Performing Tracheostomy Tube Care
Posted: Wednesday, January 5th, 2022 | Updated: Wednesday, January 5th, 2022
Posted: Wednesday, January 5th, 2022 | Updated: Wednesday, January 5th, 2022
Tracheostomy Tube Care
Two people are generally needed to perform tracheostomy tube care. One person will restrain the patient in a position that facilitates the visualization of the tracheostomy tube site. That individual is also needed to provide flow-by oxygen directed toward the tracheostomy tube opening if the patient requires oxygen therapy. In a sterile manner, the other individual will very gently clean the tracheostomy tube cannula and around the site itself. In order to perform the tracheostomy tube care, the sterile individual must first gather and prepare their supplies for use
Tracheostomy Tube Cleaning Set-up Procedure:
1. Open a set of sterile gloves and use the opened package as your sterile field
2. Open and sterilely drop a 12 ml syringe and a 20 or 22 gauge needle on your sterile field
3. Open the packaging for a suction catheter enough to be able to grab it when you're gloved up. This suction catheter must be small enough to fit in the tracheostomy tube entrance and allow suction to be terminated on and off quickly by use of the suction valve. Typically, an 8 to 10 Fr catheter will work. Note that constant suction is never indicated
4. Hang a bag of sterile 0.9% NaCl for ease of access to draw up a small volume. Wipe the injection port with alcohol
5. Open a pack of sterile gauze, cotton swabs, and pipe cleaners. Keep all of your supplies sterile and make them easy to grab
6. Turn on the suction and have the end of the line near you and your assistant
How to Perform Tracheostomy Tube Care:
1. Glove up in a sterile manner
2. Attach the needle and syringe and draw up a small volume of 0.9% NaCl
3. Grab the inner cannula of the tracheostomy tube and carefully remove it. Some cannulas will have a knob at the top that will need to be turned in order to remove
4. Once the inner cannula has been removed, clean it, inside and out, using the saline, gauze, and pipe cleaner
5. Once the inner cannula is free of mucous and is clean and dry, place it on your sterile field
6. Gently clean around the tracheostomy tube site with gauze and saline. NEVER PLACE SWABS, PIPE CLEANERS, OR GAUZE INTO THE TRACHEOSTOMY TUBE SITE ITSELF
7. Grab the suction catheter and have your assistant help to attach it to the suctioning line
8. Inject 1 or 2 ml of saline into the trachea via the entrance of the tube site
9. The patient may cough and bring up mucous at this point. Regardless, pass the sterile suction a very short distance into the tracheostomy tube site. While doing this NEVER APPLY CONSTANT SUCTION. Place your finger on and off the suction valve while entering into the site to aspirate intermittently. This procedure may have to be done a second or third time depending on if the patient is still producing a lot of mucous. Only perform this procedure when needed and provide the patient breaks as needed. Excessive cleaning may cause irritation and lead to swelling and eventually airway obstruction
10. Once the site is clean and free of mucous, replace and secure the inner cannula
11. Confirm that the patient is passing air through the tracheostomy tube appropriately. If the patient is not able to do this, troubleshoot the issue. More suctioning or cleaning of the inner cannula may be required. Some patients may need to have the skin around the site sutured and pulled back temporarily to provide a patent airway and prevent obstruction
Tracheostomy tube cleaning may be required every 1-2 hours after placement up to the first 6 hours. Afterward, the site may need cleaning every 4 to 6 hours. At any time, if the patient is unable to pass air through the tube, the site must be evaluated. The site may also need attention if the patient sounds phlegmy and is at risk for obstruction
Two people are generally needed to perform tracheostomy tube care. One person will restrain the patient in a position that facilitates the visualization of the tracheostomy tube site. That individual is also needed to provide flow-by oxygen directed toward the tracheostomy tube opening if the patient requires oxygen therapy. In a sterile manner, the other individual will very gently clean the tracheostomy tube cannula and around the site itself. In order to perform the tracheostomy tube care, the sterile individual must first gather and prepare their supplies for use
Tracheostomy Tube Cleaning Set-up Procedure:
1. Open a set of sterile gloves and use the opened package as your sterile field
2. Open and sterilely drop a 12 ml syringe and a 20 or 22 gauge needle on your sterile field
3. Open the packaging for a suction catheter enough to be able to grab it when you're gloved up. This suction catheter must be small enough to fit in the tracheostomy tube entrance and allow suction to be terminated on and off quickly by use of the suction valve. Typically, an 8 to 10 Fr catheter will work. Note that constant suction is never indicated
4. Hang a bag of sterile 0.9% NaCl for ease of access to draw up a small volume. Wipe the injection port with alcohol
5. Open a pack of sterile gauze, cotton swabs, and pipe cleaners. Keep all of your supplies sterile and make them easy to grab
6. Turn on the suction and have the end of the line near you and your assistant
How to Perform Tracheostomy Tube Care:
1. Glove up in a sterile manner
2. Attach the needle and syringe and draw up a small volume of 0.9% NaCl
3. Grab the inner cannula of the tracheostomy tube and carefully remove it. Some cannulas will have a knob at the top that will need to be turned in order to remove
4. Once the inner cannula has been removed, clean it, inside and out, using the saline, gauze, and pipe cleaner
5. Once the inner cannula is free of mucous and is clean and dry, place it on your sterile field
6. Gently clean around the tracheostomy tube site with gauze and saline. NEVER PLACE SWABS, PIPE CLEANERS, OR GAUZE INTO THE TRACHEOSTOMY TUBE SITE ITSELF
7. Grab the suction catheter and have your assistant help to attach it to the suctioning line
8. Inject 1 or 2 ml of saline into the trachea via the entrance of the tube site
9. The patient may cough and bring up mucous at this point. Regardless, pass the sterile suction a very short distance into the tracheostomy tube site. While doing this NEVER APPLY CONSTANT SUCTION. Place your finger on and off the suction valve while entering into the site to aspirate intermittently. This procedure may have to be done a second or third time depending on if the patient is still producing a lot of mucous. Only perform this procedure when needed and provide the patient breaks as needed. Excessive cleaning may cause irritation and lead to swelling and eventually airway obstruction
10. Once the site is clean and free of mucous, replace and secure the inner cannula
11. Confirm that the patient is passing air through the tracheostomy tube appropriately. If the patient is not able to do this, troubleshoot the issue. More suctioning or cleaning of the inner cannula may be required. Some patients may need to have the skin around the site sutured and pulled back temporarily to provide a patent airway and prevent obstruction
Tracheostomy tube cleaning may be required every 1-2 hours after placement up to the first 6 hours. Afterward, the site may need cleaning every 4 to 6 hours. At any time, if the patient is unable to pass air through the tube, the site must be evaluated. The site may also need attention if the patient sounds phlegmy and is at risk for obstruction
Sources:
On The Job Training and Routine Practices
On The Job Training and Routine Practices