Tracheostomy Information and Care

Tracheostomy

Emergency equipment required to be available at the bedsides of tracheostomy patients at all times

• Spare trach tubes (one same size, one size smaller)
• Obturator
• Bag/mask
• Suction equipment
• Scissors
• Extra trach ties

My Airway Signs

• All trach patients must have aCOMPLEX AIRWAYcard at their bedside.
• MD must fill out the top portion regarding airway plan/issues/risks, etc
• RN/RT must fill out the bottom portion including trach size, trach type, cuff status, suction information, and date of next trach change
• RT will indicate what "letter" trach is currently in place on this card to aid in sterilization documentation
• Pre-measured safe suction depths are on the back of the card

Tracheostomy Care Key Points

• Stoma site care every 12 hours
• Trach dressing changed every 12 hours and prn
• Trach ties changed every day and prn if wet and soiled

Who performs trach care?

• Critical Trach
  • 2 licensed staff
    • RN
    • RT
  • Although not mandatory, it is preferred to have one be a RT
• Fresh Trach
  • ENT physician and 1 licensed staff (RN or RT)
• Mature Trach
  • 1 licensed staff (RN, RT, or LVN) and trained parent/caregiver, or
  • 1 licensed staff (RN, RT, or LVN) and CA, or
  • 2 licensed staff (RN/RT and LVN)

Trach Changes

• Pediatric tubes changed once a week routinely and PRN if obstruction present or by physician order
• Adult size trach tubes changed once every 30 days and PRN
• ENT will perform very first trach change
• Use a water soluble lubricant or sterile water to shaft of tube prior to insertion (do not use petroleum based products)
• After insertion, clean and dry the obturator and hang at bedside or place in patients Trach Go Bag

Trach Tube Sterilization/Cleaning

• Shiley tubes are not cleaned or sterilized, obtain a new tube with each trach change
• Bivona tubes will be sent to sterile processing
  • Clean bivona with mild soap and warm water
  • Allow to air dry
  • Apply appropriate colored zip tie into hole on flange
  • Tubes are only sterilized a maximum of 4 times
  • Label each trach with a letter (A, B, C, D..) to identify each trach for documentation
  • Obtain necessary forms (Procedure form and Tracking form)
  • Place completed Procedure form and 5 patient stickers along with the soiled tube in biohazard bag (also place patient sticker on front of bag for identification)
  • Call DCMC SPD to notify them a trach tube is being delivered for sterilization
  • Once you have the sterilized trach back, keep the Procedure form with the chart
  • Also keep the Tracking form with the chart to keep track of which trach has been sterilized and the number of times it has been sterilized

Inner Cannula Care

• Clean any non-disposable inner cannula every 12 hours and prn using a trach cleaning kit and sterile water
• The inner cannula should not be out of the trach for longer than 15 minutes