Clinical

YOUR PATIENT MAY have a tracheostomy to bypass an upper airway obstruction, prevent aspiration, manage tracheobronchial secretions, or allow for prolonged mechanical ventilation.

DO

* Always keep supplies at your patient's bedside for suctioning; tube and stoma care; delivery of oxygen, heat, and humidity; tracheostomy tube replacement; and artificial ventilation.

* Begin assessing his tracheostomy by inspecting the stoma site, which is typically slightly larger than the tracheostomy tube.

* Note the amount, color, consistency, and odor of tracheal and stomal secretions. Confirm the tracheostomy tube size and whether it's cuffed or fenestrated.

* When your assessment findings (coarse breath sounds, noisy breathing, and prolonged expiratory sounds) indicate that your patient's airway needs clearing, suction it using sterile technique. Hyperoxygenate him before and after suctioning and between passes to compensate for suctioning-induced hypoxemia.

If the inner cannula is designed for reuse, clean it in a solution of equal parts hydrogen peroxide and 0.9% sodium chloride. Wear sterile gloves and maintain aseptic technique. Remove encrusted secretions from the lumen of a metal tube with sterile pipe cleaners or a soft sterile brush. For a plastic tube, use only sterile pipe cleaners to prevent damage by a brush. After cleaning, thoroughly rinse the inner cannula with 0.9% sodium chloride solution.

* Reinsert the inner cannula and securely lock it into place.

* Secure new ties to the tracheostomy tube flanges before removing the old ones. Insert your little finger between the tie tapes and your patient's neck to check the fit and ensure his comfort.

* Place a sterile split sponge under the tube flanges to absorb secretions.

* Place the call bell where your patient can easily reach it.

DON'T

* Don't clean and reuse an inner cannula designed for one-time use.

* Don't cut gauze and place it under the tracheostomy tube flanges; inhalation could draw fibers into the patient's trachea. Use a manufactured split sponge.

* Don't lavage with 0.9% sodium chloride solution during suctioning unless you

need to clear a blockage of clots or mucus.

* Don't allow a humidifier to empty.

* Don't let condensation accumulate in the oxygen delivery tubing.

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