Trach Care

Number One Biggest Piece of Advice!!! NEVER EVER cut or detach the old trach ties until you have the new ones secured!!! I almost killed a baby once by thinking that the trach was secure when it wasn't. Fortunately for all concerned, she survived unharmed, but I was terrified! If you're doing a two-person tie change that's different because the second person can secure the trach in the stoma while the ties are secured.

Good skin assessment is important, not just the stoma itself, but also the skin on the neck, under the chin were the flange can rub or pinch, and under the hairline where sweat can collect. Frequent cleansing of collected secretions from around the stoma will go along way to keeping it healthy. I've seen a variety of different practices, with no significant difference in outcomes. Some places use half strength H2O2, some use sterile water, some sterile saline. Some use sterile cotton swabs, some wrap the tip of same with 2x2s. Then there's the use of nystatin cream routinely without evidence of colonization. I have a problem with that. I have issues with putting something that has a lipoid base into or near to the airway. A better choice would be nystatin powder applied with a swab.

Realize that your patients with strong coughs will be able to move secretions out of the trach on their own and that will require your attention if they are unable to clean up their own trachs, if they're mechanically ventilated or if they use a Swedish nose for humidification and filtering. When a Swedish nose gets gooed up with sputum, it's nasty messy and the patient doesn't ventilate well.

Spend as much time as you can with a preceptor learning all about what your facility wants and expects for trach care and you'll be fine.

My son had a trach so i have a lot of experience (I did all of his trach cares myself). Before you feel very comfortable changing the dressing and the trach, it is helpful to put a small blanket roll (like a receiving blanket rolled up) behind the neck if they are laying on their back. Have the ties and and dressing (alevyn is the most comfortable, soft and absorbent if your hospital has it...if not then use 2x2 split gauze) all cut before you begin if you are familiar with the size the patient needs. If you are working with children, they happen to drool a lot, so always make sure that the ties and dressings are dry to prevent a rash on the neck. When cleaning the site use sterile spongue, poor saline onto it (a saline bullet is best because you know it is sterile) and wipe the site gently with that, as well as all around the neck...be sure that you also dry the site before putting ties and dressing back on to also prevent rash. To make sure the ties are tight enough but not too tight, be able to fit your pinky finger through the ties. When you are done with everything you want to make sure the trach is straight in the stoma by straightening out the patients head.

Golden nuggets re trach care here:Tracheostomy and Vent Information