Tracheostomy Care

1.  Observe for signs and symptoms that tracheostomy care is needed.
2.  Place patient in supine or semi-Fowler position and put towel across chest.
3.  Perform hand hygiene. Apply gloves and face shield.
4.  Suction tracheostomy. Remove and discard gloves and soiled tracheostomy dressing.
5.  While patient is replenishing oxygen stores, prepare equipment on bedside table.
6.  Open sterile tracheostomy kit. Pour normal saline on one opened gauze package; hydrogen peroxide on another. Leave third package dry. Pour normal saline on one opened cotton-tipped swab package; hydrogen peroxide on other. Do not recap bottles.
7.  Open sterile tracheostomy dressing package.
8.  Unwrap sterile basin and pour about 0.5 to 2 cm (1 to 2 in) hydrogen peroxide into it. Open small sterile brush package and place aseptically into sterile basin.
9.  Prepare length of twill tape 60 to 75 cm (24 to 30 in) long. Cut ends on diagonal.
10. Open package of tracheostomy tube holder according to manufacturer's directions (if used).
11. Apply gloves. Keep dominant hand sterile throughout procedure.
12. Remove oxygen source. Apply oxygen source loosely over tracheostomy, if needed.
13. Tracheostomy with inner cannula care
14. With nondominant hand, remove inner cannula and drop into hydrogen peroxide basin.
15. Place tracheostomy collar, T tube, or ventilator oxygen source over outer cannula.
16. Quickly use small brush to remove secretions inside and outside inner cannula. Then rinse inner cannula with normal saline, using nondominant hand to pour normal saline.
17. Replace inner cannula and lock in place. Reapply ventilator or oxygen sources.
18. Tracheostomy with disposable inner cannula care
19. Remove new cannula from manufacturer's packaging.
20. Withdraw inner cannula and replace with new cannula. Lock into position.
21. Dispose of contaminated cannula appropriately. Apply ventilator or oxygen sources.
22. With hydrogen peroxide–saturated cotton-tipped swabs and 4 x 4 inch gauze, clean outer cannula. Clean stoma under faceplate, circling out 5 to 10 cm (2 to 4 in).
23. With normal saline–saturated cotton-tipped swabs and 4 x 4 inch gauze, rinse tracheostomy tube and skin. With dry 4 x 4 inch gauze, lightly pat skin and outer cannula.
24. Secure tracheostomy.
Tracheostomy tie method
Have gloved assistant securely hold tracheostomy tube. Then cut old ties.
Insert one end of tie through faceplate eyelet; pull ends even. Slide ends of tie behind head and neck to other eyelet. Insert one tie through second eyelet; pull snugly. Tie ends in double square knot with space for one loose or two snug fingerwidths.
Insert fresh tracheostomy dressing under clean ties and faceplate.

Trach tube holder method
Hold tracheostomy tube securely by using an assistant or by leaving old tracheostomy tube holder in place until new device is secure.
Align strap under patient's neck. Position Velcro closures on either side of tube. Place ties under and through faceplate eyelets. Pull ends even and secure with Velcro closures. Allow space for only one loose or two snug fingerwidths under neck strap.
Position patient comfortably, and assess respiratory status. Replace oxygen sources.
Remove gloves and face shield, and discard appropriately. Recap bottles. Store reusable liquids and unused supplies appropriately. Perform hand hygiene.
Compare assessments before and after care. Assess comfort of new ties.