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2.Examine neck for subcutaneous emphysema indicates air leak into subcutaneous tissue.
evidenced by crepitus around the ostomy site.
3.Explain procedure to the patient and teach means obtain cooperation from patient.
of communication such as eye blinking or
raising a finger to indicate pain or distress.
14.Replace the inner cannula and secure it in place This secure the flange of the inner cannula to the outer
Insert the inner cannula by grasping the outer cannula.
Lock the cannula in place by turning the lock into
position.
15.Apply sterile dressing. Avoid using cotton- filled 4*4 gauze. Cotton or gauze
Open and refold a 4*4 gauze dressing into a ‘V’ fibre can be aspirated by the patient potentially creating a
shape and place under the flange on the tracheal abscess.
tracheostomy tube. Do not cut gauze pieces. Excessive movement of the tracheostomy tube irritates
Ensure that the tracheostomy tube is securely the trachea.
supported while applying dressing.
16.Change the tracheostomy ties. Leaving tape in place ensures that tube will not be
• Leave the soiled tape in place until the new one is expelled if patient coughs or moves.
applied This action provides a secure attachment with knot.
Grasp slit end of clean tape and pull it through Prevents irritation and aids in rotation of pressure site.
opening on one side of the tracheostomy tube. Excessive tightness compresses jugular veins, decrease
Pull the other end of the tape securely thoroughly blood circulation to the skin and results in discomfort
the slit end of the tracheostomy tube on the other for patient.
side.
Tie the tapes at the side to side of the neck in a
square knot.
17.Document all relevant information in the chart
Tracheostomy care carried out.
Dressing change and
• Observations.
SPECIAL CONSIDERATION
1.Tracheostomy dressing should be done every 8 hours or
whenever dressing are soiled
2.Tracheostomy tubes may come with disposable inner cannula or
without the inner cannula. If disposable inner cannula is present,
then replace the one that is inside with a new one.
3.If only single lumen is present, then suction the tracheostomy
tube and clean the neck plate and tracheostomy site.
NURSES RESPONSIBILITY
1. Tracheostomy dressing should be done every 8 hours or whenever dressing is
soiled
2. If disposable inner cannula is present, then replace the one that is inside with a
new one.
3. If only single lumen is present, clean the neck plate and tracheostomy site.
4. Emphasize the importance of handwashing before performing tracheostomy
care.
5. proper way on how to remove, change, and replace the inner cannula.
6. Check and clean the tracheostomy stoma.
7. Assess for symptoms of infection .
TEACHER REFERENCE
• Jacob Annamma. Rekha. R. clinical nursing procedures the art of nursing
practice. 2nd edition. Jaypee publications. New delhi. 2007. Page no: 328-330.
• Smeltzer et.al(2011),Brunner and Suddharths Textbook Medical Surgical Nursing,
Volume 1 12th Editions, Wolter Kluwer Pvt ,New Delhi pp 778-793
• S M Mogotlane et.al (2009), Jutas Manual of Medical Surgical Nursing, Volume 4,
1st Edition, pp.18-16-18
• Lewis et.al. (2009). Medical Surgical Nursing Assessment And Management Of
Clinical Problems.7th edition, Page No.810-71
• Sands’ Phipps Medical Surgical Nursing Health And Illness Perspective, 8th
Edition, Page No.903-905
STUDENT REFERENCE
• Smeltzer et.al(2011),Brunner and Suddharths Textbook Medical Surgical Nursing,
Volume 1 12th Editions, Wolter Kluwer Pvt ,New Delhi pp 778-793
• Javed Ansari et.al(2015), A Textbook Of Medical Surgical Nursing Pee Vee
Publications, Ist Edition, Aurelia Printers, India pp.1433-1437
• S M Mogotlane et.al(2009), Jutas Manual Of Medical Surgical Nursing, Volume 4,
1st Edition, pp.18-16-18
• Lewis et.al.(2009).Medical Surgical Nursing Assessment And Management Of
Clinical Problems.7th edition, Page No.810-71
• http://www.nsgmed.com/nursing-procedures
• www.upmc.com/patients-visitors/education
• https://www.webmd.com