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Definition of Terms

Decannulation: The process whereby a tracheostomy tube is removed once patient no longer needs it.

Humidification: The mechanical process of increasing the water vapour content of an inspired gas.

Stoma: An opening, either natural or surgically created, which connects a portion of the body cavity to the outside environment (in this case, between the trachea and the anterior surface of the neck).

Tracheostomy: A surgical procedure to create an opening between 2-3 (3-4) tracheal rings into the trachea below the larynx.

Components of Tracheostomy Tube

Outer tube

Inner tube: Fits snugly into outer tube, can be easily removed for cleaning.

Flange: Flat plastic plate attached to outer tube – lies flush against the patient’s neck.

15mm outer diameter termination: Fits all ventilator
 and respiratory equipment.
Providing Tracheostomy Care

Purposes

1.To maintain airway patency by removing mucus and encrusted secretions.
2.To maintain cleanliness and prevent infection at the tracheostomy site
3.To facilitate healing and prevent skin excoriation around the tracheostomy incision
4.To promote comfort
5.To prevent displacement

Tracheostomy care:

Introduce self and verify the client’s identity using agency protocol. Explain to the client everything that you need to do, why it is necessary, and how can he cooperate. Eye blinking, raising a finger can be a means of communication to indicate pain or distress.
Observe appropriate infection control procedures such as hand hygiene.

3. Provide for client privacy.

4. Prepare the client and the equipment.

To promote lung expansion, assist the client to semi-Fowler’s or Fowler’s position.
Open the tracheostomy kit or sterile basins. Pour the soaking solution and sterile normal saline into separate containers.
Establish the sterile field.
Open other sterile supplies as needed including sterile applicators, suction kit, and tracheostomy dressing.
5. Suction the tracheostomy tube, if necessary.

Put a clean glove on your non dominant hand and a sterile glove on your dominant hand (or put on a pair of sterile gloves).
Suction the full length of the tracheostomy tube to remove secretions and ensure a patent airway.
Rinse the suction catheter and wrap the catheter around your hand, and peel the glove off so that it turns inside out over the catheter.
Unlock the inner cannula with the gloved hand. Remove it by gently pulling it out toward you in line with its curvature. Place it in the soaking solution. Rationale: This moistens and loosens secretions.
Remove the soiled tracheostomy dressing. Place the soiled dressing in your gloved hand and peel the glove off so that it turns inside out over the dressing. Discard the glove and the dressing.
Put on sterile gloves. Keep your dominant hand sterile during the procedure.
6. Clean the inner cannula.

Remove the inner cannula from the soaking solution.
Clean the lumen and entire inner cannula thoroughly using the brush or pipe cleaners moistened with sterile normal saline. Inspect the cannula for cleanliness by holding it at eye level and looking through it into the light.
Rinse the inner cannula thoroughly in the sterile normal saline.
After rinsing, gently tap the cannula against the inside edge of the sterile saline container. Use a pipe cleaner folded in half to dry only the inside of the cannula; do not dry the outside. Rationale: This removes excess liquid from the cannula and prevents possible aspiration by the client, while leaving a film of moisture on the outer surface to lubricate the cannula for reinsertion.
7. Replace the inner cannula, securing it in place.

Insert the inner cannula by grasping the outer flange and inserting the cannula in the direction of its curvature.
Lock the cannula in place by turning the lock (if present) into position to secure the flange of the inner cannula to the outer cannula.
8. Clean the incision site and tube flange.

Using sterile applicators or gauze dressings moistened with normal saline, clean the incision site. Handle the sterile supplies with your dominant hand. Use each applicator or gauze dressing only once and then discard. Rationale: This avoids contaminating a clean area with a soiled gauze dressing or applicator.

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