› Tracheostomy Care

Get Tracheostomy Care Right

Tracheostomy care, or trach care as it is usually called, requires skill and an ability to focus both what you are doing, as well as its immediate effect on your patient.

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Organization of the supplies needed, opened and ready to go helps you perform the skill quickly and efficiently.

OK, pop quiz! Do you know the difference between a tracheostomy and a tracheotomy? Answer at the end of this page.

Most facilities have a trach care kit that you pull from the supply cart. Each kit, however holds something different, so read the cover to make sure you don’t have to pick something else up before you enter the patient’s room.

  • Some kits have individual packets or small bottles of saline and/or peroxide to clean the trach. Others do not. 
  • Most kits have the old fashioned ties you will see in this video, but most facilities have a separate trach collar that is easier to use, so pick that up as well. 
  • The spit gauze in the kit is usually pretty pathetic. Get a separate package of split gauze and you can use one of the two in the envelope.
  • Remember to put the trash can near you to throw soiled supplies away as you work.

Also, unless you really know the patient well, I would gown, glove and wear a face shield. Sometimes, if you have worked with the patient before you can be pretty sure there won’t be sputum flying across the room or landing on you, so the gown and shield can be eliminated. 

But remember, standard precautions require that you protect yourself from any body fluids (except sweat). So err on the side of caution. Trachesotomy care can be rather messy.

cuffed trach

New trachs, for the first few months are notorious for having copious amounts of sputum. It may be hard to take at first. Remember your poker face. Do not react negatively to what you see and hear. Remain professional and respect your patient’s feelings.

I personally have a hard time with sputum. I can handle vomit, diarrhea or blood, but sputum…..UUUUGGGHH…. so I understand how you may feel. Nevertheless, the job of a nurse is to support, empathize and never judge a patient for their condition. 

Tracheostomy Care Video

When you are going to be doing tracheostomy care, it is a good idea to check out where a spare trach is in the room before beginning.

An emergency is not the time to wonder where it may be.

 Some inner cannulas have two hooks on the side that you compress in order to release it from the outer cannula. Others are like what is in the video.

Removing the inner cannula can cause the outer cannula to move around and that will irritate the patient’s throat enough to make him cough. So, steady the outer cannula by holding down the face plate (flat portion that the ties run through) with your other hand. 

When you take off the non-sterile gloves, use hand sanitizer, make sure your hands are really dry and then glove with the sterile pair before continuing with tracheostomy care.

Putting the inner cannula in peroxide will make any sputum stuck to it foam and bubble. The more sputum, the more foam. Poker face….

Note: A lot of trachs now use disposable inner cannulas so trachesotomy care doesn't require cleaning the inner cannula, just replacement!

When removing the split gauze and cleaning around the stoma, some docs ask for it to be cleaned with ½ strength peroxide which is fine, just remember to rinse with NSS (normal saline solution) and dry after so it doesn’t irritate the skin. 

Note any of the following during tracheostomy care:

  • Sutures (normal right after surgery and usually removed by the surgeon in a few weeks)
  • Redness (normal initially, but keep an eye on whether it is diminishing or increasing. Increasing could mean an infection and the doc needs to be notified. It could also be due to washing the area with peroxide and not rinsing afterwards).
  • Blood (not usually seen. Small amounts from the incision not a big deal, blood in the sputum needs to be reported).
  • Color of sputum (usually white or cream or yellow. Green means you have a bacterial infection going on and needs to be reported to the doc. Usually with green sputum there is a pretty foul odor to the breath as well).

Sometimes cleaning around the trach with a Q-tip simply pushes the sputum around and you can’t get it off the skin. Try tucking the end of the Q-tip in a 4x4 gauze to give it more absorbing and wiping power. 

Again, moving that cannula around while you try to clean it will cause the patient to gag and cough. Be kind!

The ties you see in this video come with all tracheostomy care kits. Most facilities now have nice Velcro trach collars that are much easier to use.  You can cut the collar to size. The size straight out the package would fit a giant.

The ties are the hardest part of the whole procedure as far as I’m concerned.

Never, never, never, never, NEVER!! unhook the old tie before securing the new one.

NEVER, NEVER, NEVER let your patient tell you he will hold on to the trach while you switch them out. There will come a time when they will forget and let go to do something really important like scratch their nose, accidently sneeze or cough and OUT WILL COME THE TRACH!

Then you’ll be sorry!

Please remove your gloves as soon as you are done with hands-on care of the trach and wash your hands. Doing what was done in the video spreads all sorts of pathogens onto the bedrails and over bed table.

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Related Pages

Answer to the pop quiz: The difference in Tracheostomy and Tracheotomy  is the endings:

  • -ostomy means permanent opening
  • -otomy means temporary opening

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