, the prepared bedside stands between the patient and hypoxia. ## Where students slip Suction is the reliably misquoted procedure: pressures too high, suctioning on insertion, passes too long — the marks go for pre-oxygenation, no suction on the way in, and a pass under ten seconds. Epistaxis first aid is performed head-back in exam answers, sending blood to the pharynx; the correct posture is leaning forward with sustained compression, and releasing every thirty seconds undoes the tamponade. The tonsillectomy question "how do you detect bleeding in a sleeping child" expects frequent swallowing, not "ask about pain". And humidification is treated as comfort — the tracheostomy bypasses the nose's warming and moistening, so secretions harden into the plug the emergency kit exists for. ## Frequently asked questions ### What suction pressure and duration are used for adult tracheostomy suctioning? Roughly 80-120 mmHg of negative pressure, applied only on withdrawal, each pass kept under about 10 seconds with recovery between passes. ### What is the correct first aid for anterior epistaxis? Sitting the patient leaning forward and pinching the soft anterior nose continuously for 10-15 minutes, with ice — checking only after the full time, not intermittently. ### How do reactionary and secondary tonsillectomy haemorrhage differ? Reactionary bleeding occurs within about 24 hours of surgery from an open vessel; secondary bleeding occurs around day 5-10 when the slough separates, usually with infection. ### Why is humidification essential after tracheostomy? The upper airway that warms, filters and moistens air is bypassed, so unhumidified air thickens secretions and risks tube occlusion by plugs. ### What must always be available at a tracheostomy bedside? A spare tube of the same size and one smaller with obturator, blunt scissors, functioning suction, humidification, and a self-inflating bag.