Tracheostomy Care

General Tracheostomy Information

Insertion
Types of Tubes
	Adult Tracheostomy Home Care Shiley Tracheostomy Tubes at Mallinckrodt Company: Patient & Family Education http://edcenter.mallinckrodt.com/Courses/c23/AdultHCG.pdf

1. Assess Patient and Check Orders
   
   • Assess the need for suctioning
   • Assess the need for tracheostomy care
   • What trach care is ordered? What to use? How often? Can you change the ties?
   
   
2. Gather Equipment

   	Tracheostomy Care Kit
   	Suction Kit
   	Sterile disposable inner cannula
   	Tracheostomy ties and dressing as needed
   Sterile normal saline, Hydrogen Peroxide, resuscitation bag, 10 ml syringe, and other supplies as needed
   You can get additional information on tracheostomy care and supplies at: http://edcenter.mallinckrodt.com/Courses/c23/AdultHCG.pdf

   
   

3. Insert Oral Airway

   	Remember that you need to invert the airway until you get past the tongue and then flip it over.

   
   
   

4. Administer oxygen via resuscitation bag before and after suctioning
   

   	For tracheostomy ventilation, remove the mask and attach directly to the trach.
   	Manually give breaths to preoxygenate the patient prior to tracheostomy suctioning.

   
   
5. Do nasopharyngeal suctioning
   
   
6. Do oral suctioning
   
   
7. Deflate the cuff (must do after oral and nasopharyngeal suctioning
   
   
8. Suction the tracheostomy

   
   Review use of inline suction catheter

   Small video: Mac (Quicktime format) and PC format

   
   

9. Remove the inner cannula
   

   	This type of inner cannula twists to unlock or lock into place
   	This inner cannula has clips on each side that hold it in place
   	This cannula has an end with a tab similar to the ring on pop cans. You need to stabilize the trach while removing or inserting inner cannulas.

   
   
10. Insert new or cleaned inner cannula maintaining sterility of cannula
    
    
11. Clean around the stoma and trach tube flange using H₂O₂ and normal saline

    
    Small video: Mac (Quicktime format) and PC format

12. Replace dressing; do not slide over the skin
    
    
13. Reinflate the cuff
    
    
14. Change trach ties with help
    

    For new tracheostomies, the physician orders when the ties can be changed in order to prevent accidental removal of the trach. Never change ties alone with a new trach.

    
    
15. Assess patient response
    
    
16. Clean up and replace equipment
    
    

	Trach Care (GTC) (12:28 seconds) Trach Care (GTC): Reviewing trach care and equipment. Thank you Gateway Tech. College, Kenosha, WI for sharing this video with ALFA. Laura Cook, RN demonstrates and Katrina McGovern, RN, videographer.
	Trach suctioning GTC (8:41 seconds) Trach suctioning GTC: Trach suctioning in the skills lab with excellent proceedural tips. Thank you Gateway Tech. College, Kenosha, WI for sharing this video with ALFA. Laura Cook, RN demonstrates and Katrina McGovern, RN, videographer.