tracheostomy cares

Most of the trachs today are Shileys with an inner plastic cannula which is disposable. The outer portion is not sterile but the inner portion is sterile. You must make sure that you have the proper size inner cannula before you change it out. Once you have the proper size you just pinch the two releases on each side of the inner cannula (on the patient) and pull it out and throw it away. Using sterile tech. and trying not to touch the tip (innermost portion of the inner cannula) remove the new inner cannula from the package and insert gently into the trach and secure it with the side releases. Once it is secure you can now clean around the actual tracheostomy with 1/2 peroxide and 1/2 saline. If the trach ties or holder need changed the change them as well. Just remember that the newer the trach the bigger the risk to the patient if it comes out..we don't even touch them the first 24 hours .

Once I had a patient just hours back from or with a new trach and somehow when we were pulling the patient up in bed the whole trach got pulled out..talk about freaking out but I kept my cool.. the surgeon could not come right then and anesthesia was taking too long the patients sats were dropping..so I deflated the baloon on the trach and very gently eased it back into the the tracheostomy opening and blew the ballon back up. the patients sasts came back to normal and when the surgeon made it to the unit (Ithought I was going to be blasted) but he was actually appreciative of what I had done. I hope I never have to do it again.

Review Lippencotts Manuel on nursing procedure and the facilities P&P. If you will be having a lot of trachs ask for a hands-on teaching inservice from the nurse educator at your facility.