N116- Skills Performance Checklist

TRACHEOSTOMY CARE

NAME: ________________________________________ DATE: ________________________

YEAR AND SECTION: _____________________________ SCORE: _______________________

PROCEDURES DONE NOT

DONE
1. Reviews the treating clinician’s orders for tracheostomy care and verify
completion of facility informed consent documents, if necessary
2. Performs hand hygiene and dons nonsterile gloves and other necessary PPE,
depending on anticipated exposure to body fluids
3. Identifies the patient using two unique identifiers or according to facility protocol
4. Establishes privacy by closing the door to the patient’s room and/or drawing the
curtain surrounding the patient’s bed
5. Introduces self to the patient and family member(s) and explains clinical role and
procedure
6. Repositions the patient for comfort and for accessibility to the tracheostomy site.
7. Removes the old gauze using forceps or clean gloved hand
8. Discards soiled dressing on the kidney basin
9. Assesses the tracheostomy site for any signs of infection
10. Detaches the tube from the O2 source/ventilator
11. Immediately unlocks and removes the inner cannula
12. Attaches a tracheostomy connector and reconnects to the O 2 source (if available,
may replace the removed inner cannula with another sterile one, connect to the
O2 source and proceed to dressing care)
13. Soaks the used inner cannula in a soaking solution (duration of soaking depends
on hospital protocol and availability of an extra cannula).
14. Removes clean gloves and wears sterile gloves
15. Cleanses the inner cannula using cotton applicators/ brush 1. 1.

16. Taps excess soaking solution from the inner cannula and allows to air dry
17. Removes the O2 source then the connector from the tracheostomy site
18. Reattaches the inner cannula holding only the part that is exposed.
19. Locks the cannula following the direction inscribed at the side of the cannula.
20. Reattaches to the O2 source/ventilator and rechecks setting.
21. Cleanses the surrounding site using forceps with cotton balls soaked with 1. 1.
betadine or cotton applicators with betadine starting from the inner to the outer
surface.
22. Covers the surrounding site with 4 x 4 sterile gauze and secures using an
adhesive tape. Does not cut through the gauze
23. Changes tracheostomy ties accordingly 1. 1.

24-25 Two-Strip Method

a. Cuts two unequal strips of twill tape approximately 25 cm (10 in) long and 1. 1.
the other about 50 cm (20 in) long
b. Fold the end of the tape back onto itself about 2.5 cm (1 in), then cut a slit
in the middle of the tape from its folded edge. [Cuts a 1-cm (0.5 in)
lengthwise slit approximately 2.5 cm (1 in) from one end of each strip].
c. Leaving the old ties in place, thread the slit end of one clean tape through 1. 1.
the eye of the tracheostomy flange from the bottom side; then thread the
long end of the tape through the slit, pulling it tight until it is securely
fastened to the flange.
d. If the old ties are very soiled or it is difficult to thread new ties onto the
tracheostomy flange with old ties in place, have an assistant put on a
sterile glove and hold the tracheostomy in place while you replace the ties.
e. Repeat the process for the second ties. 1. 1.

f. Ask the client to flex the neck. Slip the longer tape under the client’s neck, 1. 1.
place a finger between the tape and the client’s neck, and tie the tapes
together at the side of the neck.
g. Tie the ends of the tapes using square knots. Cuts off any long ends,
leaving approximately 1 to 2 cm (0.5 in).
24-25 One-Strip Method
 a. Cuts a length of twill tape 2.5 times the length needed to go around the
client’s neck from one tube flange to the other.
b. Threads one end of the tape into the slot on one side of the flange
c. Threads one end of the tape into the slot on one side of the flange
d. Brings both ends of the tape together. Takes them around the client’s
neck, keeping them flat and untwisted.
e. Threads the end of the tape next to the client’s neck through the slot from
the back to the front
f. Have the client flex the neck. Ties the loose ends with a square knot at the
side of the client’s neck, allowing for slack by placing two fingers under the
ties as with the two-strip method. Cuts off long ends
26. Once the clean ties are secured, remove the soiled ties and discard
27.Tapes and pads the tie knot. Places a folded 4 in X 4 in gauze square under the
tie knot, and applies tape over the knot.
28.Checks the tightness of the ties
29.Discards all used materials observing universal pre-cautions. Remove gloves
30.Wash Hands and Documents procedure done and pertinent observations such as
characteristic of the surrounding skin of the tracheotomy site, and amount, color,
consistency, and odor of secretions

Grade Computation: Total score divided by the total number of items multiply to 100. Equivalent will be referred to the transmutation table
i.e. 85 = 2.00

Note: Any clarifications with the grade or skill performance must be verified within the scheduled skills laboratory time. Feel free to approach your
C.I. to clarify your grade or Skills Coordinator when necessary. The C.I. reserves the right to ask the rationale of the procedure or as necessary to
emphasize some highlights of the procedure.

REMARKS:

Clinical Instructor: Conforme: