providing tracheotomy care

1.	Goal: The patient will exhibit a tracheostomy tube and site free from drainage, secretions, and skin irritation or breakdown. Identify the patient.
2.	Determine the need for tracheostomy care. Assess patient’s pain and administer pain medication, if indicated.
3.	Explain what you are going to do and the reason to the patient, even if the patient does not appear to be alert. Reassure patient you will interrupt procedure if he or she indicates respiratory difficulty.
4.	Perform hand hygiene.
5.	Adjust bed to comfortable working position. Lower side rail closer to you. If patient is conscious, place him or her in a semi-Fowler’s position. If patient is unconscious, place him or her in the lateral position, facing you. Move the bed table close to your work area and raise to waist height. Place a trash receptacle within easy reach of work area.
6.	Put on face shield or goggles and mask. Suction tracheostomy if necessary. If tracheostomy has just been suctioned, remove soiled site dressing and discard prior to removal of gloves used to perform suctioning.
7.	Cleaning the Tracheostomy (nondisposable inner cannula)
8.	Prepare supplies:
9.	Open tracheostomy care kit and separate basins, touching only the edges. If kit is not available, open three sterile basins.
10.	Fill one basin 0.5″ deep with hydrogen peroxide or ½ hydrogen peroxide and ½ saline, based on facility policy.
11.	Fill other two basins 0.5″ deep with saline.
12.	Open sterile brush or pipe cleaners if they are not already available in a cleaning kit. Open additional sterile gauze pad.
13.	Put on disposable gloves.
14.	Remove the oxygen source if one is present. If not already removed, remove site dressing and dispose of in the trash. Stabilize the outer cannula and faceplate of the tracheostomy with one hand. Rotate the lock on the inner cannula in a counterclockwise motion with your other hand to release it.
15.	Continue to hold the faceplate. Gently remove the inner cannula and carefully drop it in the basin with hydrogen peroxide. Replace the oxygen source over the outer cannula. Remove gloves and discard.
16.	Clean the inner cannula as follows:
17.	Put on sterile gloves.
18.	Remove inner cannula from soaking solution. Moisten brush or pipe cleaners in saline and insert into tube, using back-and-forth motion.
19.	Agitate cannula in saline solution. Remove and tap against inner surface of basin.
20.	Place on sterile gauze pad.
21.	Suction outer cannula using sterile technique if necessary.
22.	Stabilize the outer cannula and faceplate with one hand.
23.	Applying Clean Dressing and Ties/Tape
24.	Remove oxygen source. Dip cotton-tipped applicator or gauze sponge in second basin with sterile saline and clean stoma under faceplate. Use each applicator or sponge only once, moving from stoma site outward.
25.	Pat skin gently with dry 4″ × 4″ gauze sponge.
26.	Slide commercially prepared tracheostomy dressing or prefolded non-cotton-filled 4″ × 4″ dressing under faceplate.
27.	Change the tracheostomy tape:
28.	Leave soiled tape in place until new one is applied.
29.	Cut piece of tape the length of twice the neck circumference plus 4″. Trim ends of tape on the diagonal.
30.	Insert one end of tape through faceplate opening alongside old tape. Pull through until both ends are even length.
31.	Slide both ends of the tape 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. You should be able to fit one finger between the neck and the ties. Check to make sure that the patient can flex neck comfortably.
32.	Carefully remove old tape. Reapply oxygen source if necessary.
33.	Remove face shield or mask and goggles. Remove gloves and discard. Perform hand hygiene. Reassess patient’s respiratory status, including respiratory rate, effort, oxygen saturation, and lung sounds.