BACHELOR OF SCIENCE IN NURSING:

CARE OF MOTHER AND CHILD AT RISK OR WITH PROBLEMS (ACUTE AND CHRONIC)
LABORATORY MODULE LABORATORY UNIT WEEK
1 4 4
Providing Tracheostomy Care

✓ Read course and laboratory unit objectives

✓ Read study guide prior to synchronous class attendance
✓ Read required learning resources; refer to course unit terminologies for jargons
✓ Participate in weekly discussion board (Canvas)
✓ Answer and submit course unit tasks

At the end of this unit, the students are expected to:

1. Identify importance and understanding of tracheostomy care.

2. Demonstrate and practice skill of providing tracheostomy care.
3. Implement safe and quality nursing care when providing tracheostomy care.
4. Practice skills in promoting physiologic responses in providing tracheostomy care.

Berman, Audrey. Kozier, Barbara (Eds.) (2008) Kozier & Erb’s fundamentals of nursing: concepts, process, and practice
Upper Saddle River, N.J.:Pearson Prentice Hall, 10th edition

https://www.youtube.com/watch?v=R54v1YDrmxM
Tracheostomy

A tracheostomy is an opening into the trachea through the neck. A tube is

usually inserted through this opening and an artificial airway is created. A
tracheostomy is performed using one of two techniques: the traditional open
surgical method or via a percutaneous insertion. The percutaneous method
can be done at the bedside in a critical care unit. The open technique is done
in an operating room where a surgical incision is made in the trachea just
below the larynx. A curved tracheostomy tube is inserted to extend through
the stoma into the trachea.

Tracheostomy tubes are available in different sizes and may be plastic, silicone, or metal, and cuffed, uncuffed, or
fenestrated. A fenestrated tracheostomy tube has an opening that allows air to pass through to the vocal cords, thus
allowing the client to communicate. Tracheostomy tubes have an outer cannula that is inserted into the trachea and
a flange that rests against the neck. The flange allows the tube to be secured in place with tracheostomy tapes/twill
ties or Velcro collars. All tubes also have an obturator, which is used to insert the outer cannula and is then removed.
The obturator, along with a spare tracheostomy tube of the same size and smaller, is kept at the client’s bedside in
case the tube becomes dislodged and needs to be reinserted. Some tracheostomy tubes have an inner cannula that
is inserted and locked into place inside the outer cannula. The purpose of the inner cannula is to prevent tube
obstruction by allowing regular cleaning or replacement. Many plastic inner cannulas are cleaned with a solution of
full or half-strength hydrogen peroxide and sterile water. Although some agency recommends using normal saline
only. It is important to check the manufacturer’s instructions for cleaning tracheostomy tubes because silicone tubes
and metal tubes can be damaged by using hydrogen peroxide. The outer cannula of the tracheostomy tube remains
in place to maintain a patent airway.

Cuffed tracheostomy tubes are surrounded by an inflatable cuff that produces an airtight seal between the tube and
the trachea. This seal prevents aspiration of oropharyngeal secretions and air leakage between the tube and the
trachea. Cuffed tubes are often used immediately after a tracheostomy and are essential when ventilating a
tracheostomy client with a mechanical ventilator. Children do not require cuffed tubes, because their tracheas are
resilient enough to seal the air space around the tube. Low-pressure cuffs are commonly used to distribute a low,
even pressure against the trachea, thus decreasing the risk of tracheal tissue necrosis. They do not need to be
deflated periodically to reduce pressure on the tracheal wall. Foam cuffed tracheostomy tubes do not require injected
air; instead, when the port is opened, ambient air enters the balloon, which then conforms to the client’s trachea. Air
is removed from the cuff prior to insertion or removal of the tube. The nurse provides tracheostomy care for the client
with a new or recent tracheostomy to maintain patency of the tube and reduce the risk of infection. Initially a
tracheostomy may need to be suctioned and cleaned as often as every 1 to 2 hours. After the initial inflammatory
response subsides, tracheostomy care may only need to be done once or twice a day, depending on the client. For
a client with a new tracheostomy, sterile technique should be used when providing tracheostomy care in order to
prevent infection. After the stoma has healed, clean gloves can be used while changing the dressing and tie tapes.

