quick questions about trach care

[Ms.RN]

hi guys

i just have a quick question about tracheostomy care. if a patient have a disposable inner cannula, do you guys change it once a day or when you are doing a trach care do you wash inside inner cannula but place it back after washing it? how often do you change the inner cannula? what is considered trach care? does anybody have like any nursing journal about how often inner cannula needs to be changed or what needs to be done?

[caliotter3]

You can either clean the inner cannula and immediately replace it, or trade it for an already clean one. In home care, we would keep rotating about four inner cannulas that we would clean and air dry. We placed them in a clean toothbrush holder, they fit in the holes just right. We did trach care once each shift and traded the inner cannulas at that time. Gave us time to clean the cannulas later. Trach care should be done according to the doctor's order, but a minimum of once daily. More often, for constant, copious secretions. You can clean around the stoma and change the trach dressing for a clean, dry one as often as you like without necessarily changing the inner cannula each time. Some patients produce more secretions than others so require trach care more often. It is not uncommon to do trach care three times daily (each shift) and PRN per order. Usually the order will call for sterile water, normal saline, one half strength H2O2/water, or soapy water, as needed and available for cleaning the trach area. The cleaner you keep the trach and trach stoma, the less likely the patient will get respiratory infections starting at this site.

[NRSKarenRN, BSN, RN]

moved to our pulmonary nursing forum

see the links here: tracheostomy and vent information

[Ms.RN]

here is my problem. i have a trach patient and he has been switched from non disposable to disposable inner cannula. now our boss want us to change his cannula to new one once a day on my shift (3-11) and trach care is suppose to be done every shift. next day my boss showed to me a cannula that she took out which was filled with moderate amount of secretion, stating i didnt change his cannula. the nurses from the midnight shift and day shifts are only changing the drainage dressing therefore his inner cannula hasnt been touched during midnight shift and day shift because afternoon shift is suppose to change to new one. my understanding of trach care is that when nurses are doing trach care every shift, they are suppose to take the inner cannula out and wash it with hydroxide and saline and also clean the trach plate and suctioning if needed. am i right or am i wrong and does inner cannula needs to be changed once a day or only when it cannot be completely cleaned?

[caliotter3]

You do what the order states. If it states change inner cannula once daily, that is the deal. Accusing one shift of not doing the cannula change when it is apparent that once daily is insufficient, is using wrong-headed reasoning. Submit a request to the doctor to change the order to read, change inner cannula BID or PRN increased secretions. That should solve the problem; or request that the order be changed to read, change inner cannula TID or PRN increased secretions. Then, blaming one nurse will not be necessary, all bases will be covered.

[GreyGull]

If you allow an airway to plug just because a "doctor's order" says one per day, you are negligent...period. You can still maintain a patent airway and abide by the physician's orders. To allow a patient's airway to plug and the patient suffer irreversible damage or death is inexcusable. Using the "I was just following doctor's orders" will not protect you in this situation. You can have the doctor order the inner cannula to be changed as often as you want but that will still not excuse not checking airway patency.

Because an order states something, commonsense should prevail. Every time you do trach care you should check the inner cannula. If secretions are particularly thick, you should be checking the inner cannula. If it is partially clogged, you should take measures to clear it by either changing to a new one or cleaning the existing one. Non-disposable inner cannulas are meant to be changed but in some home care situations that is not always possible.

I believe some basic airway maintenance education and not just "how often to change an inner cannula" should be ordered here.

[Spika RN]

I know at my job with the disposable cannulas we change them every shift with the trach care and even on the disposable cannulas it says do not wash and reuse so I am not sure about the one you guys are using but that is the disposable on non disposable when ever I did trachea care I would clean out the inner cannula