Tracheostomy Care

Tracheostomy
A tracheotomy is a surgical procedure in which an opening is made into the
trachea. The indwelling tube inserted into the trachea is called a tracheostomy tube. A
tracheostomy is used to bypass an upper airway obstruction, to allow removal of
tracheobronchial secretions, to permit the long-term use of mechanical ventilation, to
prevent aspiration of oral or gastric secretions in the unconscious or paralyzed patient
(by closing off the trachea from the esophagus), and to replace an endotracheal tube.
Materials:

Sterile gloves
Hydrogen peroxide
Normal saline solution or sterile water
Cotton-tipped applicator
Dressing
Twill tape
Type of tube prescribed, if the tube is to be changed

Procedure:
ACTIONS
RATIONALE
1. Provide patient and family instruction 1. A cuffed tube prevents air from leaking
on the key points for tracheostomy care, during positive-pressure ventilation and
beginning

with

how

to

inspect

the also

prevents

tracheal

aspiration

of

tracheostomy dressing for moisture or gastric contents. An adequate seal is

drainage.

indicated by the disappearance of any air

2. Perform hand hygiene.

leakage from the mouth or tracheostomy

3. Explain procedure to patient and family or by the disappearance of the harsh,

as appropriate.

gurgling sound of air coming from the

4. Put on clean gloves; remove and throat.

discard the soiled dressing in a biohazard 2. The tracheostomy dressing is changed
container.

as needed to keep the skin clean and dry.

5. Prepare sterile supplies, including To prevent potential breakdown, moist or

hydrogen peroxide, normal saline solution soiled dressings should not remain on the
or sterile water, cotton-tipped applicators, skin.
dressing, and tape.
6.

Put

on

sterile

3. Hand hygiene reduces bacteria on

gloves.

(Some hands.

physicians approve clean technique for 4. A patient with a tracheostomy is

long-term tracheostomy patients in the apprehensive
home.)

and

requires

ongoing

assurance and support.

7. Cleanse the wound and the plate of the 5. Observing body substance isolation
tracheostomy tube with sterile cotton- reduces cross-contamination from soiled
tipped

applicators

moistened

with dressings.

hydrogen peroxide. Rinse with sterile 6.

saline solution.

Having

necessary

supplies

and

equipment readily available allows the

8. Soak inner cannula in peroxide and procedure to be completed efciently.

rinse with saline solution or replace with a 7.
new disposable inner cannula.

Sterile

equipment

minimizes

transmission of surface ora to the sterile

9. Remove soiled twill tape with clean respiratory tract. Clean technique may be
tape, after the new tape is in place. Place used in the home because of decreased
clean twill tape in position to secure the exposure to potential pathogens.
tracheostomy tube by inserting one end 8. Hydrogen peroxide is effective in
of the tape through the side opening of loosening crusted secretions. Rinsing
the outer cannula. Take the tape around prevents skin residue.
the back of the patients neck and thread 9.

Soaking

loosens

and

removes

it through the opposite opening of the secretions from the inner lumen of the
outer cannula. Bring both ends around so tracheostomy tube.
that they meet on one side of the neck. 10. This taping technique provides a
Tighten the tape until only two ngers can double thickness of tape around the neck,
be comfortably inserted under it. Secure which

is

needed

because

the

with a knot. For a new tracheostomy, two tracheostomy tube can be dislodged by
people should assist with tape changes.

movement or by a forceful cough if left

10. Remove old tapes and discard in a unsecured. A dislodged tracheostomy

biohazard container.
11.

Although

tube is difcult to reinsert, and respiratory

some

long-term distress may occur. Dislodgement of a

tracheostomies with healed stomas may new

not

require

dressing,

tracheostomy

is

medical

other emergency.

tracheostomies do. In such cases, use a 11. Tapes with old secretions may harbor

sterile tracheostomy dressing, tting it bacteria.

securely under the twill tapes and ange 12. Healed tracheostomies with minimal
of tracheostomy tube so that the incision secretions do not need a dressing.
is covered, as shown below.

Dressings that will shred are not used

around a tracheostomy because of the
risk that pieces of material, lint, or thread
may get into the tube, and eventually into
the

trachea,

causing

obstruction

or

abscess formation. Special dressings that

do not have a tendency to shred are
used.