Tracheostomy care guidelines

St. James’s Hospital / Royal Victoria Eye and Ear Hospital

Tracheostomy Care Working Group
October 2000
These guidelines have been produced as an educational support and guide for healthcare professionals
caring for tracheostomy patients in the clinical setting. Advice onthe care of a specific patient should
always be sought from a suitably qualifiedprofessional.
The guidelines have been ratified by the Head and Neck Nurses Association of
Ireland (HANNA) and are recommended for use by its members.
GUIDELINES WRITTEN BY: TRACHEOSTOMY CARE WORKING GROUP of
ST. JAMES’S / ROYAL VICTORIA EYE AND EARHOSPITALS
Ms. Margaret Codd, RGN, BNS
(St. James’s Hospital) - Chairperson
Ms. Yvonne Sheridan, RGN
(St. James’s Hospital)
Ms. Hilary Collins, RGN
(St. James’s Hospital)
Ms. Janine Ryan, RGN
(St. James’s Hospital)
Ms. Maria Creggy, RGN
(St. James’s Hospital)
Ms. Michelle Royale, RGN
(St. James’s Hospital)
Ms. Kathleen Canavan, RN, BNS
(St. James’s Hospital)
Ms. Mildred Grubb, RN, RM, Dip.Nsg.Ed.,
Dip.Med.Ed., M.Med. Ed
(St. James’s Hospital)
Ms. Caroline Murphy RGN
(Royal Victoria Eye and Ear Hospital
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Tracheostomy care guidelines

St. James’s Hospital / Royal Victoria Eye and Ear Hospital
Tracheostomy Care Working Group
October 2000
These guidelines have been produced as an educational support and guide for healthcare
professionals caring for tracheostomy patients in the clinical setting. Advice onthe care of a
specific patient should always be sought from a suitably qualifiedprofessional.
The guidelines have been ratified by the Head and Neck Nurses Association of
Ireland (HANNA) and are recommended for use by its members.
GUIDELINES WRITTEN BY: TRACHEOSTOMY CARE WORKING GROUP of
ST. JAMES’S / ROYAL VICTORIA EYE AND EARHOSPITALS
Ms. Margaret Codd, RGN, BNS
(St. James’s Hospital) - Chairperson
Ms. Yvonne Sheridan, RGN
(St. James’s Hospital)
Ms. Hilary Collins, RGN
(St. James’s Hospital)
Ms. Janine Ryan, RGN
(St. James’s Hospital)
Ms. Maria Creggy, RGN
(St. James’s Hospital)
Ms. Michelle Royale, RGN
(St. James’s Hospital)
Ms. Kathleen Canavan, RN, BNS
(St. James’s Hospital)
Ms. Mildred Grubb, RN, RM, Dip.Nsg.Ed.,
Dip.Med.Ed., M.Med. Ed
(St. James’s Hospital)
Ms. Caroline Murphy RGN
(Royal Victoria Eye and Ear Hospital)
 GUIDELINES REVIEWED BY:
Prof. C. Timon,
Consultant Otolaryngologist,
(SJH / RVEEH)
Ms. D. Hyland,
Acting Nurse Manager, St. John’s Ward,(St. James’s Hospital)
Mr. C. Huet,
Nurse Tutor,
(RVEEH)
Mr. C. Beirne
Consultant Maxillofacial Surgeon,
(St. James’s Hospital)
Dr. J. Moriarty,
Consultant Anaesthetist,
(St. James’s Hospital)
Dr. F. O’ Connell,
Consultant Physician,
(St. James’s Hospital)
Ms. A. O’Brien,
Infection Control Sister,
(St. James’s Hospital)
Ms. O.J. Power,
Clinical Facilitator, ICU,
(St. James’s Hospital)
Ms. S. James,
Senior Speech and Language Therapist,(St. James’s Hospital)
Ms. S. Brady,
Senior Clinical Nutritionist,
(St. James’s Hospital)
Ms. A. M. O’Grady,
Senior Physiotherapist,
(St. James’s Hospital)

