Tracheostomy site care procedure


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Tracheostomy site care procedure

  1. 1. Changing Tracheostomy Dressing & Tie Tapes<br />1<br />
  2. 2. Objectives<br />Define Tracheostomy Procedure.<br />Discuss changing tracheostomy dressing and tie tapes thoroughly utilizing video presentation and demonstration.<br />Perform the procedure through return - demonstration correctly.<br />2<br />
  3. 3. Tracheostomy<br />A surgical incision in the trachea just below the larynx. <br />A curved tracheostomy tube is inserted to extend through the stoma into the trachea.<br />Tracheostomy tubes may either be plastic or metal and are available in different sizes.<br />3<br />
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  7. 7. Tracheostomy Care Video <br />7<br />
  8. 8. Demonstration<br />8<br />
  9. 9. Procedure<br />Verify the doctor’s order.<br />Apply alcohol based hand rub upon entering the client’s room.<br />9<br />
  10. 10. Prepare the client.<br />Introduce self to the patient.<br />Check the patient’s identification. <br />Explain the procedure.<br />Position the patient in Semi-Fowler’s position.<br />10<br />
  11. 11. Procedure<br />Prepare the equipment.<br />Disposable face mask <br />Clean gloves <br />Moisture – resistant bag<br />Normal saline solution<br />Hydrogen peroxide<br />Bandage scissors <br />Equipment & supplies for suctioning and for mouth care<br />11<br />
  12. 12. For Cleaning a Non – Disposable Inner Cannula and Providing Site Care<br />Prepackaged commercial tracheostomy care set<br />Sterile pads (sterile field and patient’s chest)<br />Sterile nylon brush<br />Sterile gloves<br />Disposable pick – up forceps<br />Sterile 6” (15cm) pipe cleaners <br />Cotton applicator<br />Trache tie - twice the neck circumference plus 4 inches of tracheostomy twill tape <br />4” x 4” gauze pads<br />Pre – cut 4” x 4” gauze dressing<br />12<br />
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  17. 17. Procedure<br />Wear face mask.<br />Prepare a moisture-resistant bag. <br />Open a pre - packaged commercial tracheostomy care kit.<br />Discard few drops of the hydrogen peroxide and sterile normal saline solution pour them in each container. <br />17<br />
  18. 18. Procedure<br />Put on clean gloves.<br />Remove the dressing and check the site for signs of infection and maceration.<br />Remove and soak the inner cannula.<br />Unlock the inner cannula by rotating it in a counter clockwise direction while your other hand supports the faceplate of the outer cannula.<br />Gently remove the inner cannula by pulling it toward you in line with its curvature.<br />Soak the inner cannula in the hydrogen peroxide solution .<br />18<br />
  19. 19. Procedure<br />Change to sterile gloves and clean the cannula.<br />Place each of the sterile pads across the patient’s chest and on the table.<br />Remove the cannula from the soaking solution. (Use disposable pick-up forceps, if available)<br />Clean the lumen and the entire inner cannula thoroughly using the nylon brush moistened with sterile saline. Inspect the cannula for cleanliness. If encrustations are evident, repeat cleaning.<br />19<br />
  20. 20. Procedure<br />Rinse the cannula thoroughly by agitating in the sterile saline solution.<br />After rinsing, gently tap it against the inside edge of the sterile solution container.<br />20<br />
  21. 21. Procedure<br />Dry the lumen of the cannula using the pipe cleaners.<br />Insert the inner cannula and secure it.<br />Grasp the outer flange of the inner cannula, and insert the cannula in the direction of its curvature.<br />Lock the inner cannula in place by turning the lock in clockwise direction.<br />Gently pull the inner cannula to ensure that is secure.<br />21<br />
  22. 22. Procedure<br />Pour out the sterile normal saline solution in the receptacle. If using the same solution from the same container, this may be omitted<br />Clean the incision site.<br /><ul><li>Clean around the incision site with applicator sticks dampened with sterile normal saline. Start from inner to outer.
  23. 23. Dry gently by wiping the area with gauze pad.</li></ul>22<br />
  24. 24. Procedure<br />Apply a sterile dressing.<br />Use a commercially prepared sterile dressing if available or open and refold a 4X4 gauze.<br />Avoid using a cotton-filled gauze squares, and avoid cutting the 4x4 gauze. <br />While applying the dressing, ensure that the tracheostomy tube is securely supported.<br />23<br />
  25. 25. Change the tie tapes.<br />Fasten the clean ties before removing the soiled ties.<br />Apply the tie tape as follows…<br />24<br />
  26. 26. Apply the tie tape as follows<br />Thread one end of the tape into the upper half of the slot on one side.<br />Bring both ends of the tape together, and take them around the client’s neck, keeping them flat and untwisted.<br />Ask the client to flex the neck, if conscious and coherent.<br />25<br />
  27. 27. Apply the tie tape as follows<br />Thread one piece of tape closest to the client’s neck from back to front through the other slot.<br />Place one finger underneath the tie tape before tying.<br />Tie it with a double - square knot.<br />Cut off any long ends and the old trache tie.<br />Check for tautness of the tracheostomy site.<br />26<br />
  28. 28. Procedure<br />Perform after care.<br />Document all relevant information.<br />Date, time and size of trachea<br />Characteristics of secretions (color, odor, amount, and consistency)<br />Patient’s tolerance to procedure<br />Teaching and the patient’s level of understanding.<br />27<br />
  29. 29. Return – Demonstration<br />28<br />