Tracheostomy Care Policy

Tracheostomy Care Policy 

Purpose 

A tracheostomy is an artificial opening into the trachea for the insertion of a tube to facilitate the passage of air into the lungs or to evacuate secretions. The purpose of a tracheostomy is to maintain a patent airway, evacuate secretions, reduce the risk of nosocomial infection, and prevent excoriation, breakdown, and infection of surrounding skin. 

Policy 

• Tracheostomy (trach) care is performed by a licensed nurse or respiratory therapist, per a physician's order, utilizing sterile/aseptic technique. The resident/family member may perform tracheostomy care if competent to do so. 

• Tracheostomy tube type and size will be per physician’s order. 

• Tracheostomy care will be provided at least every 8 hours and as needed, or as otherwise ordered by the physician. 

• A standby tracheostomy tube of proper size, rubber-topped hemostat, suction machine, ambubag adapter, and supplies will be kept at the bedside of the resident. 

• The outer cannula is to be changed only by a physician. In an emergency (complete obstruction), the nurse can remove both cannulas and insert a patent airway. 

Equipment 

• Disposable Tracheostomy Care Kit or 

• Tracheostomy dressing – precut sterile 4x4 gauze sponges 

• Tracheostomy ties 

• Sterile basins – 2 (1 if the inner cannula is to be discarded) 

• Sterile tube brush or sterile pipe cleaners if the inner cannula is to be cleaned 

• Sterile gloves – 2 pairs 

• Disposable inner cannula (for type of trach in place) 

• Suction machine, connecting tubing 

• Sterile suction catheter 

• Hydrogen peroxide 

• Normal saline or sterile water 

• Scissors 

• Plastic bag for waste 

• Applicators, swabs, or gauze sponges 

• Gown, face mask & goggles, if splashing is anticipated 

• Tissue 

Procedure 

I. Place resident in semi-Fowler’s position unless medically contraindicated. 

II. Open equipment and set up a sterile field. 

III. Fill the two basins provided with normal saline or sterile water. 

IV. Open the sterile catheter using aseptic technique. 

V. Suction the inner cannula using sterile technique. 

VI. If the resident has a disposable inner cannula, go to step XVI. 

Trach Care – Metal, Reusable Cannula: VII. Unlock the inner cannula of the tracheostomy tube, remove, place in a basin of peroxide, and allow to soak. 

VIII. Remove dressing, discard in an appropriate type of plastic bag, and clean the skin around the tracheostomy tube with applicators and peroxide. Remove all exudates and drainage. Do not allow any solution to enter the outer tracheostomy tube or tracheostomy opening. 

IX. Clean the inner cannula well with applicators. Rinse well with normal saline or sterile water and drain on a sterile 4x4. Allow the inner cannula to dry. 

X. Suction the trach before inserting the inner cannula. 

XI. Replace the inner cannula and lock it into place. 

XII. Proceed to step XXI. 

Trach Care, Disposable Inner Cannula: XIII. Remove soiled trach dressing. 

XIV. Remove the inner cannula and replace it with a sterile disposable inner cannula, locking it into place. 

XV. Clean the stoma site and faceplate of the outer cannula with normal saline. 

XVI. Clean the skin adjacent to the trach site with sterile water or normal saline. 

Continue for Both Reusable Metal, Disposable Inner Cannula: XVII. If the tracheostomy tube ties are soiled, replace them. Cut a slit approximately 1 – 1 ½ inch from the end of the new tapes. Place tapes through tracheostomy openings and tie before removing soiled tapes. 

XVIII. Tracheostomy ties or collar should be fastened to the side, three to four inches from the tube opening, not behind the neck. 

XIX. Position a pre-cut sterile 4x4 gauze or equivalent around the tracheostomy tube under the ties. 

XX. Clean and return equipment to its designated place and discard all disposable equipment in a plastic bag. 

XXI. Replace humidification therapy as prescribed for trach. 

References 

• Centers for Medicare & Medicaid Services (CMS), Requirements of Participation for Long-Term Care Facilities. 

• State Operations Manual (SOM), CMS.