Tracheostomy Care

  1. Performed to avoid bacterial contamination and obstruction of tracheostomy tube; frequency varies depending on amount of secretions
  2. Procedure
    1. Explain procedure and provide reassurance to the client.
    2. If not contraindicated, place client in semi-Fowler's position to promote lung reexpansion.
    3. Disconnect ventilator or humidification device.
    4. Suction trachea to clear secretions.
    5. Reconnect ventilator or humidifier.
    6. Remove all tracheostomy dressing.
    7. Assemble equipment ("trach care kit").
    8. Set up sterile field and put on sterile glove.
      1. For a single-cannula tube
        1. with sterile gloved hand, wipe client's neck under trach tube flanges with presoaked sterile sponge.
        2. wipe skin around tracheostomy with a second sponge until cleansed thoroughly (may use wet cotton-tipped applicators to cleanse around stoma).
        3. use each sponge or applicator only once.
        4. allow area to dry and apply a new sterile dressing (free of lint and fibers).
        5. change tracheostomy ties as needed.
      2. For a double-cannula tube
        1. disconnect ventilator or humidification device and unlock the inner cannula of trach tube using ungloved hand.
        2. place inner cannula in basin containing H2O2 to remove encrustations.
        3. if client on a ventilator, insert another inner cannula while old one is being cleaned and reconnect client to ventilator.
        4. cleanse stomal area and trach tube flanges with presoaked gauze sponges.
        5. clean inner cannula.
        6. remove excess liquid by gentle shaking.
        7. if client not on a ventilator, gently reinsert inner cannula into tracheostomy tube and lock in place.
        8. allow area to dry, apply dressing and new tracheostomy ties as described above.

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