TRACHEOSTOMY CARE

INTRODUCTION

• A tracheostomy is an opening through the neck into the

trachea. A tracheostomy opens the airway and aids
breathing.

• A tracheostomy may be done in an emergency, at the

patient’s bedside or in an operating room. Anaesthesia may be
used before the procedure. Depending on the person’s
condition, the tracheostomy may be temporary or permanent.
 DEFINITION
Tracheostomy care includes changing a
tracheostomy inner tube, cleaning tracheostomy
site and changing dressing around the site
 INDICATION

Obstruction of the mouth or throat

Breathing difficulty caused by edema ,injury or pulmonary conditions

Airway reconstruction following tracheal or laryngeal surgery

Airway protection from secretions or food because of swallowing
problems

Airway protection after head and neck surgery

Long-term need for ventilator support
 PURPOSES
1.To maintain airway patency
2.To prevent infection at the tracheostomy site
3.To facilitate healing and prevent skin excoriation
around tracheostomy care.
4.To promote comfort
5.To assess condition of ostomy
 EQUIPMENT
I. Tracheostomy care kit containing
1.Bowl-3
2.Sterile towel
3.Sterile nylon brush/ tube brush
4.Sterile gauze squares
5.Cotton twill ties or tracheostomy tie tapes
I. A clean tray containing
1.Hydrogen peroxide
2.Normal saline
3.Sterile gloves-1 pairs
4.Face mask and eye shield
5.Waterproof pad
Steps of Procedure
1. Identifies the patient and explains the procedure
2. Assembles the needed articles-sterile tracheostomy set with artery forceps,
thumb forceps, bowl with gauze pieces, sterile cotton applicator,
tracheostomy ties ,scissors, sterile betadine and normal saline , kidney tray
and PPE- mask with face shield or mask and goggles, pair of sterile gloves
and a pair of clean gloves ,gown (optional).
3. Performs hand hygiene, apply clean non sterile gloves, and eye/face
protection.( Gown optional)
4.Loosens tracheostomy ties on one side with one assistant supporting the
tracheostomy tube,
5. Using a non-touch technique removes soiled dressing , observes it for any
discharge and places into the kidney tray
6. Removes gloves , Washes hands
 7. Applies new pair of sterile gloves
8. Cleanses the tracheostomy stoma using betadine from the stoma to outwards
following aseptic principles . (Uses fresh piece of gauze each time)
9. Cleanses the tracheostomy flanges thoroughly .using fresh piece of gauze
and saline each time.
10. Unlocks and removes the inner cannula
11.Places the inner cannula in the sterile bowl with normal saline
without getting it immersed. ( if disposable, disposes it off )
12.Cleanses the inner cannula with a brush or cotton tipped applicator.
13.Replaces the clean inner cannula with outer surface moist .
14.Lets the stoma dry and applies new sterile dressing around the stoma
using a precut tracheostomy dressing or improvised one using gauze.
15.Changes the soiled twill or tap by removing the old one and inserts
into the eye of the tracheostomy tube from underside and ties it
securely .
16.Brings the taps/twill around the neck taking care the tube is in its place
safely and ties the tape tightly

17. Ensures the new dressing and the tape is secured well and comfortable for
the patient.

18. Disposes the used items appropriately and replace the articles

19. Removes gloves and performs hand hygiene

20.Documents the dressing change, the condition of the stoma, presence of

discharge with date and time
 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 .