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GUIDELINES INCLUDED
•
Overview of tracheostomies
•
Bedside equipment.
•
Care of the inner cannula, stoma site and tracheostomy ties.
•
Suctioning via a tracheostomy tube.
•
Humidification of inspired gases.
•
Care of cuffed tracheostomy tube
•
 Care of fenestrated tracheostomy tube
•
Care of Passy Muir speaking valves.
•
Decannulation: removal of tracheostomy tube.
•
Dealing with emergencies.
•
Resuscitation via a tracheostomy tube.
 OVERVIEW OF TRACHEOSTOMY TUBES
DEFINITIONS
INDICATIONS FOR TRACHEOSTOMY
TRACHEOTOMY: Incision made below the
cricoid cartilage through the 2nd-4th
tracheal rings
TRACHEOSTOMY: The opening or stoma made
by this incision.
TRACHEOSTOMY TUBE: Artificial airway
inserted into the trachea during
tracheotomy
•
Bypass acute upper airway obstruction.
•
Chronic upper airway obstruction.
•
 Facilitate weaning from mechanical
ventilation by decreasing anatomical
deadspace.
•
Prevention / treatment of retained
tracheobronchial secretions.
•
Prevention of pulmonary aspiration.
Figure 1.TRACHEOSTOMY TUBE IN SITU
Figure 2. TRACHEOSTOMY TUBE COMPONANTS
COMPONANTS OF TRACHEOSTOMY TUBE (See Figure 2)
1.Outer tube
2.Inner tube: Fits snugly into outer tube, can be easily removed for cleaning.
3.Flange:
Flat plastic plate attached to outer tube - lies flush against the patient’s
neck.
4.15mm outer diameter termination: Fits all ventilator and respiratory equipment.
All remaining features are optional
5.Cuff:
Inflatable air reservoir (high volume, low pressure) - helps anchor the
tracheostomy tube in place and provides maximum airway sealing with the
least amount of local compression. To inflate, air is injected via the...
6.Air inlet valve: One way valve that prevents spontaneous escape of the injected air.
7.Air inlet line: Route for air from air inlet valve to cuff.
8.Pilot cuff: Serves as an indicator of the amount of air in the cuff
9.Fenestration: Hole situated on the curve of the outer tube - used to enhance airflow in
and out of the trachea. Single or multiple fenestrations are available.
Speaking valve / tracheostomy button or cap: Used to occlude the tracheostomy tube
opening (a) former - during expiration to facilitate speech and swallow,
(b) latter - during both inspiration and expiration prior to decannulation.

BEDSIDE EQUIPMENT
Every patient with a tracheostomy tube should have the following equipment available at
the
bedside:
•
Spare tracheostomy tubes
Same size and type as patient is wearing.
Smaller size
•
Tracheal dilator.
•
Suctioning equipment
Suction machine fitted with filter; suction tubing;
suction catheters (see suctioning page for sizes);
gloves (as below); bottle of sterile water to rinse
tubing - change daily.
 Ensure equipment is assembled and working
properly.
•
Humidification equipment
Equipment depends on method used - see
humidification page.
Ensure equipment is assembled and working
properly.
•
Gloves
Non-sterile **
Sterile gloves (for suctioning)
•
Infectious waste bag
•
Dry clean container for holding the speaking valve, occlusive cap/button or spare inner
cannula when not in use. (Get from theatre)
**Natural rubber latex gloves to be used by all except those who have latex allergy.
Nitrile gloves to be used by those with latex allergy.
 \

CARE OF THE INNER CANNULA, STOMA SITE AND

TRACHEOSTOMY TIES
AIM:1.To maintain a patent airway.
3.To prevent infection.
2.To maintain skin integrity.
4. To prevent tube displacement
FREQUENCY OF CLEANING
EQUIPMENT FOR STOMA CARE
Inner Cannula:
Check every shift
-see box below.
Clean PRN
Stoma: PRN to keep clean and dry
 Ties:PRN to keep clean and dry
Dressing trolley
Dressing pack
Pair of sterile gloves
Unsterile gloves
Normal saline solutionScissors
Lyofoam dressing
Suctioning equipment
New trach. ties
Infectious waste bag
(Sterile pipe cleaners - single use only)
To check inner cannula: Wash hands. Wearing a non-sterile glove, remove inner cannula.
Handle only the outer portion of the cannula. If clean, reinsert and lock into place. If soiled -
continue with step (d) below.
(a)Wash hands.
(b)Wearing unsterile gloves remove and dispose of the soiled dressing.
(c)Wash hands. Put on sterile gloves.
(d) First, remove and clean the inner cannula using sterile pipe cleaners and normal saline.
Dry. Reinsert.
(e)Secondly, clean the stoma site using gauze and normal saline. Pat dry. Apply lyofoam /
keyhole dressing if necessary.
(f)Lastly, if ties are soiled and need changing, have a second nurse hold the tracheostomy
tube securely in place, remove and replace tracheostomy ties. (Leave 1 finger space
between ties and the patient’s neck.)
(g)Ensure patient comfort.
(h)Discard of used equipment as per hospital policy.
(i)Wash Hands.
(j)Document procedure in the patient’s notes.
Note:
Leave first dressing intact for 24hrs if possible as the tracheostomy is a fresh wound.

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Tracheostomy Care Guidelines

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