during, and after suctioning, 100% oxygen
for 3 minutes or 3 deep breathes. Suction
Definition:
A tracheostomy is a surgical incision into the
trachea to insert a tube through which the
patient can breathe more easily and
secretions can be removed. A small
horizontal incision is made just below the 1 st
tracheal ring and tracheostomy tube is
inserted – it can be temporary or permanent.
In most cases, this is temporary measure.
Once patient can tolerate temporary closure
referred to as “buttoning”, tracheostomy
tube is removed and incision heals.
Site of incision for tracheostomy:
Purposes:
 To maintain a patent airway
 To maintain cleanliness and
prevent infection at the tracheostomy site
 To facilitate healing and prevent
skin excoriation around tracheostomy
incision
 To promote comfort
Considerations:
• Sterile technique is always used
for infection control.
• Hyperoxygenate client before,
no more than 10 seconds.
*Patient with tracheostomy usually cannot
speak, establish a way of
communicating. The tracheal opening
prevents air from reaching the vocal
cords so speech is not possible.
*Later the patient will be able to speak by
placing a button or finger over the
opening thus forcing air around the
tube.
Considerations:
• Avoid using cotton-filled gauze
squares and avoid cutting the 4x4 gauze.
The client might aspirate cotton lint
which could create tracheal abscess.
• If the client coughs and the tube
is dislodge accidentally, the initial
nursing action is to grasp the retention
sutures and spread the opening. If
agency policies permits the nurse then
attempts immediately to replace the
tube.
Parts of tracheostomy tube:
 It is composed of 3 parts:
• Outer cannula
• Inner cannula
• Obturator

 OUTER CANNULA. This
cannula is curved and has a flange near the
opening which rests against the surface of
the neck. Ties attached to this flange secure
the cannula to patient’s neck.
 INNER CANNULA. Fitted inside
the outer tube. A latch usually holds cannula
securely and allows it to be removed for
cleaning.
 OBTURATOR. It is used only to
insert the outer tube. It is removed once the
outer tube is in place.
*Most tubes are available in standard sizes 0-
12 or French 24 to 44
*Plastic tube has a larger lumen and is softer
than the metal tube. It molds more easily
to the trachea, so it causes less irritation
and is more comfortable for the patients.
Types of tracheostomy tube:
• Double – lumen tube
• Single – lumen tube
Types of tracheostomy tube:
• Cuffed tube – a cuff when
inflated seals the airway.
Cuff – prevent aspiration of fluids. Inflated
during continuous mechanical ventilation,
during and after eating, during and 1 hour
after tube feeding.
Types of tracheostomy tube:
• Cuffless tube – use for long
term
Types of tracheostomy tube:
• Fenestrated tube – has a pre cut
opening. This tube allows the client to
speak.
Types of tracheostomy tube:
• Metal tracheostomy tube – for
permanent tracheostomy. Popular types
are the Jackson and Holinger tubes.
Types of tracheostomy tube:
• Talking tracheostomy tube –
provides a means of communication for
the client who is using a ventilator on a
long-term basis.
Types of tracheostomy tube:
Equipments:
 Bedside table
 Towel
  Tracheostomy suction supplies
 Sterile tracheostomy care kit
 Sterile 4x4 gauze pads
 Hydrogen peroxide
 Normal saline solution
Equipments:
 Sterile cotton-tipped swabs
 Sterile dressing (precut and sewn
surgical dressing)
 Sterile basin
 Small sterile brush
 Roll of twill tape, tracheostomy
ties, or Velcro tracheostomy ties
 Scissors
 Sterile gloves (2)
 Face shield
Procedures:
• Observe for signs and symptoms
of need to perform tracheostomy care:
excess peristomal secretions, soiled
tracheostomy ties, soiled dressing
diminished airflow, or signs and
symptoms of airway obstruction.
Signs and symptoms are related to presence
of secretions at stoma site or within
tracheostomy tube.
Procedures:
• Check when tracheostomy care
was last performed.
Tracheostomy care is provided at least 2
hours and more often if indicated.
• Explain procedure to client; have
another nurse or a family member to
assist in the procedure.
Encourages cooperation and prevents
accidental extubation of
tracheostomy tube.
Procedures:
• Assist in comfortable position
usually supine or semi-fowler’s
Promote client’s comfort and prevents nurse’s
muscle strain.
• Place towel across chest.
Reduces transmission of microorganisms.
• Wash hands, apply gloves, and
face shield if applicable.
 Reduces transmission of microorganisms.
Procedures:
• Suction tracheostomy. Before
removing gloves, remove tracheostomy
soiled dressing; discard in glove with
coiled catheter.
Removes secretions to avoid occluding outer
cannula while inner cannula is
removed. Reduce need for client to
cough.
Procedures:
• Open sterile tracheostomy kit.
Open gauze packages aseptically and
pour normal saline on one package and
hydrogen on another. Leave third package
dry. Open two cotton-tipped swab
packages, and pour normal saline on one
package and hydrogen peroxide on
another. Open sterile tracheostomy
dressing package. Unwrap sterile basin
and pour ½ inch hydrogen peroxide into
it. Open sterile brush package and place
into sterile basin. Cut tape and lay aside
in dry area.
Prepares equipment and allows for smooth,
organized completion of
tracheostomy care.
Procedures:
• Apply gloves. Keep dominant
hand sterile throughout the procedure.
• Remove oxygen source and inner
cannula with nondominant hand. Drop
into hydrogen peroxide basin.
Removes inner cannula for cleaning.
Hydrogen peroxide loosens secretions
from inner cannula.
• Place tracheostomy collar, T tube
or ventilator oxygen source over cannula.
Maintains oxygen supply to client.
Procedures:
• Quickly pick up inner cannula
and use small brush to remove secretions
inside and outside inner cannula.
Prevents oxygen desaturation; tracheostomy
brush provides mechanical force to
remove thick or dried secretions.
• Hold inner cannula over basin
and rinse with normal saline.
Removes secretions and hydrogen peroxide
from inner cannula.
Procedures:
• Replace inner cannula and secure
locking mechanism, if applicable.
Reapply trach collar, T tube, or ventilator
oxygen source.
Secures inner cannula and reestablishes
oxygen supply.
Procedures:
TRACHEOSTOMY STOMA
• With hydrogen peroxide
saturated cotton-tipped swabs and gauze,
clean exposed outer cannula surfaces and
stoma under faceplate extending 2 to 4
inches in all directions from the stoma.
Clean in circular motion from stoma
outside.
Aseptically removes secretions from stoma
site. Moving in outward circle pulls
mucus and other contaminants from
 stoma to periphery. head and around neck to other eyelet and
insert one tie through second eyelet.
Procedures:

