Tracheostomy care is the process of maintaining a clean and functional tracheostomy, which is a surgically created opening in the windpipe (trachea) that allows a person to breathe through a tube called a tracheostomy tube or cannula. As a nurse, you are responsible for performing tracheostomy care for your patients who have tracheostomies and preventing complications that can affect their tracheostomies and their health.
To perform tracheostomy care, you need to follow these steps:
- Gather the necessary equipment, such as a suction catheter, sterile water or saline solution, gloves, gauze, dressing or stoma cover, and a new tube or inner cannula if needed.
- Wash your hands and put on gloves. Explain the procedure to the patient and ensure their comfort and privacy.
- Suction mucus and secretions from the tracheostomy tube using a suction catheter. Insert the catheter gently into the tube until you feel resistance or hear a cough. Apply suction while withdrawing the catheter in a circular motion. Repeat until the tube is clear of secretions. Do not suction for more than 10 seconds at a time and allow the patient to rest between suctioning.
- Clean the tracheostomy site, the tube, and the suction catheter with sterile water or saline solution. Use gauze soaked in the solution to wipe around the stoma and the tube. Rinse the catheter with the solution and discard it in a waste container.
- Replace the tube with a new one or change the inner cannula if it has one. Remove the old tube or inner cannula carefully and insert the new one gently. Secure the tube with tape or a device and check its position and function. Do not change the tube without the doctor’s order and supervision.
- Apply a dressing or a stoma cover around the tracheostomy site to protect it from dirt and moisture. Change the dressing or stoma cover as often as needed or as ordered by the doctor.
- Check the cuff pressure of the tube if it has one to ensure it is not too high or too low. Use a manometer to measure the pressure and adjust it according to the doctor’s order. The cuff pressure should be between 20 and 25 cm H2O.
- Monitor the patient’s breathing, oxygen level, heart rate, and signs of infection or irritation. Report any changes or abnormalities to the doctor immediately.
- Document your tracheostomy care procedure and your findings in the patient’s chart.
Tracheostomy care should be done at least once a day or more often as needed, depending on the number of secretions and the type of tube. Tracheostomy care should be done by following the guidelines and recommendations of the doctor and the health care team.
