Tracheostomy Care and Suctioning Procedure Notes
Introduction
The video demonstrates tracheostomy care, specifically focusing on trach care and suctioning.
Initial preparation and steps outlined before direct patient interaction are essential for safety and effectiveness.
Initial Steps and Preparation
The speaker starts with preparations including assessment, verification, and checking orders.
Supplies are organized for effective access during the procedure.
Set-Up
The speaker emphasizes the need for a better ergonomic setup in practice, although a less optimal arrangement is used in this demonstration to provide a better view.
Initial setup also involves possible hyperoxygenation for the patient, typically following institutional policy (usually 1-2 minutes).
Hand Hygiene and Gloves
Importance of hand hygiene is emphasized before touching the patient or supplies.
Clean gloves are donned before the removal of external dressing (an external split sponge dressing).
Detailed Procedure
Stomal Assessment
Gently remove the external dressing from around the stomal site.
Document observations of skin condition:
Drainage amount and color
Presence of odor
Skin integrity assessment (look for redness and signs of maceration given the moist environment of the area).
Following assessment, the oxygen source is replaced if required.
Sterile Setup for Tracheostomy Care
Transition into sterile procedure:
Remove gloves, perform hand hygiene, then put on sterile gloves.
Overview of tracheostomy kit:
Typically contains sterile saline, a sterile scrub brush, gauze, cotton-tipped applicators, trach ties, and pipe cleaners.
Sterile Items Handling
Carefully open and arrange items on a sterile drape:
Gloves and the cleaning brush can be placed for easy access.
Tracheostomy Cannula Care
Removal of Inner Cannula
A distinction between dominant (sterile) and non-dominant (clean) hands is made:
Non-dominant hand handles the inner cannula's outer portion.
Remove inner cannula by twisting and unsticking it gently.
Drop the removed cannula into sterile saline for soaking.
Cleaning of Inner Cannula
Retrieve the sterile brush with the sterile hand:
Brush the inside of the inner cannula carefully to clean it thoroughly.
Rinse if necessary (previously advised rinsing may not be as critical with saline cleaning).
Dry the inner cannula with pipe cleaners:
Emphasis on thorough drying to prevent moisture retention.
Replacing Inner Cannula
Reinsertion requires maneuvering into place while ensuring it locks securely.
Post-insertion, oxygen is restored to the patient.
External Site Cleaning
Assessment and Cleaning Technique
Transition to cleaning the stomal site:
Dropping to the moist 4x4 gauze for cleaning primarily involves wetting and using circular motions away from the airway.
Use cotton-tipped applicators for precision cleaning around the stoma, ensuring the inner to outer moving technique to avoid pushing debris inward.
Securing New Split Sponge
The split sponge is placed correctly around the tracheostomy without causing blockages or debris entry.
Changing Trach Ties
Removal and Replacement Protocol
Emphasis on teamwork (preferably having a second person), to prevent dislodging during tie changes.
New ties are threaded and secured while existing ties remain until the new setup is complete.
Detailed steps for knotting and securing ties are provided (enough slack for comfort while avoiding abrasion against skin).
Conclusion and Documentation
Final adjustments are made for the patient’s comfort, including returning the oxygen supply and ensuring stable positioning.
A reminder that the trach size information is critical for maintenance but also confirming all procedures are documented accurately is highlighted.
Verification of oxygen supply and patient condition before completion of the care.
Summary of Important Points
Importance of hand hygiene and sterile technique.
Consistent monitoring of patient response throughout care.
Accurate documentation post-care for ongoing management and assessment.