TRACHEOSTOMY

CARE
BY: B E A N N C A A N G E L E S , S T E P H A N I E
ESCALA, TYRONE MAGNO

TRACHEOSTOMY
A tracheotomy is a surgical procedure in
which an opening is made into the trachea.
The indwelling tube inserted into the trachea
is called a tracheostomy tube.
A tracheostomy is used to bypass an upper
airway obstruction, to allow removal of
tracheobronchial secretions, to permit the
long-term use of mechanical ventilation, to
prevent aspiration of oral or gastric secretions
in the unconscious or paralyzed patient (by
closing off the trachea from the esophagus),

MATERIALS
Sterile gloves
Hydrogen peroxide
Normal saline solution or sterile water
Cotton-tipped applicator
Dressing
Twill tape/Tracheostomy tie tape
Type of tube prescribed, if the tube is to be
changed

ASSESSMENT
Respiratory status (ease of breathing, rate, rhythm,
depth, lung sounds, and oxygen saturation level)
Pulse rate
Secretions from the tracheostomy site (character and
amount)
Presence of drainage on tracheostomy dressing or ties
Appearance of incision (redness, swelling, purulent
discharge, or odor)

PROCEDURE
ACTION
1. Perform hand hygiene.

2. Explain procedure to
patient and family as
appropriate.

3. Put on clean gloves;

remove and discard the
soiled dressing in a
biohazard container.

RATIONALE
1. Hand hygiene reduces
bacteria on hands.
2. A patient with a
tracheostomy is
apprehensive and requires
ongoing assurance and
support.
3. Observing body
substance isolation
reduces crosscontamination from soiled

4. Prepare sterile supplies,

including hydrogen peroxide,
normal saline solution or
sterile water, cotton-tipped
applicators, dressing, and
tape.

4. Having necessary supplies

and equipment readily
available allows the
procedure to be completed
efciently.

5. Sterile equipment
5. Put on sterile gloves.
minimizes transmission of
(Some physicians approve
surface ora to the sterile
clean technique for long-term respiratory tract.
tracheostomy patients in the
home.)

6. Hydrogen peroxide is
6. Cleanse the wound and the effective in loosening crusted
plate of the tracheostomy
secretions. Rinsing prevents
tube with sterile cottonskin residue.
tipped applicators moistened

7. Soak inner cannula in

peroxide and rinse with
saline solution or replace
with a new disposable inner
cannula.

8. Remove soiled twill tape

with clean tape, after the
new tape is in place. Place
clean twill tape in position to
secure the tracheostomy
tube by inserting one end of
the tape through the side
opening of the outer
cannula. Take the tape
around the back of the
patients neck and thread it

7. Soaking loosens and

removes secretions from the
inner lumen of the
tracheostomy tube.

8. This taping technique

provides a double thickness
of tape around the neck,
which is needed because the
tracheostomy tube can be
dislodged by movement or
by a forceful cough if left
unsecured. A dislodged
tracheostomy tube is difcult
to reinsert, and respiratory
distress may occur.

both ends around so that they

meet on one side of the neck.
Tighten the tape until only two
ngers can be comfortably
inserted under it. Secure with a
knot. For a new tracheostomy,
two people should assist with
tape changes.
9. Remove old tapes and
discard in a biohazard
container.
10. Although some long-term
tracheostomies with healed
stomas may not require a
dressing, other tracheostomies
do. In such cases, use a sterile
tracheostomy dressing, tting it
securely under the twill tapes

9. Tapes with old secretions

may harbor bacteria.
10. Healed tracheostomies with
minimal secretions do not need
a dressing. Dressings that will
shred are not used around a
tracheostomy because of the
risk that pieces of material, lint,
or thread may get into the
tube, and eventually into the
trachea, causing obstruction or
abscess formation. Special
dressings that do not have a