Tracheostomy Care II: Procedure

Begin by performing hand hygiene and putting on personal protective equipment including a gown, gloves, mask, and eye protection. If necessary, suction the tracheostomy using a sterile suction catheter to prevent occluding the outer cannula while the inner cannula is removed. This protects both patient and healthcare worker.

Stabilize the outer cannula and faceplate, then release the lock and remove the old inner cannula, discarding it in a plastic bag. Change to sterile gloves before inserting the new disposable inner cannula. Reapply the oxygen source if needed. This procedure prevents contamination and maintains airway patency.

Remove the oxygen source if necessary and clean the stoma under the faceplate using a saline-dipped applicator or gauze sponge. Gently pat the skin with a dry 4x4 gauze sponge to remove excess moisture. This prevents skin irritation and infection at the tracheostomy site.

A second nurse is essential to hold the faceplate and prevent accidental extubation while the old collar is removed and the new collar is placed. One nurse stabilizes the tracheostomy tube while the other applies the new collar around the patient's neck and secures the Velcro tabs.

Check the fit by ensuring one finger's width gap between the neck and the collar. This measurement prevents the collar from being too tight, which could restrict circulation or cause discomfort, while ensuring it remains secure enough to support the tracheostomy tube.

Reassess the patient's respiratory status, including respiratory rate, effort, oxygen saturation, and lung sounds. These assessments determine the effectiveness of interventions and identify potential complications such as airway obstruction or inadequate oxygenation. Document all findings and patient responses following the procedure.

Slide a commercially prepared tracheostomy dressing or pre-folded non-cotton-filled 4x4 dressing under the faceplate to reduce skin irritation and protect the site. The dressing absorbs moisture and protects the skin from friction and irritation caused by the tracheostomy tube and collar, promoting healing and comfort.