When the client breathes through a tracheostomy, air is no longer heated, humidified, and filtered as it is when passing
through the upper airways; therefore, special precautions are necessary. Humidity may be provided with a mist collar.
Clients with long-term tracheostomies may use a heat moisture exchange device known as a “Swedish nose” that fits
onto the connector of the inner cannula. They may also wear a stoma protector such as a 4×4 gauze held in place
with a cotton tie over the stoma or a light scarf to filter air as it enters the tracheostomy.

Purposes of Tracheostomy Care

• To maintain airway patency
• To maintain cleanliness and prevent infection at the tracheostomy site
• To facilitate healing and prevent skin excoriation around the tracheostomy incision
• To promote comfort

Procedure:
1. Assess the clients:
a. Respiratory status (ease of breathing, rate, rhythm, depth, lung sounds, and oxygen saturation)
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. Introduce self and verify the client’s identity. Explain the procedure, its purpose, and how the client can
participate. Provide instruction for means of communication to indicate pain or distress.
3. Perform hand hygiene and observe other appropriate infection prevention procedures.
4. Provide privacy.
5. Assist the client to a semi-fowler or fowler’s position.
6. Open the tracheostomy kit or sterile basins. Establish
a sterile field and open other sterile supplies (sterile
applicators, suction kit (if needed), tracheostomy
dressing, and disposable inner cannula, if applicable).
7. Suction the tracheostomy tube if needed and allow the
client to rest and restore oxygenation.
8. Pour soaking solution and normal saline solution into
separate containers.
9. Wear clean gloves.
 10. Remove the oxygen source, unlock the inner cannula (if present), and remove it gently by pulling it out
towards you in line with its curvature. Place the inner cannula in the soaking solution if not a disposable.
11. Place the oxygen source over or near the outer cannula to prevent oxygen desaturation.
12. Remove the soiled tracheostomy dressing. Dispose it by peeling off the clean gloves inside out over the
soiled dressing, and discard.
13. Perform hand hygiene and wear sterile gloves.
14. Clean the inner cannula from the soaking solution using the brush or pipe cleaners moistened with sterile
normal saline. Rinse the inner cannula thoroughly in the sterile normal saline. Tap it gently against the inside
edge of the sterile saline container and dry the inside of the cannula.
15. Replace the inner cannula and secure it in place by turning the lock.
16. Clean the incision site and tube flange using sterile applicators or gauze dressings moistened with normal
saline. NOTE: Half-strength hydrogen peroxide mixed with sterile saline solution may be used to remove
crusty secretions around the tracheostomy site (do not use directly on the site). Dry thoroughly the skin and
tube flange with dry gauze.
17. Apply a sterile dressing under the flange of the tracheostomy tube while
supporting securely.
18. Change the tracheostomy ties or Velcro collar by securing the new ties
first before removing the old ties.
19. Remove and discard sterile gloves, and perform hand hygiene.
20. Document the procedure and relevant data
a. Record suctioning, tracheostomy care, and the dressing change,
noting the assessments.

After providing tracheostomy care on a client, create an FDAR charting for the client.
DATE/ TIME FOCUS DATA, ACTION and RESPONSE

Watch the link for the procedure: https://www.youtube.com/watch?v=R54v1YDrmxM

Berman, Audrey. Kozier, Barbara (Eds.) (2008) Kozier & Erb’s fundamentals of nursing: concepts, process, and practice
Upper Saddle River, N.J.:Pearson Prentice Hall, 10th edition

https://www.youtube.com/watch?v=R54v1YDrmxM