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TRACHEOSTOMY

CARE

By:
Jessica G. Hufana
Melissa O. Vergara

A TRACHEOSTOMY is an opening in the anterior wall of the trachea inferior to the


cricoid cartilage. Made surgically or percutaneously, it provides tracheal access for
airway management via a temporary or permanent tracheostomy tube. A tracheostomy
can be used to bypass an acute or chronic upper airway obstruction, allow removal of
tracheobronchial secretions, and prevent aspiration of oral or gastric secretions in
unresponsive patients. For patients with chronic respiratory failure, it may be performed
to replace an endotracheal (ET) tube and facilitate long-term mechanical ventilation.
After the hole is made, a plastic tube is placed in the hole to keep it open. A ribbon is tied
around the neck to keep the tube in place. The surgery is done in the hospital. Do not do
strenuous activity or hard exercise for 6 weeks after surgery. After your surgery you may
not be able to speak. Ask your doctor for a referral to a speech therapist to help you
learn to talk with your tracheostomy. Once the hole in the neck is not sore from the
surgery, clean the hole with Q-tips or a cotton ball at least once a day to prevent
infection. The bandage (gauze dressing) between the tube and neck helps catch mucus.
It also keeps the tube from rubbing on the neck. Change the bandage when it is dirty, at
least once a day. Change the ribbons (trach ties) that keep the tube in place if they get
dirty. Make sure you hold the tube in place when you change the ribbon. Be sure you can
fit 2 fingers under the ribbon to make sure it is not too tight.
Providing Tracheostomy Care
Your nurse or your physician will teach you the proper way to care for your tracheostomy
tube before you go home. Routine tracheostomy care should be done at least once a day
after you are discharged from the hospital.
1. Gather the following supplies:
o sterile gloves (two pairs)
o clean gloves
o A cleaning kit ,basin or supplies
o Sterile suction catheter kit
o Hydrogen peroxide

o Commercially prepared sterile tracheostomy dressing or sterile 4 x 4 gauze


dressing
o Sterile Normal Saline
o Clean cotton-tipped swabs
o Clean pipe cleaners or small brush
o Clean washcloth
o Clean towel
o cotton twill ties
o Clean scissors
2. Perform Hand hygiene. Wash your hands thoroughly with soap and water and
provide client privacy.
3. Assist the client to a semi-Fowler's position to promote lung expansion
4. Open the tracheostomy kit or sterile basins. Pour hydrogen peroxide and sterile
normal saline into separate containers. Open the other sterile supplies as needed,
including sterile applicators, suction kit and tracheostomy dressing.
5. Suction the tracheostomy tube. Put a pair of sterile gloves. Suction the full length
of the tracheostomy tube to remove secretion and ensure a patient airway. Rinse
the suction catheter and wrap the catheter around your hand, and peel the glove
off so that it turns inside out over the catheter. Unlock the inner cannula and
remove it by gently pulling it out toward you in line with its curvature. Place the
inner cannula in the normal saline solution. Remove the soiled tracheostomy
dressing in your gloved hand and discard it.
6. Clean the inner cannula. Remove the inner cannula from the soaking solution.
Clean the lumen and entire cannula thoroughly using the brush or pipe cleaners
moistened with sterile normal saline. Rinse the inner cannula thoroughly in the
sterile normal saline. Use a pipe cleaner folder in half to dry the inside of the
cannula ,do not dry the outside. Rationale: This removes excess liquid from the
cannula and prevents possible aspiration by the client.
7. Replace the inner cannula, securing it in place. Insert the inner cannula by
grasping the outer flange and inserting the cannula in the direction of its
curvature. Lock the cannula in place by turning the lock into position to secure the
flange of the inner cannula to the outer cannula.
8. Clean the incision site and tube flange. Using sterile applicators or gauze dressings
moistened with normal saline, clean the incision site. Use each applicator once
then discard. Hydrogen peroxide may be used to remove crusty secretions usually
mixed with sterile normal saline, use separate sterile container if necessary.

Rationale: Hydrogen peroxide can be irritating to the skin and inhibit healing if not
thoroughly removed.
9. Apply a sterile dressing. Use a commercially prepared tracheostomy dressing of
non-raveling material, or open and refold a 4x4 gauze dressing into a V shape.
Place the dressing under the flange of the tracheostomy tube. While applying the
dressing, ensure that the tracheostomy tube is securely supported. Rationale:
Avoid using cotton tint gauze fiber because it can be aspirated by the patient
potentially creating a tracheal abscess

10.

Change the tracheostomy ties.

Two-strip method
Cut two unequal strips of twill tape, one approximately 10 inches and the other one is
20 inches long. Cut 0.5 inch lengthwise slit approximately 1 inch from one end of each
strip. Fold the end of the tape and cut a slit in the middle of the tape from its folded
edge. Leaving the old ties in place, thread the slit end of one clean strip of tape
through the eye of the tracheostomy flange from the bottom side, then thread the
long end of the tape through the slit, pulling it tight until it is securely fastened to the
flange. Rationale: Leaving the old ties in place while securing the clean ties prevents
inadvertent dislodging of the tracheostomy tube. Avoid the use of knots which can
come untied or cause pressure and irritation.

Holding the trach tube in place, lace the tie through one hole of the neckplate, around
the back of the neck, through the other hole of neckplate, and again around the back of
the neck. Pull the tie snugly and tie it there should be enough space for no more than
two fingers between the tie and the neck. Ask the client to flex his/her neck. Rationale:
Flexing the neck increases its circumference the way coughing does. Once the clean ties
are secures, remove the soiled ties and discard.
One-strip Method
Cut a length of twill tape 2.5 times the length needed to go around the clients neck from
one tube flange to the other. Thread one end of the tape into the slot on one side of the
flange. Bring both ends of the tape together, and take them around the clients neck,
keeping them flat and untwisted. Thread the end of the tape next to the clients neck
through the slot from the back to front. Have the client flex his/her neck. Tie the loose
end with a square knot at the side of the clients neck allowing for slack by placing two
fingers under the ties, as with the two-strip method. Cut off long ends.
11.
Tape and pad the tie knot. Place a folded 4x4 gauze square under the tie
knot, and apply tape over the knot. Rationale: This reduces skin irritation from the
knot and prevents confusing the knot with the clients gown ties.
12.
Check the tightness of the ties. Frequently check the tightness of the
tracheostomy ties and the position of the tracheostomy tube. Rationale: Swelling
of the neck may cause the ties to be too tight, interfering with cough and
circulation. Ties can loosen or restless clients allowing the tracheostomy tube to
extrude from the stoma.
AFTER THE PROCEDURE
Assess breathing and tolerance of the procedure. Dispose of supplies and used solutions.
Wash hands. Chart the procedure and any observations made during the procedure such
as amount, color, and consistency of sputum and appearance of the incision.

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