Proper care of the skin around the tracheostomy site will help to prevent infection and irritation at the stoma site.
Supplies you will need
Your hospice nurse will provide you with a prepackaged kit that usually contains:
- Sterile gauze pads
- Sterile cotton swabs
- Sterile gloves
- Sterile cup
- Pipe cleaner brush
- Trach ties or tapes
You will also need:
- Sterile hydrogen peroxide
- Extra gloves
- New inner cannula (if applicable)
What to do:
- If there are crusty secretions, use the cotton swabs soaked in hydrogen peroxide to gently loosen.
- Soak two of the gauze sponges in hydrogen peroxide. Use each gauze sponge for only ONE sweep around the outer portion of the trach.
- Choose a clean, flat and smooth work area. A clean table will work.
- Wash your hands.
- Explain to the patient what you are going to do even if you do not think they can hear you.
- Put on your clean extra gloves (not sterile).
- Suction the patient (see Tracheostomy Suctioning teaching sheet )
- Take off the used gloves and throw away.
- Wash your hands and place kit on clean work surface.
- Open the kit using the outer wrapping as a clean work area.
- Put on the sterile gloves.
- Carefully remove the inner cannula of the trach by turning and gently pulling it out.
- If changing the inner cannula to a new one, skip to #14 a.
- Place this cannula in hydrogen peroxide and use the brush to clean the inner rim.
- Rinse this inner cannula in the hydrogen peroxide, tap it gently to dry.
- Rinse the inner cannula with sterile normal saline. Gently shake water off inner cannula.
- Replace the cannula back into the trach. Turn to lock in place.
- Insert the new inner cannula back into the trach. Turn to lock in place.
- Prepare to change the tapes: (see diagram)
- Be careful – the ties are the only thing that holds the trach in place!
- Find the clean ties in the kit. If only one tie is provided, cut it in half.
- Knot one end on each tie to keep it from fraying.
- Cut a ½-inch slit near the other end of the tape (nurse will show you).
- Thread the knotted end through opening on one side of the trach plate.
- Pull the end through the slit.
- Gently pull it tight against the trach plate.
- Repeat on the other side.
- Tie the tapes securely at the back of the neck. Leave a 2-finger space so it is not too tight around the neck.
- You will have two sets of tapes on the neck. Cut the dirty tapes and remove carefully. Be careful not to cut any of the small balloon tubing.
- Throw the dirty tapes away.
- Place a gauze pad between the opening site and the trach tube to absorb secretions and prevent irritation.
- Straighten the area; dispose of supplies.
- Wash your hands.
Additional instructions from your nurse
Observe for any changes in color or odor of tracheostomy secretions. If there is bleeding or swelling of the trach site, report this to your nurse.
Adapted from: Harkreader, H., & Hogan, A.M. (2007). Fundamentals of nursing: Caring and Clinical Judgment (3rd ed.). St. Louis, MO: Saunders.