Tracheostomy Care:

Tracheostomy Care
Care of the Patient with a Tracheostomy
This material was developed by Mrs. Robin White MSN while on the faculty in the Wright State University-Miami Valley College of Nursing and Health. This material is based upon work supported by the Ohio Learning Network. Any opinions, findings and conclusions or recommendations expressed in this material are those of the author and do not necessarily reflect the views of the Ohio Learning Network.

Read Kozier & Erb pps. 1314-1318 Read Kozier & Erb Techniques pps. 458-467 Identify parts of a tracheostomy tube & their purposes Demonstrate safe & effective tracheostomy care

Principles of a Tracheostomy
A patient with a tracheostomy has had a surgically created opening made in the lower airway, usually at the level of the 2nd or 3rd tracheal ring When a tracheostomy is inserted, the upper airway is bypassed- this also includes bypassing the following normal functions humidifying warming filtering of air

Principles of a Tracheostomy:
Mucociliary transport & cough mechanism are impaired with placement of a trach tube Maintenance of airway patency is very important

Parts of a Tracheostomy:
Outer cannula with cuffs Inner cannula Obturator (to blunt end) Trach tie/ trach collar (oxygen)

Tracheostomy Care:
Cleaning of the inner cannula is generally performed every 8 hours, & changing the cannula (sterile procedure) every 24-48 hours (or per facility policy) Prior to cleansing the inner cannula, hyperinflate & hyperoxygenate the patient, & suction the airway to remove secretions The area around the trach stoma should be intact/pink, free of irritation, swelling, & purulent drainage Only manufactured drain sponges with slit should only be used around the trach site to avoid lint from entering the stoma

Tracheostomy Care:
Always assess the integrity of the new trach tube & obturator to be inserted by inflating the cuff to check for a leak Prior to changing the tube, hyperoxygenate the patient & hyperextend the neck The cuff on an artificial airway creates a seal between the wall of the trachea & the outside of the tube, allowing positive pressure ventilation & preventing aspiration of foreign material into the airway & lungs

Complications of overinflation of the trach cuff include (due to excess pressure on tracheal wall):
Tracheitis Bleeding Tracheal erosion/necrosis Tracheomalacia Tracheal stenosis Tracheoesophageal fistula Tracheoinnominate artery fistula Cuff herniation

Tracheostomy Care Equipment:

Hydrogen peroxide Sterile saline Sterile gloves Disposable tracheostomy kit Clean scissors (if ties must be replaced

Tracheostomy Care Kit:

Sterile gloves Gauze sponges Drain sponge Cotton swabs Pipe cleaners Forceps Trach tie Brush 3 containers Sterile sodium chloride & hydrogen peroxide

Tracheostomy Care Procedure:

Wash hands Explain procedure Place patient in high fowlers position Open sterile pack Loosen caps on peroxide & saline bottles Remove & discard neck dressing with clean gloves Open/don sterile gloves Set up sterile field & separate sterile basins Check labels/dates on bottles- if previously used, lip the bottles Place sterile drape over patient Using non-dominant hand (now the clean hand), pour solutions into basins (1 NACL & 1 H2O2/NACL mix) Remove the inner cannula using clean hand & drop into the NaCl/peroxide mix)

Tracheostomy Care Procedure:

Dip sterile applicators & gauze in NaCl/peroxide mix, & clean around trach site Next, rinse trach site using sterile applicators & gauze Pick up inner cannula with clean hand on clean end & scrub interior & exterior with brush Rinse inner cannula in NaCl Dry inner cannula with pipe cleaner, leaving small amount of saline on cannula to decrease friction for reinsertion Reinsert cannula with clean hand/lock into place Apply a sterile drain sponge to trach site with forceps or sterile hand Thread clean ties through flange holes & tie securely/carefully cut & remove soiled ties

Tracheostomy Care Documentation:

Condition of tracheal site Size/type of trach Patient tolerance- be specific (vital signs, O2 saturation, etc.) Color, volume, consistency of sputum Improvement in breath sounds