INSTRUMENTS USED y Sterile disposable tracheostomy cleaning kit or supplies including sterile containers, sterile nylon brush and

/or pipe cleaners, sterile applicators, gauze squares

y y

Towel or drape to protect bed linens Sterile suction catheter kit (suction catheter and sterile container for solution)

y y y y y y

Sterile normal saline (check agency protocol for soaking solution) Sterile gloves (2 pairs) Clean gloves Moisture-proof bag Commercially prepared sterile tracheostomy dressing or sterile 4-in. x 4-in. gauze dressing Cotton twill ties

y

Clean scissors

PROVIDING TRACHEOSTOMY CARE 1. Assess the following: a. Respiratory status including ease of breathing, rate, rhythm, depth, lung sounds, and oxygen saturation level. b. Pulse rate c. Character and amount of secretions from tracheostomy site d. Presence of drainage on tracheostomy dressing or ties e. Appearance of incision (note any redness, swelling, purulent discharge, or odor) 2. Plan for care of the tracheostomy.

While applying the dressing. Lock the cannula in place by turning the lock (if present) into position to secure the flange of the inner cannula to the outer cannula. Rationale: This removes excess liquid from the cannula and prevents possible aspiration by the client. 12. c. Rationale: Hydrogen peroxide can be irritating to the skin and inhibit healing if not thoroughly removed. Establish a sterile field. gauze. Apply a sterile dressing. clean the incision site. Prepare the client and the equipment. a. Put a clean glove on your non-dominant hand and a sterile glove on your dominant hand (or put on a pair of sterile gloves. 6. Use a pipe cleaner folded in half to dry only the inside of the cannula. Prior to performing the procedure. such as eye blinking or raising a finger. a. c. c. Open the tracheostomy kit or sterile basins. b. Rationale: this moistens and loosens dried secretions. 4. Remove the inner cannula from the soaking solution. and peel the glove off so that it turns inside out over the catheter. 11. a. securing it in place. Open other sterile supplies as needed including sterile applicators. gauze dressing into a V shape. Twill tape and specially manufactured Velcro ties are available. After rinsing. a. Rationale: This avoids contaminating a clean area with a soiled gauze dressing or applicator. 9. potentially creating a tracheal abscess. if needed. do not dry the outside. unlock the inner cannula (if present) and remove it by gently pulling it out toward you in line with its curvature. d. Provide for client privacy.) b. Clean the inner cannula. Rationale: Excessive movement of the tracheostomy tube irritates the trachea. Clean the flange of the tube in the same manner. Suction the full length of the tracheostomy tube to remove secretions and ensure a patent airway. b. ensure that the tracheostomy tube is securely supported. b. d. 8. Put on sterile gloves. while leaving film moisture on the outer surface to lubricate the cannula for reinsertion. to indicate pain or distress. Suction the tracheostomy tube. Assist the client to a semi-Fowler s or Fowler s position to promote lung expansion. c. Inset the inner cannula by grasping the outer flange and inserting the cannula in the direction of its curvature. Provide for a means of communication. Thoroughly dry the client s skin and tube flanges with dry gauze squares. and tracheostomy dressing. a. Keep your dominant hand sterile during the procedure. Place the inner cannula in the soaking solution. a. Hydrogen peroxide may be used (usually in a half-strength solution mixed with sterile normal saline. b. . Avoid using cotton-filled gauze squares or cutting the 4-in. Explain to the client what you are going to do. f. x 4-in. b. why it is necessary. Thoroughly rinse the cleansed area using gauze squares moistened with normal saline. and how he or she can cooperate. Change the tracheostomy ties. Inspect the cannula for cleanliness by holding it at eye level and looking through it into the light. Rationale: cotton lint or gauze fibers can be aspirated by the client. Using the sterile applicators or gauze dressings moistened with normal saline.3. Rinse the suction catheter and wrap the catheter around your hand. d. Use a commercially prepared sterile tracheostomy dressing of non-raveling material or open and refold a 4-in. Change as needed to keep the skin clean and dry. 5. 10. Rinse the inner cannula thoroughly in the sterile normal saline. b. use a separate sterile container if this is necessary) to remove crusty secretions. c. Place the soiled linen in your gloved hand and peel the glove off so that it turns inside out over the dressing. Clean the incision site and tube flange. introduce self and verify the client s identity using agency protocol. Use each applicator or gauze dressings only once and then discard. a. Remove the soiled tracheostomy dressing. Check agency policy. d. Replace the inner cannula. Using the gloved hand. gently tap the cannula against the inside edge of the sterile saline container. e. 7. Perform hand hygiene and observe other appropriate infection control procedures. Pour the soaking solution and sterile normal saline into separate containers. Handle the sterile supplies with your dominant hand. Clean the lumen and entire inner cannula thoroughly using the brush or pipe cleaners moistened with sterile normal saline. suction kit. x 4-in. Discard the glove and the dressing. Place the dressing under the flange of the tracheostomy tube.

