Caring for a Tracheostomy (Suctioning, Cleaning, & Changing

the dressing & Tie)

 Purpose:
 Clears airway of secretions
 Promotes tracheostomy healing
 Minimizes tracheal trama or
necrosis

Equipment:
 Tracheostomy care kit:
 Sterile bowls or trays (2)
 Cotton-tipped swabs
 Pipe cleaners
 Nonabrasive cleaning brush
 Trach- ties
 Gauze pads
 Normal Saline (500 mL bottle) Assessment: (should focus on the following)
 Hydrogen peroxide  Agency policy
 Suction machine or wall suction setup  Status of tracheostomy
 Suction catheter (size should be ½ of the  Type & size of trach tube
lumen of the trachea; adult, size 14-16  Respiratory status ( Resp. character, breath
French) sounds)
 Nonsterile gloves  Color, amount, & consistency of secretions
 Sterile gloves  Skin around trach- site
 Towel or waterproof drape  Condition of dressing & ties
 PPE
 Hemostat
 Pen

Nursing Diagnoses: (may include) Outcome Identification & Planning

 Ineffective airway clearance r/t weak Desired Outcomes:
cough  Respirations are 14-20 breaths/min, of
 Risk of infection r/t excess secretions at normal depth, smooth, & symmetric
tracheal stoma  Upper lung fields are clear
 Tracheostomy sit remains intact without
redness or signs of infection

IMPLEMENTATION
 Action Rationale
Suctioning a Tracheostomy:

1. Explain procedure to client 1. Reduces Anxiety; promotes cooperation

2.Hand hygiene; organize equipment
3. Perform any procedure that loosens secretions (e.g. 3. Promotes removal of secretions from all
postural drainage, percussion, nebulization) lobes of lungs
4. Lower side rails & position client on side or back with
HOB elevated. 4. Promotes maximal breathing during
5. Turn suction machine on & place finger over end of procedure
tubing attached to suction machine.
5. Tests suction pressure (should not exceed
120 mm Hg)

