Tracheostomy Care

Care of the Patient with a

Tracheostomy
Network Principles of a Tracheostomy
A patient with a tracheostomy has had a surgically created opening
made in the lower airway, usually at the level of the 2nd and 3rd
tracheal ring.
When a tracheostomy is inserted, the upper airway is bypassedthis also includes bypassing the following normal functions.
humidifying
warming
filtering Of air

Principles of a Tracheostomy:
Mucociliary transport & coughmechanism are impaired with
placement of a trach tube
Maintenance of airway patency is very important

Parts of a Tracheostomy:
Outer cannula with cuffs
Inner cannula
Obturator (to blunt end)
Trach tie/ trach collar (oxygen

Tracheostomy Care:
Cleaning of the inner cannula is generally perform every 8 hours, &
changing the cannula (sterile procedure) every 24-48 hours (or per
facility policy).
Prior to cleansing the inner cannula, hyperinflate hyperoxygenate
the patient, & suction the airway to remove secretions.
The area around the trach stoma should be intact/pink, free of
irritation, swelling, & purulent drainage.
Always assess the integrity of the new trach tube obturator to be
inserted by inflating the cuff to check for leak.
Prior to changing the tube, hyperoxygenate the patient &
hyperextend the neck.
The cuff on an artificial airway creates a seal between the wall of
the trachea & the outside of the tube, allowing positive pressure

ventilation & preventing aspiration of foreign material into the airway

& lungs.

Complications of overinflation of excess pressure on

tracheal wall
Tracheitis
Bleeding
Tracheal erosion/necrosis
Tracheomalacia
Tracheal stenosis
Tracheoesophageal fistula

Tracheostomy Care Equipment:

Hydrogen peroxide
Sterile saline
Sterile gloves
Disposable tracheostomy kit
Clean scissors (if ties must be replced

Tracheostomy Care Kit:

Sterile gloves
Gauze sponges
Drain sponge
Cotton swabs
Pipe cleaners
Forceps
Trach tie
Brush
3 containers
Sterile sodium
chloride & hydrogenperoxide

Tracheostomy Care Procedure:

Wash hands
Explain procedure
Place patient in high fowlers position.
Open sterile pack.
Loosen caps on peroxide & saline bottles.
Remove & discard neck dressing with clean gloves.
Open/don sterile gloves.
Set up sterile field & separate sterile basins.

Check labels/dates on bottles- if previously used, lip the bottles.

Place sterile drape over patient.
Using non-dominant hand (now the clean hand), pour solutions
into basins (1 NACL & 1 H2O2/NACL mix).
:
Remove the inner cannula using clean hand & drop in the
NaCl/peroxide mix).
Dip sterile applicators & gauze in NaCl/peroxide mix, & clean around
trach site.
Next, rinse trach site using sterile applicators & gauze
Pick up inner cannula with clean hand on cleanend & scrub
interior & exterior with brush.
Rinse inner cannula in NaCl.
Dry inner cannula with pipe cleaner, leaving small amount of saline
on cannula to decrease friction for reinsertion.
Reinsert cannula with clean hand/lock into place.
Apply a sterile drain sponge to trach site with forcep or sterile hand
Thread clean ties through flange holes & tie securely/Tracheostomy
Care.
Documentation
Condition of tracheal site
Size/type of trach
Patient tolerance- be specific (vital signs, O2 saturation, etc.)
Color, volume, consistency of sputum
Improvement in breath sound

Tracheostomy Care
Checklist
Procedure
1. Gather Supplies: Tracheostomy care kit, clean gloves, normal
saline, and hydrogen peroxide.
2. *Wash hands and explain procedure to client.
3. Apply clean gloves and remove oxygen tracheostomy mask and
place on clients chest while performing care.
4. Remove old tracheostomy dressing and dispose of in the gloves.
5. Loosen lid on peroxide and saline and open tracheostomy kit.
Don sterile gloves in kit. Prepare kit first removing sterile pad and
placing it next to kit as a sterile field.
6. Once you have your sterile field ready remove q-tips, brush and
sterile gauzes from kit and place on the sterile field.
7. Contaminating your nondominant hand pour peroxide into the
large compartment of the kit and saline into the medium
compartment of the kit.
8. *Using sterile hand moisten one q-tip and gauze with peroxide
and one with saline and place in smallest compartment of the
tracheostomy kit.
9. Once kit is prepared remove inner cannula by turning
counterclockwise with your clean hand and place in the hydrogen
peroxide.
10. From your sterile field pick up brush with sterile hand and
pass it to your clean hand at the handle.
11. *Remove inner cannula from peroxide with your sterile hand
and use the sterile brush to cleanse inside of the tube.
12. Once inner cannula cleansed with peroxide rinse in the saline
and then while still in sterile hand place into the outer
tracheostomy tube in client. Using clean hand lock tube by turning
clockwise until the two blue dots align.

Performed
Yes

No

13. Use hydrogen peroxide soaked q-tip and gauze pad to cleanse
under and on top of face plate. Use saline soaked q-tip and gauze
pad to rinse peroxide from same areas. Replace new tracheostomy
dressing. Remove sterile gloves and apply clean gloves.
14. Replace oxygen mask and dispose of soiled supplies.
15. Document procedure.