TH

HNN329 - Tracheostomy Dressing

The procedure requires two people for safety and efficiency.

Initial Setup

  • Assess the current dressing to determine if it needs changing (appearance: goopy).

  • Ensure the patient's comfort by repositioning and removing oxygen if tolerated.

  • Adjust the gown to access the tracheostomy easily.

  • Sit up the patient for comfort and support, head tilt back to see the trache more easy

  • Use a Bluie (absorbent pad) to catch any drips during the process.

  • Call assistance to help with the procedure.

  • Prepare sterile gloves for both caregivers.

  • Pre-cleaning: Wipe down the sterile field and allow it to dry.

Materials Needed

  • Dressing pack set up the sterile field for the

  • Special tracheostomy gauze (preferred over regular gauze to avoid contamination).

  • Disposable bin bag

  • 0.9% sodium chloride for cleaning the site (less irritating than alcohol).

  • Additional spare gauze for drying or stabilizing if needed.

  • Clean gloves and sterile gloves

Performing the Dressing Change

  • Open dressing pack by adding cleaning solution for use and prepare gauze

  • Reusing Ties: Assess the cleanliness of tracheostomy ties before reusing; replace if excessively soiled.

  • Use clean gloves to remove the old dressing and ties.

  • Assistants' Role: Hold the tracheostomy tube securely during dressing change to maintain airway patency.

    • Don’t put too much pressure on the tracheostomy site while cleaning to avoid discomfort or damage to the surrounding tissue.

    • Monitor patient status, including respiratory rate and comfort level, during the process.

    • Could do vital sign the procedure to assess any changes in the patient's condition and ensure they are stable throughout and after the cleaning process.

  • Undo ties while the tube is held secure.

  • Option to leave ties on for a quick change or remove entirely for washing.

  • Dispose of the old dressing using appropriate infection control measures.

  • Perform hand hygiene before putting on sterile gloves.

  • Ensure the gauze used to clean and dress is adequately drained to avoid liquid entering the wound by making sure the dressing aren’t too wet.

  • Clean and dirty hand with one swipe and avoid relapse, can ask the holder to switch hand to allow better cleaning

  • Pat with clean gauze for dry clean

Applying New Dressing

  • Apply the new dressing by folding sides down smoothly to prevent pressure injuries.

  • Reapply ties: ensure proper technique with a loop system.

    • 1/3 and make a loop then insert

    • Pull the tail through the loop

    • Put the long side to the other side (make sure not to move patient head too much)

    • Do the same for both sides

    • Tie a knot while asking the helper to put 1 finger in for it not too tight

  • Ensure ties are both secure (not too tight) and correctly positioned around the patient's neck.

  • Monitor the patient's comfort while tying to avoid discomfort.

  • Confirm that the dressing is smooth and secured properly.

  • Return the patient to a comfortable position.

  • Dispose of waste responsibly and clean up the area.

Indications

1. Indications for Changing a Tracheostomy Dressing

Tracheostomy dressings are changed to maintain a clean and dry environment around the stoma, prevent infection, and ensure patient comfort. Indications for changing the dressing include:

  • Visible soiling or saturation with secretions, blood, or exudate.

  • Routine care as part of scheduled hygiene (usually once per shift or every 8-12 hours, depending on facility policy).

  • Signs of infection (e.g., redness, swelling, foul odor, or increased drainage around the stoma).

  • Skin breakdown or irritation noted under or around the dressing.

  • Dislodgement or improper placement of the dressing.

  • Increased patient discomfort or reports of itching/burning at the site.

2. Risks Associated with Tracheostomy Dressing Changes

Changing a tracheostomy dressing is a delicate procedure and can be associated with several risks, especially in vulnerable or unstable patients. These include:

  • Accidental decannulation (removal or displacement of the tracheostomy tube).

  • Infection if aseptic technique is not followed.

  • Skin breakdown or pressure injuries from repeated taping or dressing materials.

  • Bleeding from fragile skin or stoma irritation.

  • Respiratory distress during the procedure, especially if suctioning is required.

  • Aspiration of secretions during the dressing change.

  • Anxiety or discomfort for the patient, potentially leading to agitation and increased respiratory effort.

3. Role of the RN in Managing These Risks

Registered Nurses (RNs) play a critical role in mitigating the risks associated with tracheostomy dressing changes through:

  • Assessment:

    • Monitoring the stoma and surrounding skin for signs of infection or breakdown.

    • Evaluating respiratory status before, during, and after the procedure.

  • Preparation:

    • Gathering all necessary sterile supplies before beginning.

    • Ensuring emergency equipment (e.g., spare trach tubes, suction, oxygen) is at the bedside.

  • Aseptic Technique:

    • Using sterile gloves and materials to prevent infection.

    • Maintaining a clean field throughout the procedure.

  • Patient Safety:

    • Stabilizing the tracheostomy tube during the dressing change.

    • Communicating with the patient to reduce anxiety and ensure cooperation.

  • Education:

    • Teaching patients and families about signs of infection or complications.

    • Providing instruction for dressing changes if care is being transitioned to home.

  • Documentation:

    • Recording the condition of the stoma, dressing, and patient’s response to the procedure.

    • Reporting any abnormalities to the healthcare team promptly.