TRACHEOSTOMY CARE: tracheotomy care including changing a tracheotomy inner tube,

cleaning tracheotomy site and changing dressing around the site

PURPOSE:

 To maintain airway patency

 To prevent infection at the tracheotomy site
 To facilitate healing and prevent skin excoriation around the tracheotomy site
 To promote comfort
 To assess condition of ostomy

ARTICALS USED IN CARE OF TRACHEOSTOMY

 Tracheotomy care kit containing

 Sterile towel
 Sterile bowel for solution
 Sterile gauze squares
 A clean tray containing
 Sterile suction catheter
 Normal saline
 Sterile gloves two pairs
 Face mask
 Suction apparatus

PROCEDURE

STEPS OF PROCEDURE RATIONALE

1.Assess the condition of stoma {redness, Presence of any of these indicates infection and
swelling , character of secretion, presence of culture test may be warranted
purulence or bleeding}
2. Explain procedure to the patient if conscious Obtain co-operation from patient
and teach means of communication such as eye
blinking or raising a finger to indicate pain or
distress
3. Assist patient to a fowler position and place Promotes lung expansion
waterproof pad on chest
4.wash hands thoroughly Prevents cross infection
5.Assemble equipment: open the sterile The solution and saline removes mucus and
tracheotomy kit, pour solution ,open other crust which promote bacterial growth
sterile supplies as needed including sterile
applicator, suction kit and tracheotomy care kit
{dressing kit} put on face mask .
6. Wear sterile gloves. Place sterile towel on
patient chest
7.Suction the full length of tracheostomy tube For remove secretion
and pharynx thoroughly
8.Rinse the suction catheter and discard it
9.Unlock the inner cannula and remove it by It helps to remove the secretions
gently pulling it out towards you in line with
its curvature place the inner
10.Remove the solid tracheostomy dressing
discard the dressing and gloves
11.Wear the second pair of gloves
Clean the flange of the tube using sterile gauge Using applicator or gauze once only, avoid
moistened with solution and then with normal contaminating a clean area with the soiled
saline use each applicator once only gauze
12.Clean the stoma area with gauze {make Solution helps to loosen dry crusted secretions.
only a single sweep with each gauze sponge solution is irritating to the skin and inhibits a
before discarding } half strength solution and healing if not removed thoroughly
mixed with normal saline may be used,
thoroughly cleans the area using gauze squares
moisten with sterile normal saline
13.Dry the stoma with dry sterile gauze It helps to prevent wound infection
An infected wound may be clean with gauze
saturated with an antiseptic solution, then dried
A thin layer of antibiotic ointment may be
applied to the stoma with a cotton swab
14.Cleaning the inner cannula Through sensing is important to remove
Remove inner cannula from the soaking solution from inner cannula
solution Removes solution adhering on the cannula
Clean the lumen and entire cannula thoroughly
using the brush
Rinse the clean cannula by rinsing it sterile
normal saline{agitating the cannula in the
container with saline cleans it well}
Gently tape the cannula against the inside of
the sterile saline container after rinsing
15.Replace the cannula and secure it in place This secure the flange of the inner cannula to
Insert the inner cannula by garsping the outer the outer cannula
flange and pushing in the directions of its
curvature
Lock the cannula in place by turning the lock {
if present} into position
16.Apply sterile dressing
Open and refold a 4×4 gauze dressing into a V Avoid using cotton filled 4× 4gauze cotton or
shape and place under the flange of the gauze fiber can be aspirated by the patient
tracheostomy tube potently creating a tracheal abscess
Ensure that the tracheostomy tube is securely Excessive movement of the tracheostomy tube
supported while applying dressing irritating the trachea
17.Change the tracheostomy ties
 Leave the soiled tape in place until the Leaving tape in place ensures that tube will not
new one is applied be expelled if patient cough and moves
 Cut a piece of tape that is twice the This action provides secure attachment with
neck circumference plus 10 cm .cut the knot diagonal cut facilities insertion of tape
ends of tape diagonally into opening of neck plate
Apply the new tape
 Grasp slit end of clean tape and pull it
opening on one side of the
tracheostomy tube
 Pull the other end of the tape securely
through the slit end of the tracheostomy
tube on the other hand
 Tie the tapes at the side of the neck in
a square knot
 Alternate knot from side to side each
time tapes are changed
 Ties should be tight enough to keep
Excessive tightness compresses jugular veins
tube securely in the stoma , and loose
decrease blood circulation to the skin and
enough to permit two fingers to fit
results in discomfort for patient
between the tape and neck
 Remove old tape carefully

Nursing responsibilities:

 Tracheostomy dressing should be done every 8 hours or whenever dressing are soiled
 Tracheostomy tubes may come with disposable inner cannula or without the inner
cannula if disposable inner cannula .if disposable inner cannula is present than replace
the one that is inside with a new one
 If only single lumen is present, then suction the tracheostomy tube and clean the neck
plate and tracheostomy site.
 DEMONSTRATION
ON
Tracheostomy care

Submitted to: Res mam:

Miss. SATINDER kaur
Demonstrator
ucon, faridkot
Submitted by
Raman kumari
m.sc [n] 1 year
st