Tracheostomy Care

General Tracheostomy Information

Insertion
Types of Tubes
 


  1. 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?
  2. Gather Equipment
  3. Tracheostomy Care kit

    Tracheostomy Care Kit

    Suction Kit Suction Kit
    Inner Cannula Sterile disposable inner cannula
    Trach Ties 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

     

  4. Insert Oral Airway

     

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

     

  5. Administer oxygen via resuscitation bag before and after suctioning 
    Resuscitation Bag For tracheostomy ventilation, remove the mask and attach directly to the trach.
    Ventilating Trach Manually give breaths to preoxygenate the patient prior to tracheostomy suctioning.
    Ventilating Tracheostomy  
  6. Do nasopharyngeal suctioning 
     
  7. Do oral suctioning 
     
  8. Deflate the cuff (must do after oral and nasopharyngeal suctioning 
  9. Suction the tracheostomy

    Review use of inline suction catheter

    Small video: Mac (Quicktime format) and PC format

     

  10. Remove the inner cannula 
    Inner cannula - twist This type of inner cannula twists to unlock or lock into place
    Inner Cannula - clips This inner cannula has clips on each side that hold it in place
    Removing trach cannula 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.
  11. Insert new or cleaned inner cannula maintaining sterility of cannula 
     
  12. Clean around the stoma and trach tube flange using H2O2 and normal saline

    Small video: Mac (Quicktime format) and PC format

  13. Replace dressing; do not slide over the skin 
     
  14. Reinflate the cuff 
     
  15. 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.

  16. Assess patient response 
     
  17. 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

American Head and Neck Society 
http://www.headandneckcancer.org/patienteducation/docs/tracheostomy.php

Dale 240 Blue Tracheostomy Tube Holder 
http://www.dalemed.com/prod/tracheostomytube.html

ICU - USA Tracheostomy 
http://www.icu-usa.com/tour/procedures/trach.htm