The document provides guidance on tracheostomy care. It describes that a tracheostomy is a surgical opening in the trachea below the larynx through which a curved tracheostomy tube is inserted. It outlines the assessment of a client's respiratory status, secretions, and incision after tracheostomy. The steps for providing tracheostomy care include cleaning the inner cannula with hydrogen peroxide and saline, replacing the inner cannula, cleaning the incision site and tube flange, and securing dressings. Maintaining a clean tracheostomy tube is important to prevent infection and promote healing.

1. MEDICAL AND SURGICAL NURSING
TRACHEOSTOMY CARE
Lecturer: Mark Fredderick R. Abejo RN,MAN
__________________________________________________
TRACHEOSTOMY
A surgical insicion in the trachea just below
the larynx.
A curved tracheostomy tube is inserted to
extend through the stoma into the trachea. Tracheostomy Tube in Place
Clients who need long-term airway support.

2. Lecture Notes on Tracheostomy Care
Prepared By: Mark Fredderick R Abejo R.N, M.A.N
Clinical Instructor
Tracheostomy tubes have an outer cannula that Assessment:
is inserted into trachea and a flange that rests Assess
against the neck and allows the tube to be Respiratory status
secured in place with tape or ties. Pulse rate
Obturator is kept at the client’s bedside in Character and amount of secretions from
case the tubes tracheostomy site
Presence of drainage
Appearance of incision
Steps / Procedure Rationale
Identify and inform
the client and explain To allay anxiety
the procedure.
Wash hands and
observe other
appropriate infection
control procedure
Cuffed tracheostomy tubes are surrounded by Assist the client to a
an inflatable cuff that produce an airtight seal semi-Fowler’s or To promote lung
between the tube and the trachea. Fowlers position expansion
This seal prevents aspiration of orophrayngeal Prepare the
secretions and air leakage between the tube and equipment, open the
the trachea. tracheostomy kit.
Pour hydrogen
peroxide into
Providing Tracheostomy Care separate container
Establish a sterile
Purposes field, open other
To maintain airway patency sterile supplies:
To maintain cleanliness and prevent infection tracheostomy
at the tracheostomy site dressing, suction
To facilitate healing and prevent skin Suction the
excoriation around tracheostomy incision tracheostomy tube
To promote comfort After suctioning,
NOTE: wrap the catheter
Initially a tracheostomy may need to be around your hand and
suctioned as often as every 1 – 2 hours. After the peel the glove off
initial inflammatory response subsides, it may with the catheter
done once or twice a day. inside the glove and
discard
Equipment: Using the other Hydrogen peroxide
- Sterile disposable tracheostomy cleaning kit gloved hand, unlock moisten and loosens
- Towel the inner cannula (if dried secretions
- Sterile suction kit present) and remove
- Hydrogen peroxide and sterile normal saline it gently and place on
- Sterile gloves the hydrogen
- Clean gloves peroxide solution
- Sterile 4 x 4 gauze dressing Remove the soiled
- Cotton twill tracheostomy
- Clean scissors dressing, place the
soiled dressing in

3. Lecture Notes on Tracheostomy Care
Prepared By: Mark Fredderick R Abejo R.N, M.A.N
Clinical Instructor
your gloved hand and
peel the glove off
with the soiled
dressing and discard
Put on another
sterile gloves. Keep
dominant hand sterile
during the procedure.
Clean the inner
cannula:
 Remove the inner
cannula from the
soaking solution
 Clean the lumen and
entire cannula
thoroughly using a
brush or pipe Tape and pad the tie knot.
cleaners moistened Check the tightness of the ties.
with sterile NSS Document all relevant information.
 Rinse the inner Rinsing is important to
cannula thoroughly remove hydrogen
in the sterile normal peroxide
saline.
 Using sterile
technique, suction
the outer cannula.
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.
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.
 Hydrogen peroxide may be used to remove
crustysecretions. Thoroughly rinse the
cleaned area, using gauze squares moistened
with sterile normal saline.
 Clean the flange of the tube in the same
manner.
 Thoroughly dry the client’s skin and tube
flanges with dry gauze squares.