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.