What safety precautions must the nurse take when caring for a client with a tracheostomy?

Overview

A tracheostomy is a surgical opening through the neck into the windpipe (trachea). The opening is also called a stoma. A tracheostomy helps you breathe if you have a lung or nerve problem, an infection, or trouble handling secretions.

Taking good care of a tracheostomy is very important. It can prevent infections and help keep you breathing easily.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line (811 in most provinces and territories) if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

How can you care for yourself at home?

General tips

Your doctor or nurse will give you instructions about how to take care of your tracheostomy, or trach (say "trayk"). This will include how to suction your trach, how to clean the opening in your neck (stoma), and how to clean and replace the trach's inner tube (inner cannula). Be sure to follow all of these instructions closely.

• Have your emergency supplies ready and available wherever you are.
• Be sure to connect to oxygen before and after suctioning and cleaning, as needed.
• Always wash your hands before and after caring for your tracheostomy.
• Keep the air in your home moist with a room humidifier.
• Eat while sitting up. If any food gets into the tube, suction it out right away.
• Wear clothing that is loose around your neck, and avoid clothing with loose fibres.
• In a bath or shower, avoid getting water into the tracheostomy. Cover the stoma so that no water gets in but you can still breathe. You can also shower with your back to the water.
• Do not swim.
• Replace the tube holder (trach tube tie) if it gets wet or damaged. If it is not damaged, it can be washed and dried and used again.

Suctioning

Always have suction supplies ready, including a fully charged suction machine. Suction the trach 3 to 4 times a day, or more if needed. For example, two of the times could be before you go to bed and when you wake up in the morning. You will need suction catheters, a suction machine, and a mirror. Here are the steps to take:

1. Wash your hands with soap and water for at least 30 seconds.
2. Connect to oxygen for 30 to 60 seconds before suctioning.
3. Connect a catheter to the suction machine tubing. Insert the catheter into the trach. Push the tube in gently to the premeasured length.
4. Slowly pull the catheter out of the trach, rolling it back and forth between your fingers, with your thumb over the control valve (this turns the suction on). Do not keep the suction on for more than 10 seconds at a time.
5. Wait about 30 seconds and repeat inserting and pulling out the tube until all the mucus has been removed.
6. Throw away the used catheter. Or ask your doctor how to clean it properly to use it again. Connect to oxygen after suctioning. Wash your hands again.

Stoma care

The opening in your neck is called a stoma. To care for your stoma, clean and dry it 2 times a day, and as needed. Do not let crust form on the skin at the stoma. You will need saline fluid or sterile water, 8 or 10 cotton-tipped swabs, gauze pads, a small cup, a mirror, presplit gauze, and ointment for the skin. Follow these steps:

1. Wash your hands with soap and water for at least 30 seconds.
2. Fill the cup with the saline fluid or sterile water. Dampen a gauze pad or cotton-tipped swab and squeeze out any excess liquid from the gauze.
3. Clean and remove dried mucus around the stoma with the damp gauze pad or cotton-tipped swabs. To prevent spreading an infection, wipe the gauze or swab only once and then throw it away. Repeat with new, sterile material until the skin is clean. Be sure to look for any changes to the area, such as changes in colour or swelling.
4. Dry your skin with a clean gauze pad. If your doctor tells you to use skin ointment for your stoma, apply the ointment with the remaining cotton-tipped swabs. If needed, use a new, presplit gauze to protect the skin.
5. Wash your hands again.

Cleaning the inner cannula

A cannula is the tube that fits into the stoma. Clean and replace the inner cannula 2 times each day, and as needed. For a reusable inner cannula, you will need 2 small bowls, a small cannula pipe brush, sterile water or saline fluid, and a mirror. To clean the inner cannula:

1. Wash your hands with soap and water for at least 30 seconds.
2. Pour a small amount of sterile water or saline fluid into both bowls.
3. Unlock the inner cannula from the trach and remove it by gently turning it counterclockwise then pulling it out and down. Put the reusable inner cannula into the first bowl. (If the inner cannula is disposable, throw it away and replace it with a new inner cannula.) Clean the inside and outside of the reusable inner cannula with the brush.
4. Rinse the cannula in the second bowl. Shake the cannula out and slide it gently back into the outer cannula. Make sure the cannula is locked in place and you cannot pull it out.
5. Wash your hands again.

When should you call for help?

Call 911 anytime you think you may need emergency care. For example, call if:

• You have severe trouble breathing, and coughing or suctioning does not help.
• Your trach falls out and you cannot get it back in.

Call your doctor or nurse call line now or seek immediate medical care if:

• You have trouble breathing after suctioning.
• You have signs of infection, such as:
  • Increased pain, swelling, warmth, or redness in the stoma.
  • Red streaks leading from the stoma.
  • Pus draining from the stoma.
  • A fever.
• Your secretions change.

Watch closely for changes in your health, and be sure to contact your doctor or nurse call line if you have any problems. Make sure you have your emergency supplies, including the obturator, available when help arrives or when you arrive at the doctor's office.

What safety precautions are necessary when caring for someone with a tracheostomy?

What are key safety measures the nurse must maintain for the client with a tracheostomy?

What are the nursing considerations in caring the tracheostomy tube?

When caring for a client with a tracheostomy What should the nurse be aware of?