CH III: tracheostomy care

1. changing a tracheostomy inner tube

2. cleaning tracheostomy site

3. changing around the site

Tracheostomy care includes actions such as:

1. maintain airway patency

2. prevent infection at tracheostomy site

3. facilitate healing

4. promote comfort

5. assess condition of ostomy

Goals/purposes of tracheostomy care include:

STANDARD TRACHEOSTOMY TUBE

what type of tracheostomy tube?

SINGLE LUMEN TRACHEOSTOMY TUBE

what type of tracheostomy tube?

DOUBLE LUMEN TRACHEOSTOMY TUBE

what type of tracheostomy tube?

CUFFED TRACHEOSTOMY TUBE

what type of tracheostomy tube?

UNCUFFED TRACHEOSTOMY TUBE

what type of tracheostomy tube?

FENESTRATED TUBES

what type of tracheostomy tube?

1. STANDARD TRACHEOSTOMY TUBE [TT]

2. SINGLE LUMEN TT

3. DOUBLE LUMEN TT

4. CUFFED TT

5. UNCUFFED TT

6. FENESTRATED TT

types of tracheostomy tubes include:

1. Small bowls/gallipots — 2 pcs

2. Sterile towel

3. Sterile nylon/tube brush

4. Sterile gauzes

5. Sterile gloves — 1 pair

6. Tracheostomy tie tapes

in prepping equipment, tracheostomy care kit must contain:

1. Normal saline

2. Waterproof pad

3. Sterile gloves — 1 pair

4. Face mask/eye shield

in prepping equipment, clean tray must contain:

1. Small bowls/gallipots — 2 pcs

2. Sterile towel

3. Sterile nylon/tube brush

4. Sterile gauzes

5. Sterile gloves — 1 pair

6. Tracheostomy tie tapes

7. Normal saline

8. Waterproof pad

9. Face mask/eye shield

all equipments for tracheostomy tube care include:

assessing condition of stoma

1st procedure of tracheostomy care includes:

1. redness

2. swelling

3. character of secretions

4. (+) purulence/bleeding

Assess condition of stoma for what?

Examine neck around the ostomy site

2nd procedure of tracheostomy care includes:

subcutaneous emphysema evidenced by crepitus

Examine neck around ostomy site for what finding?

Explain procedure to the patient

3rd procedure of tracheostomy care includes:

Assist patient to Fowler’s position

4th procedure of tracheostomy care includes:

Place waterproof pad on chest

5th procedure of tracheostomy care includes:

Wash hands thoroughly

6th procedure of tracheostomy care includes:

Assemble all equipments

7th procedure of tracheostomy care includes:

Open the sterile tracheostomy kit

8th procedure of tracheostomy care includes:

Pour sterile normal saline in small bowls

9th procedure of tracheostomy care includes:

Open other sterile supplies as needed including:

1. sterile applicators,

2. suction kit, and

3. tracheostomy care kit

10th procedure of tracheostomy care includes:

Put on face mask and eye shield.

11th procedure of tracheostomy care includes:

Do sterile gloves

12th procedure of tracheostomy care includes:

Place sterile towel on patient’s chest

13th procedure of tracheostomy care includes:

Unlock the inner cannula and remove it by gently pulling it out towards you in the line with its curvature via counterclockwise rotation

14th procedure of tracheostomy care includes:

Place the inner cannula in the bowl with normal saline

15th procedure of tracheostomy care includes:

Remove the soiled tracheostomy dressing

16th procedure of tracheostomy care includes:

Discard the dressing and gloves

17th procedure of tracheostomy care includes:

Clean the flange of the tube using sterile applicators or gauze moistened with normal saline [use each applicator once only]

18th procedure of tracheostomy care includes:

Clean the stoma tube with the gauze

19th procedure of tracheostomy care includes:

Thoroughly rinse the cleaned area using gauze squares moistened with sterile normal saline

20th procedure of tracheostomy care includes:

Dry the stoma tube with dry sterile gauze

21st procedure of tracheostomy care includes:

Apply thin layer of antibiotic ointment to the stoma with a cotton swab if applicable

22nd procedure of tracheostomy care includes:

Remove the inner cannula from the soaking solution

1st procedure in cleaning inner cannula includes:

Clean the lumen and entire cannula thoroughly using the brush

2nd procedure in cleaning inner cannula includes:

Rinse the cleaned cannula by rinsing it with sterile normal saline.

3rd procedure in cleaning inner cannula includes:

Replace the inner cannula and secure it in place

4th procedure in cleaning inner cannula includes:

Insert the inner cannula by grasping the outer

5th procedure in cleaning inner cannula includes:

Lock the cannula in place by turning the lock into position

6th procedure in cleaning inner cannula includes:

Apply sterile dressing

7th procedure in cleaning inner cannula includes:

Open and refold a gauze dressing into a ‘V’ shape

8th procedure in cleaning inner cannula includes:

Place V-shaped gauze dressing under the flange on the tracheostomy tube

9th procedure in cleaning inner cannula includes:

Ensure that the tracheostomy tube is securely supported while applying dressing

10th procedure in cleaning inner cannula includes:

Leave the soiled tape in place until the new one is applied

1st procedure in changing tracheostomy ties includes:

Grasp slit end of clean tape and pull it through opening on one side of the tracheostomy tube

2nd procedure in changing tracheostomy ties includes:

Pull the other end of the tape securely through the slit end of the tracheostomy tube on the other side

3rd procedure in changing tracheostomy ties includes:

Tie the tapes at the side to side of the neck.

4th procedure in changing tracheostomy ties includes:

EURT

Leaving tape in place ensures that tube will not be expelled if patient coughs or moves. True or false?

1. Tracheostomy care carried out

2. Dressing change

3. Observations

Document all relevant information in the chart such as:

1. every 8 hours

2. whenever dressing is soiled.

Tracheostomy dressing should be done in 2 situations, which are:

replaced with new one

If disposable inner cannula is present, then the cannula that is inside is?

1. neck plate

2. tracheostomy site

If only single lumen is present, clean:

before [and after] performing tracheostomy care

When in tracheostomy care do we emphasize the importance of handwashing?

infection

Assess tracheostomy stoma for symptoms of what abnormal finding?