Ventilator-dependent patients, especially those with tracheostomies, require specialized care and precision to avoid external threats. Since a tracheostomy tube is directly inserted into the trachea through a slit opening, any negligence can result in severe life-threatening complications. Tracheostomy care, though, is routine work for the care providers; however, it is considered an aerosol-generating procedure, and it needs some special predefined guidelines to follow to avoid any complications for both care providers and patients.
Equipment Required for Tracheostomy Care
The following supplies may be suggested to perform a tracheostomy with utmost care:
- Tracheostomy cleaning disposable kit including sterile containers, pipe cleaners, gauze squares, and applicators
- Suction catheter kit
- Saline, sterile gauze dressing, and cotton twill ties
- Medical gloves and towels
- Sterile scissors
- Moisture-proof bag
Step 1: Prerequisites of Tracheostomy
- Prepare the patient, explaining what procedure you will perform and how he can cooperate
- Wash or sanitize hands thoroughly
- Use appropriate equipment like a face mask, gloves, and gowns
- Keep all required equipment ready beforehand
- Set the position of the patient, Fowler’s or semi-Fowler’s, as required to perform tracheostomy care
- Assess:
- Respiratory status and pulse rate of the patient
- Nature and the amount of secretions
- Appearance of incision to find swelling, discharge, redness or any kind of odor
- Signs of drainage on the dressing
Step 2: Tracheostomy Suctioning Care
Since coughing is a possible outcome of tracheostomy care, it is recommended to perform airway suction following the predefined guidelines, but only when needed. Suctioning, though, helps in removing mucus from the tube and keeps the airway clear; however, it is preferred only in conditions where a patient is unable to cough secretions out or feels difficulty breathing.
The following are some special guidelines for performing suction:
- Preoxygenate the patient if suggested in the care plan
- Insert the catheter into the trach tube to the point where resistance or cough is present
- Apply continuous suction for 10 to 15 seconds using a light rotating motion
- Reoxygenate the patient and repeat the process until all resistance is cleared completely
Step 3: Replace or Clean Inner Cannula
Tracheostomy tubes come with two types of cannulas, disposable and reusable. Disposable cannulas are discarded after use, while reusable cannulas are reinserted after cleaning and drying properly. Carers can adopt a guided way to replace or reinsert the inner cannula after performing a hygiene routine.
- Unlock and take out the inner cannula carefully
- If it is disposable, discard it and replace it with a new one
- If reusable:
- Soak it in saline solution
- Clean all sides thoroughly using a cleaning brush
- Place in a saline-filled rinsing tray to clean any residue, as hydrogen peroxide may cause skin irritation
- Dry the inner side of the cannula properly using a pipe cleaner, but not the outer side
- Reinsert and secure the cannula
Step 4: Stoma Cleaning and Skin Care
The stoma, or opening of the tracheostomy, starts healing within a week after the procedure is performed. During this period, the nursing staff is required to check the stoma regularly and take special measures to clean it properly. Keeping the surrounding area of the incision or stoma clean is important to avoid infections and skin irritation.
- Inspect the surrounding area of the incision for swelling, redness, or any kind of discharge, especially foul-smelling.
- Dip gauze dressing or sterile applicators in saline solution and clean the incision area
- Always clean in a single outward motion and discard the applicator or gauze after each wipe
- Gently clean any dry secretions
- Use moistened gauze squares to rinse the cleaned area thoroughly
- Use the same procedure for cleaning the flange of the trach tube
- Dry the tube flanges and the patient’s skin thoroughly using dry gauze
Step 5: Changing Dressing and Twill Ties
The tracheostomy incision is covered with gauze squares to avoid contact with outer threats, which need to be changed regularly to keep the stoma dry, clean, and moisture-free. It is recommended to use a pre-cut sterile dressing available in the market; however, a regular 4×4 gauze square can also be used by folding it into a V-shape. Cutting the dressing is never recommended, as it can make fuzz or lint enter the stoma, causing severe irritation and infection.
- Read More: 10 Steps for the Care of Ventilator Patients
The healthcare provider can remove the old dressing once it becomes wet or soiled and can replace it with a new one while keeping the tube firm in its place. He can also change ties if needed, one at a time, with the help of an assistant to secure ties properly and avoid popping out of the tube.
Step 6: Reassuring Patient Condition and Ventilator Connection
After providing proper care, the next step is to reassess the patient’s condition and ventilator connection. The care providers ensure that there is no tension pulling on the trach tube so that there is no chance of tube displacement or discomfort for the patient. Moreover, they check patients’ vital signs and comfort level, along with oxygen saturation level and active alarms, to ensure that the ventilator is functioning properly.
Need Specialized Long-Term Ventilator Care?
At Rite Choice Ventilator Specialty AFH LLC, we deliver 24/7 specialized long-term ventilator care in a comfortable, home-like environment. Call us at (360) 944-4471 Or Contact our team today to learn more about our services or discuss your loved one’s care needs.