6. Open sterile irrigation solution & pour into sterile cup 6. Allows for sterile rinsing of catheter
7. Set up Tracheostomy care equipment: 7.
 Open trach- kit & set up on bedside table
 Maintain sterility, place bowls & tray with supplies in
separate locations on paper
 Provides ½ strength peroxide mixture
 Open Sterile saline & peroxide bottles & fill 1st bowl for tracheostomy canula cleaning;
with equal parts of saline & peroxide (do not let
maintains sterility of supplies
container touch the bowl)
 Provides rinse for cannula
 Fill 2nd bowl with saline  Maintains sterility
 Don sterile glove on dominate hand (on top of
nonsterile glove) 8. Provides hyperoxygenation before
8.Increas O2 concentration to Tracheostomy collar or Ambu suctioning
bag to 100% 9. Maintains aseptic technique
9. Open sterile gloves & suction catheter package 10. Prevents soiling of clothing
10. Place towel or drape on client’s chest under 11. Protects nurse from contact with
Tracheostomy. secretions
11. Don PPE 12. Maintains sterile technique
12. Don sterile glove on dominant hand (on top of nonsterile
glove)
13. With sterile hand pick up suction catheter & attach 13.Esure correct attachment of catheter
suction control port to tubing of suction source (held with
nonsterile hand) 14. Facilitates control of tubing
14. Slide sterile hand from control port to suction catheter
tubing (may wrap tubing around hand) 15. prevents mucosal trauma when catheter
15. Lubercate 3-4in. of catheter tip with irrigating solution is inserted
16. Ask client to take several deep breaths with 16. Provides additional O2 to body tissues
tracheostomy collar intact or Ambu bag at tracheostomy before suctioning.
tube enterance, If necessary have assistant deliver four or
five breaths with Ambu bag 17. allows access to tracheostomy
17. Remove tracheostomy callar or Ambu bag
PORT.
 Action
Suctioning a Tracheostomy:
18. Insert catheter approx. 6 in. in inner cannula (or until
resistance is met or cough reflex is stimulated. BE SURE
FINGER IS NOT COVERING OPENING OF SUCTION
PORT.
19. Encourage the client to cough
20. Place thumb over suction port
21. Withdraw catheter in a circular motion, rotating it
between the thumb & finger. Intermittently release & apply
suction during withdrawl.
DO NOT APPLY SUCTIONS FOR MORE THAN 10S.
22. Place tip of suction catheter in sterile solution for 1-2s.
23. Ask client to take about 5 breaths while you listen to
bronchial breath sounds & assess status of secretions. If
necessary have assistant deliver 4 or 5 deep breaths with
Ambu bag.
24. Repeat steps 19-23 once or twice if secretions are still
present.
25. If performing Tracheostomy cleaning, wrap catheter
around sterile hand (do not touch suction port) & proceed ti
step 3 below. If not performing trach- cleaning, or dressing/
tie change, discard materials.
26. position client for comfort, raise side rails & place call
light within reach
27. Remove and discard gloves & perform hand hygiene
Rationale
18, Places catheter in upper airway &
promotes clearance; prevents trauma to
membranes d/t suction from catheter
19. Promotes loosening & removal of
secretions
20. Initiates suction (often catheter
stimulates cough)
21. Removes secretions from sides of the
airway.
- Prevents hypoxia; minimizes trauma to
mucosa
22. Clears secretions from tubing
23. Permits reoxygenation; determines need
for repeat suctioning
24. Promotes adequate clearing of airway
25. Maintains sterility & control
26. Promotes safety; facilitates
communication.
 Action
Cleaning a Tracheostomy & Changing Dressing
1. Preform hand hygeine & don nonsterile gloves
2. Set up tracheostomy care eauipment (see step 7 in
“suctioning a trach”
3. Place 4 cotton tipped swabs in peroxide mixture, then
place across tracheal car tray
4. Pick up 1 sterile gauze with fingers of sterile hand
5. Stabilize neck plate with nonsterile hand (or have
assistant do so)
6. With sterile hand, use gauze to turn inner cannula counter
clockwise until catch is released (unlocked)
7. Gently slide cannula out using an outward & downward
arch
8. Place cannula in bowl of ½ strength peroxide
9. Discard gauze
10. Unwrap catheter & suctions outer cannula of
tracheostomy
11. Have client take deep breaths or use Ambu bag to
deliver 100% O2
12. Disconnect suction catheter from suction tubing &
remove sterile glove from dominant hand, pulling up & over
the suction catheter. Discard.
13. Remove tracheostomy dressing
14. using gauze pads, wipe secretions & crusts from around
tracheostomy tube.
15. Use moist swabs to clean under neck plate at insertion
site.
16. Remove & discard nonsterile gloves
17. Don sterile gloves
18. pick up inner cannula & scrub gently with cleaning
brush
19. Use pipe cleaners to clean lumen of inner cannula
thoroughly.
20. run inner cannula through peroxide mixture
21. Rinse cannula in bowl containing sterile saline.
22. place cannula in sterile gauze & dry thoroughly; use dry
pipe cleaner to remove residual moisture from lumen.
23. Slide inner cannula into outer cannula (keeping inner
cannula sterile), using smooth inward & downward arch &
rolling inner cannula from side to side with fingers.
24. Hold neck plate stable with other hand & turn inner
cannula clockwise until catch (lock) is felt & dots are in
alignment.
25. Remove & discard sterile gloves & don non sterile
gloves
26.Leave old ties in place
27. slip end of new tie through tie holder on neck plate & tie
a square knot 2-3 in. from neck plate.
28. Repeat step 27 on other side of neck plate
29. Once new ties are secured, remove old ties & discard
Rationale
2. Provides fluid of irrigation of lungs to
loosen secretions during suctioning
3. Provides moist swabs for cleaning skin
4. Allows touching of non sterile items
while maintaining sterility
5. Decreases discomfort & trauma during
removal of cannula
6. Separate inner & outer cannulas
7. Follows curve of tracheostomy tube
8. Softens secretions
9. Avoids contaiminating sterile items
10. Removes remaining secretions
11. Provides oxygenation after suctioning
13. Exposes skin for cleaning
14.removes possible airway obstruction &
medium for infection
17. Prevents contamination of hands;
reduces risk of infection transmission
18. Removes crusts & secretions from
outside & inside of cannula
19. Decreases accumulation of mucus in
lumen
20. removes remaining debris
21. Rinses away peroxide mixture &
residual debris
22. Prevents introduction of fluid into
trachea
23. Facilitates insertions & reduces
resistance.
26. Prevents accidental dislodgment of
Tracheostomy during replacement
 Action Rationale
Cleaning a Tracheostomy & Changing Dressing

30. Apply tracheostomy dressing:

30. Absorbs excess secretions
 Hold ends of tracheostomy dressing
 Gently lift neck plate & slide end of dressing under
plate & tie.
 Pull other end of dressing under neck plate & tie
 Slide both ends up toward neck, using a gentle
rocking motion, until middle of dressing rests under
neck plate.
31. Postition client for comfort
32. remove gloves & discard soiled materials
33. Preform hand hygiene 34. Promotes safety; facilitates
34. Raise side rails & place call light within reach communication.

EVALUATION:
Were desires outcomes achieved? Examples of
evaluation include:
 Desired outcome met: Respirations are 14-20
breaths/min, of normal depth, smooth, &
symmetric
 Desired outcome met: Breath sounds are clear
to auscultation bilaterally
 Desired outcome met: Tracheostomy site is dry
with no redness or swelling
DOCUMENTATION:
The following should be noted on the client’s record:
 Breath sounds before & after suctioning
 Number of times suctioned
 Character of respirations
 Status of tracheostomy site
 Size of tracheostomy cannula
 Cleaning provided & dressing change
 Significant changes in VS
 Color, amount & consistency of secretions
 Tolerance to treatment (i.e., state of incisions,
drains
 Replacement of O2 equipment after treatment
Refrences:
Book: Nurses’ Guide to Clinical Procedures, By: Jean Smith-Temple,Joyce Young, Ph.D., Rn, Ccrn
Johnson

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