TRACHEOSTOMY CARE Handouts

TRACHEOSTOMY CARE prepared by: Leonel G. Lozada

What is a Tracheostomy?
A tracheostomy is an opening (made by an incision) through the neck into the trachea (windpipe). A tracheostomy opens the airway and aids breathing.

When is a tracheostomy considered?
Obstruction of the mouth or throat
Breathing difficulty caused by edema (swelling), injury or pulmonary (lung) 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 (breathing machine) support

What is a Tracheostomy tube?
A tracheostomy (trach) tube is a small tube inserted into the tracheostomy to keep the stoma (opening) clear.
All trach tubes have an outer cannula (main shaft) and a neck-plate (flange). The flange rests on your neck over the stoma (opening). Holes on each side of the neck-plate allow you to insert trach tube ties to secure the trach tube in place.

Purposes of Tracheostomy Care:
Maintain airway patency
Promote cleanliness
Prevent infection
Prevent skin irritation

Tracheostomy Care procedure:
1. Gather the needed materials:

2. Wash your hands thoroughly with soap and water.
3. Put on the gloves.
4. Suction the tracheostomy tube.
5. Remove the inner cannula.
6. Insert the fenestrated cannula.
7. Hold the inner cannula over the basin and pour the hydrogen peroxide over and into it. Use as much hydrogen peroxide as you need to clean the inner cannula thoroughly.
8. Clean the inner cannula with pipe cleaners or a small brush.
9. Thoroughly rinse the inner cannula with normal saline, tap water or distilled water.
10. Dry the inside and outside of the inner cannula completely with a clean 4 x 4 fine mesh gauze pad.
11. Reinsert the inner cannula and lock it in place.
12. Remove the soiled gauze dressing around your neck and throw it away.
13. Inspect the skin around the stoma for redness, hardness, tenderness, drainage or a foul smell. If you notice any of these conditions, call your nurse or physician after you finish routine care.
14. Soak the cotton-tipped swabs in a solution of half hydrogen peroxide and half water. Use the swabs to clean the exposed parts of the outer cannula and the skin around the stoma.
15. Wet the wash cloth with normal saline, tap water or distilled water. Use the wash cloth to wipe away the hydrogen peroxide and clean the skin.
16. Dry the exposed outer cannula and the skin around the stoma with a clean towel.
17. Place fine mesh gauze under the tracheostomy tie and neck-plate by folding it or cutting a slit in it.
18. Remove your gloves and throw them away.
19. Wash your hands with soap and warm water.

Changing the trach tube ties
Measure and cut a piece of tie long enough to go around your neck twice. Cut the tie at an angle so it is easier to insert the tie into the neck-plate.
Untie one side of the old tie and remove that side from the neck-plate. Do not completely remove the old tie until the new one is in place and is securely fastened.
Holding the trach tube in place, lace the tie through one hole of the neck-plate, around the back of your neck, through the other hole of neck-plate, and again around the back of your neck.
Pull the tie snugly and tie a square knot on the side of your neck. There should be enough space for no more than two fingers between the tie and your neck.
Cut, remove and discard the old tie. If you have a cuffed trach tube, be careful not to cut the cuff balloon when removing the old trach tube tie.

Medical and Surgical Nursing, Clinical Management for Positive Outcomes, Joyce Black and Jane Hokanson Hawks