Tracheostomy (Trach) Care Overview (Nursing Skills)

Summary

This video provides a comprehensive guide on performing tracheostomy care, emphasizing the importance of sterile technique and safety. The step-by-step process includes suctioning the patient, assessing the stoma for infection, and ensuring proper protection during the procedure. Key tasks include removing the inner cannula, cleaning the flange and stoma, replacing the cannula, and adjusting the trach ties. It also covers how to prevent skin breakdown, properly place the dressing, and ensure secure, safe trach care. The video highlights the importance of maintaining sterility, hand hygiene, and proper technique throughout the procedure.

Takeaways

• 😀 Always suction the patient before performing tracheostomy care to ensure clear airways.
• 😀 Use goggles or a face shield during tracheostomy care to protect yourself from potential exposure, especially if the patient coughs.
• 😀 Open the sterile tracheostomy care kit and ensure all necessary supplies are readily available, including gauze, saline, dressing, inner cannula, and ties.
• 😀 Make sure to remove the inner cannula, dispose of it if disposable, or clean it if reusable, along with the old dressing before starting the procedure.
• 😀 Perform hand hygiene after removing gloves and before putting on sterile gloves to maintain sterility during the procedure.
• 😀 Clean the secretions from the flange of the tracheostomy tube using cotton-tipped applicators and pipe cleaners, without inserting them into the stoma.
• 😀 Use saline-soaked gauze to clean under the flange and around the stoma, ensuring it is not dripping before applying it.
• 😀 When inserting the new inner cannula, do so at an angle, following the curvature of the trach tube, and lock it securely in place.
• 😀 Change the tracheostomy ties while keeping one hand on the trach tube to prevent accidental dislodgement, ensuring the new ties are not twisted.
• 😀 Ensure the new ties are snug but not too tight, allowing space for two fingers underneath to avoid causing discomfort or skin breakdown.
• 😀 Finish the procedure by placing a new split dressing under the flange, ensuring it’s positioned high enough to prevent skin irritation, and label the dressing according to facility policy.

Q & A

Why is it important to suction the patient before performing trach care?

Suctioning the patient before trach care ensures that the airways are clear and helps prevent the aspiration of secretions into the lungs during the procedure. This is a critical step in maintaining the patient’s respiratory health and preventing infection.

What safety precautions should be taken during trach care to avoid exposure?

To avoid exposure, especially when the patient coughs, it is recommended to wear goggles or a face shield during trach care. This helps protect the caregiver from potentially infectious respiratory droplets.

What supplies are needed for trach care?

The supplies needed include a sterile trach care kit, sterile saline solution, gauze, cotton-tipped applicators or pipe cleaners, sterile gloves, a new dressing, inner cannula, trach ties, and a sterile drape or towel.

What is the proper method to clean the stoma and the area around the tracheostomy?

The stoma and the area around the tracheostomy should be cleaned with saline-soaked gauze or cotton-tipped applicators, carefully scrubbing around the flange to remove secretions. A dry piece of gauze can also be used to dry the area to prevent moisture buildup.

How do you replace the inner cannula during trach care?

To replace the inner cannula, it should be inserted at an angle, following the curvature of the tube, and locked into place securely. If the inner cannula is not disposable, it should be cleaned with a brush and saline solution before reinsertion.

What should you do if the trach ties are not sterile?

If the trach ties are not sterile, open the tie package and place them next to the sterile field. Once ready, they should be handled with clean hands and applied carefully during the procedure.

Why is it important to keep one hand on the tracheostomy during tie changes?

Keeping one hand on the tracheostomy ensures that the tube remains in place and prevents accidental dislodgement during the tie change, especially if the patient coughs or moves unexpectedly.

What is the purpose of using two fingers to test the tightness of the trach ties?

The purpose of using two fingers to test the tightness of the trach ties is to ensure that they are neither too tight, which could cause discomfort or pressure ulcers, nor too loose, which could allow the trach to become dislodged.

What should be done with the old trach ties after replacing them?

After replacing the old trach ties, they should be discarded properly, ensuring that no contaminated materials are left around the sterile field. The new ties should be secured and adjusted to ensure they fit comfortably.

What should be done after completing the trach care procedure?

After completing the trach care procedure, the dressing should be placed under the flange and around the tracheostomy. The dressing should be labeled according to facility policy. All supplies should be discarded, and the procedure should be documented appropriately.