Tracheostomy care is an essential nursing skill that involves cleaning and maintaining a tracheostomy tube to prevent infection and other complications. Here's a step-by-step guide explaining each procedure with its rationale. Note that disposable gloves are to be worn at all times and changed as often as needed to maintain a sterile work environment, and to protect both patient and healthcare worker.
Step 1: Perform hand hygiene, and put on personal protective equipment: gown, gloves, mask and eye protection. If necessary, suction the tracheostomy using a sterile suction catheter to prevent occluding the outer cannula while the inner cannula is removed. Remove gloves.
Step 2: Put on clean gloves and open the package with the new disposable inner cannula and other supplies without contaminating them.
Step 3: Change gloves.
Step 4: Stabilize the outer cannula and faceplate of the tracheostomy and remove the inner cannula.
Step 5: Discard gloves, put on sterile gloves, and insert the new inner cannula into the outer cannula. Reapply oxygen source if needed.
Step 6: Remove the oxygen source if necessary and clean the stoma under the faceplate with a saline-dipped applicator or gauze sponge.
Step 7: Pat skin gently with a dry 4x4 gauze sponge to remove excess moisture.
Step 8: Slide commercially prepared tracheostomy dressing or pre-folded non cotton-filled 4x4 dressing under the faceplate.
Step 9: Obtain the assistance of a second individual to hold the tracheostomy tube in place while the old collar is removed and the new collar is placed.
Step 10: Open the package for the new tracheostomy collar to allow access to the new collar.
Step 11: Change gloves.
Step 12: One nurse holds the faceplate while the other removes the collar.
Step 13: The first nurse holds the tracheostomy faceplate to prevent accidental extubation.
Step 14: The other nurse places the collar around the patient's neck and secures the Velcro tabs on the tracheostomy holder.
Step 15: Check the fit of the tracheostomy collar. You should be able to fit one finger between the neck and the collar. If necessary, reapply the oxygen source.
Step 16: Remove gloves, assist the patient to a comfortable position, raise the bed rail, and lower the bed.
Step 17: Remove the gown, face shield or goggles and mask. Perform hand hygiene.
Step 18: Reassess the patient's respiratory status, including respiratory rate, effort, oxygen saturation, and lung sounds. These determine the effectiveness of interventions and identify complications.
Here is a step-by-step procedural guide for tracheostomy care.
First, open the package with the new disposable inner cannula without contaminating it.
Hold and stabilize the outer cannula and faceplate. Release the lock, remove the old inner cannula, and discard it in a plastic bag.
Then, discard the gloves, put on sterile gloves, and insert the new inner cannula.
Clean the stoma using a saline-dipped applicator, then gently pat the skin with a dry gauze sponge to remove excess moisture.
Slide the tracheostomy dressing under the faceplate to reduce skin irritation.
To replace the tracheostomy collar, seek help from another nurse.
Both nurses should wear clean gloves. One nurse will hold the faceplate to prevent accidental extubation while the other nurse removes the collar.
Open the new tracheostomy collar package, apply it around the patient's neck, and secure it with Velcro tabs.
Assess the collar's fit by ensuring one finger's width gap between the neck and the collar.
Finally, remove the gloves, goggles, mask, perform hand hygiene, and document the procedure.
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