and the dressing change. y Have the client flex the neck. Ask the client to flex the neck.5 in. Slip the longer tape under the client s neck. Repeat the process for the second tie. Placing the finger under the tie prevents making the tie too tight. Leaving the old ties in place. This is very important because the movement of the tube during this procedure may cause irritation and stimulate coughing. y Thread one end of the tape into the slot in one side of the flange. remove the soiled ties and discard. Rationale: Flexing the neck increases it circumference the way coughing does. y Thread the end of the tape next to the client s head through the slot from the back to the front. pulling it tight until it is securely fastened to the flange.5 times the length needed to go around the client s neck from one tube flange to the other. tracheostomy care. which can come untied or cause pressure and irritation.Two Strip Method (Twill Tape) y Cut two unequal strips of twill tape. place the finger between the tape and the client s neck.5 cm (1 in. Rationale: Swelling of the neck may cause the ties to become too tight. 14.). Tape and pad the tie knot.5-in. y Bring both ends of the tape together. Frequently check the tightness of the tracheostomy ties and position of the tracheostomy tube.) lengthwise slit approximately 2. Place a folded 4-in. and tie the tapes together at the side of the neck. allowing for slack by placing two fingers under with the ties as with the two-strip method. 15. leaving approximately 1 to 2 cm (0. gauze under the tie knot. Take them around the client s neck. Document all relevant information. Rationale: leaving the old ties in place while securing the clean ties prevents inadvertent dislodging of the tracheostomy tube. one approximately 25 cm (10 in. a.). Rationale: This reduces irritation from the knot and prevents confusing the knot with the client s gown ties. Ties can loosen in restless clients. Cut off long ends. allowing the tracheostomy to extrude from the stoma. a. Adequate ends beyond the knot prevent the knot from inadvertently untying. y y y y y y y One Strip Method (Twill Tape) y Cut a length of twill tape 2. then cut a slit in the middle of the tape from its folded edge. interfering with coughing and circulation. and apply tape over the knot. then thread the long end of the tape through the slit. Cut off any long ends. Rationale: cutting one tape longer than the other allows them to be fastened at the side of the neck for easy access and to avoid the pressure of a knot on the skin at the back of the neck. Coughing can dislodge the tube if the ties are undone. a. thread the slit end of one clean tape through the eye of the tracheostomy flange from the bottom side. which could interfere with coughing or place pressure on the jugular veins. Tie the lose ends with a square knot at the side of the client s neck. Cut a 1-cm (0. Tie the ends of the tapes using square knots. have an assistant put on sterile glove and hold the tracheostomy in place while you replace the ties. Record suctioning. Once the clean ties are secured. 13. noting your assessments.) long.) long and the other about 50 cm (20 in. . If old ties are very soiled or it is difficult to thread new ties onto the tracheostomy flange with old ties in place. x 4-in. keeping them flat and untwisted. Rationale: Square knots prevent slippage and loosening. Check the tightness of the ties. Securing tapes in this manner avoids the use of knots.

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