Tracheostomy Care

General Tracheostomy Information

Assess Patient and Check Orders
- Assess the need for suctioning
- Assess the need for tracheostomy care
- What trach care is ordered? What to use? How often? Can you change the ties?
Gather Equipment

	Tracheostomy Care Kit
	Suction Kit
	Sterile disposable inner cannula
	Tracheostomy ties and dressing as needed
Sterile normal saline, Hydrogen Peroxide, resuscitation bag, 10 ml syringe, and other supplies as needed
You can get additional information on tracheostomy care and supplies - See web sites below

Insert Oral Airway

Remember that you need to invert the airway until you get past the tongue and then flip it over.
Administer oxygen via resuscitation bag before and after suctioning
For tracheostomy ventilation, remove the mask and attach directly to the trach.
Manually give breaths to preoxygenate the patient prior to tracheostomy suctioning.
Do nasopharyngeal suctioning
Do oral suctioning
Deflate the cuff (must do after oral and nasopharyngeal suctioning
Suction the tracheostomy
Review use of inline suction catheter

Small video: Mac (Quicktime format) and PC format

Remove the inner cannula

	This type of inner cannula twists to unlock or lock into place
	This inner cannula has clips on each side that hold it in place
	This cannula has an end with a tab similar to the ring on pop cans. You need to stabilize the trach while removing or inserting inner cannulas.

Insert new or cleaned inner cannula maintaining sterility of cannula
Clean around the stoma and trach tube flange using H₂O₂ and normal saline
Small video: Mac (Quicktime format) and PC format
Replace dressing; do not slide over the skin
Reinflate the cuff
Change trach ties with help

For new tracheostomies, the physician orders when the ties can be changed in order to prevent accidental removal of the trach.

Never change ties alone with a new trach.
Assess patient response
Clean up and replace equipment

Additional Resources:

Here is a very good source of information as well as an interesting situation, a child with a tracheostomy.
http://www.tracheostomy.com/index.html

Nursing Updates

	Remember that you need to invert the airway until you get past the tongue and then flip it over.

	For tracheostomy ventilation, remove the mask and attach directly to the trach.
	Manually give breaths to preoxygenate the patient prior to tracheostomy suctioning.