Tracheostomy Care

1. Tracheostomy Care

2. Tracheostomy Care • Procedure • Always Use Standard Precautions • Always Suction the tracheostomy prior to removing the old dressings • remove and clean inner cannula • Use a sterile solution of hydrogen peroxide and normal saline to clean inner canula

3. Tracheostomy Care • Suction patients following MD orders. • Choose a suction catheter number that is twice the size as the trach tube • Suction the patient the appear to become restless, struggling for breath or producing copious amounts of phlegm and follow MD order • Always oxygenate or inform patient to take a deep breath prior to the start of suctioning

4. Tracheostomy Care • Listen to lung sounds at the start and end of the procedure • Never suction for longer than 10 seconds (take deep breath) • Stop if you see bleeding or the patient struggling for air.

5. Suctioning of the tracheostomy • Refer to the Kardex for the orders for the patient • Identify self, explain procedure and check patient identifiers • Explain procedure to patient- place in Semi-Fowlers position • Assess patients understanding and provide patient with communication system

6. Suctioning • Auscultate lungs • Check O2 Saturation level • Apply drape under patient • Hook suction catheter to suction machine • Turn on suction machine to 120 mm/hg • Pour solutions hydrogen peroxide/ Normal saline • May use one or two handed sterile gloving • If one handed keep dominant hand sterile

7. Suctioning and Cleaning • Unlock and place the inner cannula in the hydrogen peroxide • Aspirate through the suction catheter normal saline solution “priming the line” • Ask patient to take several deep breaths or remove patient’s O2 prior to suctioning and replace immediately after

8. Suctioning and Cleaning • Remove thumb from suction control and insert the cannula 5-6 inches or until resistance is met • Apply intermittent/continuous suctioning for maximum of 10 seconds in a clockwise motion • Allow patient to rest in between suction passes and oxygenate if ordered • Cleanse catheter in-between suction passes with normal saline • When completed turn off machine and remove suction catheter

9. Cleaning • Apply second set of sterile gloves if needed or use hand that sterility was maintained • Use pipe cleaners and brush to cleanse the inner cannula • Place inner cannula in normal saline once inspection is complete • Remove excess liquid and replace inner cannula and lock in place

10. Cleaning • Cleanse site on the outside of the tracheostomy site • Use dressings that are free from lint • Place dry sterile dressing around tracheostomy face plate site (T-dressing) • If ties need to be changed attach new ties first than remove old ones • Ascultate lung sounds and check O2 sat • Document patient’s tolerance • Wash hands and remove and dispose of used equipment