• With normal saline saturated

• Pull snugly.

cotton-tipped swabs and gauze, rinse Ensures tracheostomy will not come out.
hydrogen peroxide from trach tube and
skin surfaces. Procedures:

Rinses hydrogen peroxide from surfaces. If

not removed from skin, hydrogen • Tie ends securely in double
peroxide can promote tissue injury. square knot, allowing space for only one
loose or two snug fingers in tie.

• With 4x4 inch gauze, pat lightly
at skin and exposed outer cannula
surfaces.
Dry surfaces prohibit formation of moist
environment for microorganism
One finger-length of slack prevents ties from
being too tight when tracheostomy
dressing is in place and also prevents
movement of trach tube in lower
airway.

Procedures:
growth and skin excoriation.
• Insert fresh tracheostomy
dressing under clean ties and faceplate.
TRACHEOSTOMY TIES AND DRESSING
Absorbs drainage. Dressing prevents pressure
CHANGE
on clavicle heads.

Procedures:

• Ask assistant to hold tube in

• Position client comfortably and
place. Cut ties.
assess respiratory status.
Secure trach tube. Reduces risk of incidental
Promotes comfort. Some may require post-
extubation
tracheostomy care suctioning.

• Cut twill tape long enough to go

• Remove gloves and face shield
around client’s neck twice (24 to 30
and discard.
inches). Cut ends on diagonal.

Cutting ends of tie on diagonal aids in

inserting tie through eyelet.
• Wash hands.

Procedures: Reduces transmission of microorganisms.

• Insert one end of tie through Indication for Suctioning Tracheostomy

faceplate eyelet and pull ends even.

•
•
Presence of mucus in airway
Slide both ends of tie behind the
 • Increased pulse

• Increased respirations

• Noisy respirations

• Restlessness

Complications

• Airway obstruction

• Accidental decannulation

• Infection