Tracheostomy Care What is a Tracheostomy?

A tracheostomy, commonly called a trach, refers to a surgically created hole that extends from the neck skin into the windpipe or trachea. This operation is performed for a number of reasons. Some persons have tracheostomy to bypass obstructions in their airway from injuries, scarring, or tumors. for Some patients have of a tracheostomy the treatment sleep

edges. If kit is not available, open two saline basins. Rationale: Basins are sterile receptacles for cleaning solutions. b. Fill one basin 0.5” (1.25 cm) deep with hydrogen peroxide). Rationale: Hydrogen peroxide helps remove dry, encrusted secretions. c. Fill other basin 0.5” (1.25 cm) deep with saline. Rationale: Saline rinses and removes hydrogen peroxide and lubricates the outer surface of the inner cannula for easier reinsertion. d. Open sterile brush or pipe cleaners if they are not already available in cleaning kit. Open additional sterile gauze pad. Rationale: Sterile brush or pipe cleaner provides friction to clean inner surface of cannula.

disorders, such as obstructive sleep apnea. Many patients have a tracheostomy for improvement of breathing and for suctioning secretions from the lungs that are unable to clear with coughing. In most patients the tracheostomy enables a person to function more normally and continue to breathe, despite significant medical problems. For this reason this artificial airway needs to be maintained in order to prevent serious or lifethreatening frequently problems. related to These problems of are the blockage

5. Don’t disposable gloves.
Rationale: exposure substances. 6. Remove the oxygen source if one is present. Rotate the lock on the inner Gloves to protect and against body blood

tracheostomy tube. Procedure: 1. Explain procedure to client. Rationale: for patient. 2. If tracheostomy tube has just been suctioned, remove soiled dressing from around tube and discard with gloves when they are removed. Rationale: Suctioning prevents secretions from accumulating in inner cannula and occluding airway. Explanation facilitates cooperation and provides reassurance

cannula in a counterclockwise motion to release it. Rationale: Releasing the lock permits removal of the inner cannula.

7. Gently remove the inner cannula and
carefully discard. Rationale: peroxide secretions. Soaking loosens in dry, hydrogen hardened drop it in the basin with hydrogen peroxide. Remove gloves and

3. Perform hand hygiene and open necessary
supplies. Rationale: Hand hygiene deters the spread of microorganisms. Cleaning a Nondisposable Inner cannula 4. Prepare supplies before cleaning inner cannula. a. Open tracheostomy care kit and separate basins, touching only the

8. Clean the inner cannula. a. Don’t remove sterile gloves.
Rationale: b. Remove Sterile inner gloves maintain from surgical asepsis. cannula soaking solution. Moisten brush or pipe cleaners in saline and insert into tube, using back – and – forth motion.

Rationale: Movement of brush creates friction and helps remove accumulated secretions. c. Agitate cannula in saline solution. Remove and tap against inner surface of basin. Rationale: Saline rinses inner cannula. Tapping tube against basin removes excess saline in inner tube. d. Place on sterile gauze pad. Rationale: Placing on sterile gauze maintains sterility and frees both hands for suctioning. 9. Suction outer cannula using sterile technique if necessary. Rationale: Suctioning removes any remaining secretions. 10. Replace inner cannula into outer cannula. Turn lock clockwise and check that inner cannula is secure. Reapply oxygen source if needed. Rationale: Clockwise motion secures inner cannula in place. Replacing a Disposable Inner Cannula 11. Release lock. Gently remove inner cannula and place in disposal bag. Discard gloves and new don sterile ones to lock insert on new inner cannula. Replace with appropriately sized cannula. Engage cannula. Rationale: patent. Applying Clean Dressing and Tape Disposable cannulas, although more costly, ensure that airways is clean and

Rationale:

Hydrogen peroxide may cause

tissue damage and needs to be removed from skin and surrounding area. 14. Pat skin gently with dry 4”x4” gauze. Rationale: Gauze removes excess moisture. 15. Slide cotton commercially filled 4”x4” prepared under tracheostomy dressing or prefolded nondressing faceplate. Rationale: Lint or fiber from cotton-filled gauze pad can be aspirated into the trachea and cause irritation. 16. Change the tracheostomy tape: a. Leave soiled tape in place until new one is applied Rationale: Leaving tape in place ensures that tracheostomy will not be expelled if patient coughs or moves. b. Cut piece of tape that is twice the neck circumference plus 4” (10cm). Trim ends of tape on the diagonal. Rationale: This action provides for secure attachments with knot in front at neckplate. Diagonal cut facilitates insertion of tape into openings on faceplate. c. Insert one end of tape through faceplate opening alongside old tape. Pull through until both ends are even. Rationale: Doing so provides attachment for one side of faceplate. d. Slide both tapes under patient’s neck and insert one end through remaining opening on other side of faceplate. Pull snugly and tie ends in double square knot. Check that patient can flex neck comfortably. Rationale: accidental breadth that A secure tape prevents of permits the neck expulsion tape not

12. Dip cotton-tipped applicator in sterile
saline and clean stoma under faceplate. Use each applicator only once, moving from stoma site outward. Rationale: Saline is nonirritating to tissue. Cleansing from the stoma outward and using each applicator only once promotes aseptic technique. 13. If secretions prove difficult to remove, apply diluted ½ strength hydrogen peroxide to area around stoma, faceplate, and outer cannula. Rinse area with saline.

tracheostomy tube. Allowing one finger under will flexion that is comfortable and ensure tape compromise circulation to the area. e. Carefully remove old tape. Reapply oxygen source if necessary. Rationale: New tape provides for secure attachment.

17. Remove gloves and discard. Perform hand hygiene. Assess patient’s respirations. Document assessments and completion of procedure. Rationale: Assessment and accurate documentation comprehensive care. Nursing Considerations: 1. Assess insertion site for any redness or purulent drainage; if present, these may signify an infection. 2. Assess patient for pain. 3. Assess lung sounds and oxygen saturation levels. 4. If tracheostomy is fresh, pain medication may be needed before performing tracheostomy care. 5. If mucus is plugging the tracheostomy tube, first irrigate and suction. If this is not successful, remove the inner cannula and repeat the irrigation and suction. If there is still obstruction, there may be mucus plugging the outer cannula and it should be replaced. CHAVEZ, KATELENE B. 4 DCN GROUP 10 SBC – CON 7:00 AM – 3:00PM provide for