03.04 Trach Care

In this video we’re going to look at trach care. Remember you should always suction the patient before trach care, so if you haven’t watched that skill video yet, make sure you watch it! And remember as you’re doing this, you want to be assessing the stoma for signs of infection or skin breakdown.

First you’re going to open your sterile trach care kit and a sterile 4x4 pack of gauze, then pour sterile saline solution into the pack of gauze. You’ll notice the nurse is wearing goggles. If the patient coughs, you could get exposed, so we always recommend goggles or a face shield for trach care.

Then you have some other supplies that you need access to, so you’re going to open those onto your sterile field inside your kit. The new dressing, the new inner cannula, and the trach ties. Now - if your trach ties, or trach holder ISN’T sterile, just open it and set it next to the sterile field so that you can reach it.

Now you need to remove the inner cannula - these are disposable, so this will just get tossed. And remove the old dressing as well. Then remove your gloves and perform hand hygiene.

Now you can grab the sterile glove pack from the kit and put on your sterile gloves. Again, go to the Sterile Gloves skill video if you need help here. You’re gonna keep your dominant hand sterile throughout the whole procedure.

To clean the secretions from the flange of the tracheostomy, you’ll use a combination of the cotton-tipped applicators and pipe cleaners. Just don’t insert them into the stoma itself. If needed, you can dip them into the saline solution.

To clean under the flange and around the stoma, you’re going to use the saline-soaked gauze. You’ll want to grab a piece of gauze and ring it out, then stick it under the flange and pull it out the other side - you can use the end of the cotton-tipped applicator to help push it through if you need to.

Repeat this with a clean piece of gauze each time, and use another piece to wipe off any excess secretions if you need to. Make sure you’re lifting the flange to clean underneath it.

Once you’re satisfied with cleaning, you need to replace inner cannula with new, clean disposable inner cannula and lock it in place.

If you have to clean your inner cannula, you’ll use the brush in the kit and sterile saline solution. Notice we do NOT use hydrogen peroxide unless there is an obvious skin infection - it prevents healing.

Now it’s time to change the trach ties. Make sure your new ties are ready to go and within arms reach. You want to always keep one hand on the trach itself and start by untying one side of the existing ties. If you have a velcro holder like this, simply undo the velcro and pull it out of the flange.

Then you’re going to insert the new ties through that flange hole and secure the velcro. Remember, you have to keep one hand on the trach in case the patient coughs - that thing could fly right out!

With one hand, slide both the new and the old ties behind the patient’s head (still holding the trach with your other hand) and pull the new ties snug.

Now you can remove the old ties from the other flange and secure the new ties to the other side. Just make sure they aren’t twisted.

Check to make sure you can fit 2 fingers snugly beneath the ties. Too loose and the trach could dislodge, too tight and it could irritate the patient and make them cough.

Last step - you will carefully place the new split dressing under the flange around the trach. Again, you can use the tip of the cotton-tipped applicators if you need help pushing it up under the flange. Make sure it’s high enough to be under the flange to prevent skin breakdown.

Then you’ll label the dressing per facility policy, discard all your supplies, and document the procedure.

Easy as that, right!? The big thing to remember is that the respiratory system is sterile, so anything going INTO the trach or around the stoma HAS to be sterile. And, of course, keep one hand on the trach at all times when you’re changing the ties!
We hope that was helpful! Now, go out and be your best selves today. And, as always, happy nursing!