2-40

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2-40. PERFORMING TRACHEOSTOMY CARE

Changing the tracheostomy dressing, cleansing the skin around the stoma, and cleaning the inner cannula are collectively referred to as tracheostomy care.

a. Assemble necessary equipment and supplies.

(1) Trach cleaning kit (obtain from CMS).

 

(2) Clean scissors.

 

(3) Hydrogen peroxide.

 

(4) Sterile saline--pour bottle.

 

(5) Sterile gloves--2 pairs.

 

(6) Exam gloves--2.

 

(7) Waste receptacle.

b. Explain the procedure to the patient and establish a method of communication.

c. If suctioning is required, perform that procedure prior to beginning tracheostomy care. It is routine to perform tracheostomy care after suctioning.

d. Position the patient in semi-Fowler's position if permissible.

e. Wash your hands and set up the equipment using aseptic technique.

(1) Open the cleaning kit, using wrapper as a sterile field.

 

(2) Open dressings and other supplies and place on sterile field.

 

(3) Pour hydrogen peroxide in one basin and sterile saline in the other (disposable basins/containers are included in the kit).

f. Put on exam gloves and remove soiled tracheostomy dressing. Tracheostomy secretions should be considered contaminated and handled accordingly.

g. Remove and discard exam gloves and put on sterile gloves.

h. Clean inner cannula, if present.

(1) Unlock the inner cannula and remove.

 

(2) Place the inner cannula in the hydrogen peroxide, allowing it to soak for a few minutes.

 

(3) Clean the inner cannula with the test tube brush.

 

(4) Rinse the inner cannula in the sterile saline.

 

(5) Remove the inner cannula from the saline and allow it to drain on a sterile 4x4 gauze sponge.

i. Cleanse the tracheostomy incision and surrounding area with antiseptic swabs.

(1) If crusting occurs, remove with sterile swabs soaked in hydrogen peroxide.

 

(2) Do not allow cleansing solutions to enter the tracheostomy opening.

j. Reinsert the inner cannula and lock in place.

k. Apply sterile tracheostomy dressing. Use precut, non-raveling sterile 4x4. Place it with the slit toward the chin, allowing the uncut portion to absorb secretions.

l. Reapply ties.

(1) Cut and remove soiled, outer tube ties if necessary. The patient or an assistant should hold the outer tube in place to prevent dislodgement of the tube.

 

NOTE: If an assistant is not available and the ties must be changed, secure new ties in place before cutting and removing soiled ties.

(2) Cut a slit about one inch from the end of each tape.

 

(3) Insert the slit end of the tape through the flange of the outer cannula, and draw the other end of the tape through the slit (Figure 2-6).

Figure 2-6. Tracheostomy dressing.

(4) Tie the tapes securely with a knot, never a bow. Position the knot at the side of the patient's neck rather than the back. Trim off excess tape.

m. Remove and discard gloves or return all equipment to the appropriate location.

n. Record procedure in Nursing Notes. 

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