Performing Tracheostomy Care Using Modified Sterile Technique

Performing Tracheostomy Care Using Modified Sterile Technique

Equipment
■ Tracheostomy suction equipment.
■ Tracheostomy care kit or the following sterile supplies:
■ Several cotton-tipped applicators, 2 basins, a brush, sterile 4 in. x 4 in. gauze pads, sterile precut tracheostomy dressing.
■ 2 pairs of procedure gloves.
■ Disposable inner cannula that is the same size as the tracheostomy, if available.
■ Normal saline solution or tap water if agency policy allows.
■ Roll of twill tape or hook-and-loop fastener (Velcro) tracheostomy holder.
■ Bandage scissors.
■ Towel or linen-saver pad.
■ Overbed table.
■ Face shield.
■ Protective gown.
■ Mild soap and 2 clean washcloths.
■ For reusable inner cannula only: hydrogen peroxide.

Assessment
■ Assess respiratory status (i.e., rate, depth, and rhythm; breath sounds; color; and pulse oximetry results).
■ Assess the tracheostomy site for drainage, redness, or swelling.
■ Be Safe! Determine when the patient last ate. Schedule this procedure at least 3 hours after a meal to decrease risk of aspiration.

Post-Procedure Reassessment
■ Assess the area around the stoma site for skin breakdown.
■ Evaluate the patient’s tolerance of the procedure and any signs of respiratory distress.

Key Points
■ Position the patient in semi-Fowler’s position.
■ Don gown, eye protection, and gloves.
■ Suction the tracheostomy.
■ Remove soiled dressing; remove gloves; wash hands.
■ Set up the sterile field and prepare equipment, keeping supplies sterile.
■ Don clean procedure gloves.
■ Remove the oxygen source if the patient is receiving oxygen, offer oxygen blow-by, and attach to the outer cannula. If that is not possible, clean and return the inner cannula before proceeding.
■ Remove the inner cannula with your nondominant hand. If the cannula is disposable, discard it; if the cannula is reusable, clean it.
■ Clean the stoma under the faceplate with the cotton-tipped applicators saturated with normal saline solution or tap water.
■ Clean the top surface of the faceplate and the skin around it with the saline or water-soaked gauze pads, or with a washcloth and tap water. Dry the skin with dry sterile gauze.
■ Be Safe! With the help of an assistant, remove soiled tracheostomy ties/stabilizer. If you must change ties without help, always place the new tape before cutting the soiled tape or holder.
■ Ask the patient to flex his neck, and with an assistant stabilizing the tracheostomy tube, apply new tracheostomy ties.
■ Insert a precut, sterile tracheostomy dressing under the faceplate and new ties.
■ Be Safe! Use only sterile, precut dressing. Or open and refold a 4 in. x 4 in. gauze pad into a V shape. Do not cut 4 in. 4 in. gauze, and do not use cotton-filled gauze squares.

Documentation
■ Document date and time of the tracheostomy care.
■ Note:
■ Color, amount, consistency, and odor of secretions.
■ Condition of the stoma and skin around the stoma site (presence of drainage, redness, or swelling).
■ Record:
■ Respiratory status, including rate, depth, and pattern.
■ Skin color.
■ Breath sounds.
■ Note the patient’s tolerance of the procedure.
■ Document any interventions that were needed.

Disposable tracheostomy equipment

An unfolded and refolded gauze dressing