Tracheostomy Care Tutorial

Summary

This instructional video provides a comprehensive guide on performing tracheostomy (trach) care. It begins by introducing the necessary supplies, including a trach care kit, trach ties, inner and outer cannulas, and cleaning solutions. The video explains the parts of a trach, such as the inner cannula, outer cannula, obturator, and trach collar, and highlights safety considerations. Step-by-step instructions demonstrate proper cleaning of the inner and outer cannulas, use of sterile gloves and drapes, and placement of a fenestrated trach dressing. The video emphasizes patient safety throughout, including maintaining oxygen supply and preventing contamination during the procedure.

Takeaways

• 🩺 Trach care requires a specific kit including dressing, ties, wire brush, q-tips, pipe cleaners, sterile gloves, drape, saline, and sometimes hydrogen peroxide.
• 💡 Different trach kits may have variations, such as removable buckets or additional saline/hydrogen peroxide bottles.
• 👃 The trach collar delivers oxygen directly over the tracheostomy rather than over the nose and mouth.
• 🔑 The inner cannula can be removed for cleaning without compromising the patient's ability to breathe.
• 🛡️ The outer cannula ensures airway safety and remains in place even if the inner cannula is removed.
• ♻️ Disposable inner cannulas should be replaced daily or twice daily, depending on the patient's needs.
• 🚫 A red cap or trach button blocks the airway and is used for patients preparing for decannulation.
• ⚠️ The obturator is a safety device used to reinsert the trach if accidentally dislodged, and should always be accessible.
• 🧴 Cleaning involves using sterile saline (or peroxide), wire brush for the inner cannula, and q-tips/gauze for the outer cannula and stoma area.
• 🧤 Maintain sterile technique: only touch sterile surfaces with sterile hands and keep contaminated hands separate.
• ⏱ Trach care is typically performed twice daily or every 8 hours, depending on the patient's secretion levels.
• 🫁 Always restore oxygen immediately after removing the inner cannula to prevent patient hypoxia.
• 🧻 Fenestrated trach dressings are placed under the trach carefully to avoid pulling or dislodging the tube.

Q & A

What supplies are included in a typical trach care kit?

A typical trach care kit includes a fenestrated trach dressing, trach ties or Velcro ties, a wire brush, Q-tips, pipe cleaners, sterile gloves, a sterile drape, hydrogen peroxide (sometimes separate), and sterile saline.

What is the purpose of a trach collar?

A trach collar delivers oxygen directly over the tracheostomy site rather than over the nose and mouth, ensuring the patient receives adequate oxygen through their trach.

What is the difference between the inner and outer cannula of a trach?

The inner cannula fits inside the outer cannula and can be removed for cleaning. The outer cannula stays in place to maintain the airway, allowing the patient to breathe even if the inner cannula is removed.

What does a 'no cuff' trach indicate?

A 'no cuff' trach means there is no inflatable cuff inside the trach tube to hold it in place; it is secured only with ties, and the tube can be more easily dislodged if not properly secured.

What is a disposable inner cannula, and how often should it be replaced?

A disposable inner cannula has flanges for easy removal and should be replaced every day or twice a day, depending on the patient's needs.

What is the purpose of a trach obturator?

A trach obturator is a safety device used to reinsert the outer cannula if it is accidentally dislodged, ensuring the airway remains open.

What is the correct procedure for cleaning the inner cannula?

Remove the inner cannula using a non-sterile hand for handling the exterior, then clean it thoroughly with a wire brush in a saline or hydrogen peroxide solution, and rinse before reinserting.

How should the outer surface of the trach be cleaned?

Use Q-tips or gauze dipped in sterile saline to clean around the trach site, including behind the neck plate and the area where the trach enters the neck, discarding used materials immediately.

When should trach care be performed?

Trach care is usually performed twice a day or every eight hours, depending on the patient's needs and secretion levels.

How should oxygen be managed during trach care?

Ensure the patient receives oxygen when the inner cannula or outer cannula is removed. Temporarily remove the trach collar only when necessary and promptly replace it to maintain oxygenation.

What is a trach 'button' and when is it used?

A trach button is a small, red capped tube that blocks the tracheostomy completely. It is used for patients who are doing well and preparing for decannulation (removal of the trach).