Tracheotomy Care

DEMONSTRATION
Tracheostomy care
Definition-
 Tracheostomy care includes changing a
tracheostomy inner tube, cleaning
tracheostomy site and changing dressing
around the site.
Purposes-
 To maintain airway patency.
 To prevent infection at the tracheostomy
site.
 To facilitate healing and prevent skin
excoriation around the tracheostomy site.
 To promote comfort.
 To assess condition of ostomy.
Equipment-
 Tracheostomy care kit containing:
 Gallipots (3).
 Sterile towel.
 Sterile nylon brush / tube brush.
 Sterile gauze squares.
 Cotton twill ties or tracheostomy tie tapes.
 Sterile bowl for solution.
A clean tray containing:
 Sterile suction catheter.
 Hydrogen peroxide.
 Normal saline.
 Sterile gloves 2 pairs.
 Clean scissors.
 Face mask and eye shield.
 K basin.
 Waterproof pad.
Nursing action-
 Assess condition of stoma: (Redness,
swelling, character of secretions, presence
of prudence or bleeding).
 Examine neck for subcutaneous
emphysema evidenced by credit us
around the ostomy site.
 Explain procedure to the patient and teach
means of communication such as eye
blinking or raising a finger to indicate pain
or distress.
 Assist patient to a fowler’s position and
place waterproof pad on chest.
 Wash hands thoroughly.
 Assemble equipment’s.
 Open the sterile tracheostomy kit, pour
hydrogen peroxide and sterile normal saline in
separate gallipots.
 Open other sterile supplies as needed
including sterile applicators, suction kit and
tracheostomy care kit .
 Put on face mask and eye shield.
 Don sterile gloves. Place sterile towel on
patient’s chest.
 Suction the full length of tracheostomy
tube and pharynx thoroughly.
 Rinse the suction catheter and discard it.
 Unlock the inner cannula if present and
remove it by gently pulling it out towards
you in line with its curvature. Place the
inner cannula in the bowl with hydrogen
peroxide solution (Applicable for tubes
having inner and outer cannula).
 Remove the soiled tracheostomy dressing,
discard the dressing and gloves.
 Don a second pair of sterile gloves.
 Clean the flange of the tube using sterile
application or gauze moistened with
hydrogen peroxide and then with normal
saline. Use each applicator once only.
 Clean the stoma area with gauze (make
only a single sweep with each gauze
sponge before discarding).
 Halfstrength hydrogen peroxide may be
used.
 Thoroughly cleanse the area using gauze
squares moistened with sterile normal saline.
 Dry the stoma with dry sterile gauze.
 An infected wound may be cleaned with
gauze saturated with an antiseptic
solution, then dried.
 Cleaning the inner cannula
 Remove the inner cannula from the soaking
solution.
 Clean the lumen and entire cannula
thoroughly using the brush.
 Rinse the cleaned cannula by rinsing it with
sterile normal saline.
 Gently tap the cannula against the inside of
the sterile saline container after rinsing.
 Replace the inner cannula and secure it in
place:
 Insert the inner cannula by grasping the outer
flange and pushing in the direction of its
curvature.
 Lock the cannula in place by turning the lock
into position.
 Apply sterile dressing:
 Open and resold a 4×4 gauze dressing into a
‘V’ shape and place under the flange of the
tracheostomy tube.
 Do not cut gauze pieces.
 Ensure that the tracheostomy tube is securely
supported while applying dressing.
 Change the tracheostomy ties:
 Leave the soiled tape in place until the new
one is applied.
 Cut a piece of tape that is twice the neck
circumference plus 10 cm. Cut the ends of
tape diagonally.
 Apply the new tape.
 Remove old tape care fully.
 Method of folding gauze square for
placement under face plate.
 Grasp slit end of clean tape and pull it through
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 side.
 Changing tracheostomy ties/tapes.
 Tie the tapes at the side of the neck in a
square knot.
 Alternate knot from side to side each time
tapes are changed.
 Tie should be tight enough to keep tube
securely in the stomach, and loose enough to
permit two fingers to fit between the tape and
neck.
 Document all relevant information in the
chart:
 Sectioningdone.
 Tracheostomy care carried out.
 Dressing changed.
 Observations.
SPECIAL CONSIDERATION-
 Tracheostomy dressing should be done every
8 hours or whenever dressings are soiled.
 Tracheostomy tubes may come with
disposable inner cannula or without the inner
cannula. If disposable inner cannula is
present then 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.
Conclusion-
 Tracheostomy care is very necessary in
the critical care unit. If the nurses are not
aware about this then it will create more
problem to the patient.

Tracheotomy Care

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DEMONSTRATION

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