1

Skills Checklist to Accompany Fundamentals of Nursing:

The Art and Science of Person-Centered Care, 9th edition
Name Date

Unit Position

Instructor/Evaluator: Position

SKILL 39-5
Providing Care of a Tracheostomy Tube
Needs Practice
Satisfactory
Excellent

Goal: The patient exhibits a tracheostomy tube and site free

from drainage, secretions, and skin irritation or breakdown. Comments

1. Gather equipment.
2. Perform hand hygiene and put on PPE, if indicated.
3. Identify the patient.
4. Assemble equipment on the overbed table or other surface
within reach.
5. Close the curtains around the bed and close the door to
the room, if possible.
6. Determine the need for tracheostomy care. Assess the
patient’s pain and administer pain medication, if
indicated.
7. Explain what you are going to do and the reason for doing
it to the patient, even if the patient does not appear to be
alert. Reassure the patient you will interrupt the procedure
if he or she indicates respiratory diffculty.
8. Adjust the bed to a comfortable working position, usually
elbow height of the caregiver (VHACEOSH, 2016). Lower
the side rail closest to you. If conscious, place the patient in
a semi-Fowler’s position. If unconscious, place the patient
in the lateral position, facing you. Move the overbed table
close to your work area and raise it to waist height. Place a
trash receptacle within easy reach of the work area.
9. Put on face shield or goggles and mask. Suction
tracheostomy, if necessary. If tracheostomy has just been
suctioned, remove soiled site dressing and discard before
removal of gloves used to perform suctioning.

Cleaning the Tracheostomy: Disposable Inner Cannula

10. Carefully open the package with the new disposable inner
cannula, taking care not to contaminate the cannula or the
inside of the package. Carefully open the package with the
sterile cotton-tipped applicators, taking care not to
contaminate them. Open the sterile cup or basin and fll
0.5 in deep with saline. Open the plastic disposable bag
and place within reach on work surface.

Copyright © 2019 Wolters Kluwer.

 2

SKILL 39-5
Providing Care of a Tracheostomy Tube (Continued)
Needs Practice
Satisfactory
Excellent

Comments

11. Put on disposable gloves.

12. Remove the oxygen source if one is present. Stabilize the
outer cannula and faceplate of the tracheostomy with your
nondominant hand. Grasp the locking mechanism of the
inner cannula with your dominant hand. Press the tabs and
release the lock. Gently remove the inner cannula and
place in disposal bag. If not already removed, remove site
dressing and dispose of it in the trash.
13. Working quickly, discard gloves and put on sterile gloves.
Pick up the new inner cannula with your dominant hand;
stabilize the faceplate with your nondominant hand and
gently insert the new inner cannula into the outer cannula.
Press the tabs to allow the lock to grab the outer cannula.
Reapply oxygen source, if needed.

Applying Clean Dressing and Holder

14. Remove oxygen source, if necessary. Dip cotton-tipped
applicator or gauze sponge in cup or basin with sterile
saline and clean stoma under faceplate. Use each applicator
or sponge only once, moving from stoma site outward.
15. Pat skin gently with dry 4 × 4 gauze sponge.
16. Slide commercially prepared tracheostomy dressing or
prefolded non–cotton-flled 4 × 4-in dressing under the
faceplate.
17. Change the tracheostomy holder:
a. Obtain the assistance of a second person to hold the
tracheostomy tube in place while the old collar is
removed and the new collar is placed.
b. Open the package for the new tracheostomy collar.
c. Both nurses should put on clean gloves.
d. One nurse holds the faceplate while the other pulls up
the Velcro tabs. Gently remove the collar.
e. The frst nurse continues to hold the tracheostomy
faceplate.
f. The other nurse places the collar around the patient’s
neck and inserts frst one tab, then the other, into the
openings on the faceplate and secures the Velcro tabs
on the tracheostomy holder.
g. Check the ft of the tracheostomy collar. You should be
able to ft one fnger between the neck and the collar.
Check to make sure that the patient can fex the neck
comfortably. Reapply the oxygen source, if necessary.

Copyright © 2019 Wolters Kluwer.

 3

SKILL 39-5
Providing Care of a Tracheostomy Tube (Continued)
Needs Practice
Satisfactory
Excellent

Comments

18. Remove gloves. Remove face shield or goggles and mask.

Assist the patient to a comfortable position. Raise the bed
rail and place the bed in the lowest position.
19. Reassess the patient’s respiratory status, including
respiratory rate, effort, oxygen saturation, and lung
sounds.
20. Remove additional PPE, if used. Perform hand hygiene.

Copyright © 2019 Wolters Kluwer.