Avoid manipulation and movement of the trach tube as much as possible. Excessive displacement of the tube can cause pressure injuries in the trachea and tracheal spasms.


o   All primary caregivers should know what type of trach the patient has (brand

name, size, cuffed).


o   When trach collar is in place, you may gently clean around tracheal stoma with

Q-tip or gauze and water as often as needed. o   With helper present to hold the trach tube in place, you may remove the collar

one side at a time to clean and dry the skin underneath using a wet gauze.
o   Once cleaned, apply 3M Cavilon No-Sting Barrier Film ("lollipop") around stoma,

covering any areas that may become wet. Allow to air dry. You only need to

apply lollipop once a day.


o   To absorb wetness around the trach site, place gauze drain sponges, Lyofoam T sponge, or Lyofoam Max T around the tube.

o   If possible, avoid tucking dressings underneath the trach collar, as this can cause deflection of the trach tube and lead to injury inside the trachea. If you must use a dressing under the collar to absorb wetness, apply a thin gauze drain sponge or Lyofoam Max T (if available), taking care to minimize trach tube movement. Do not tuck Lyofoam T under trach collar.

o   If using Lyofoam T: The shiny side of the dressing goes against the skin. The foam side faces out.

o   If using Lyofoam Max T: The foam side goes against the skin. The shiny side faces out.

o Change dressing as soon as it becomes saturated. The Lyofoam T and Lyofoam Max T dressings are more absorbent, so they may stay on longer than a simple gauze dressing. Anticipate needing to change a gauze dressing frequently.

· Change the trach collar as soon as it becomes soiled or wet. Only do so with assistance of a helper. The helper holds the trach tube in place, while the primary caregiver removes the collar one side at a time and applies the new collar.

· o   The collar should be snug, but not too tight. The trach tube flange should be

· flush with the neck, not sticking out away from it. You should be able to slip 2

· fingers between the side of the neck and the collar. CUFF PRESSURE:

· o   Cuff pressure should be between 20-27 cmH20 (=15-20 mmHg).

· o   Check cuff pressure with manometer after "blows", any other time the cuff

· needs to be deflated and reinflated, and if the patient feels that the cuff

· pressure is too low.

· o   Avoid unnecessary cuff pressure checks. SUCTIONING:

· o   Perform in-line suctioning as often as needed.

· O        Deeper suctioning causes bronchial spasm. This is roughly double the length           from the tip of the suction catheter to the black line on the catheter.
o   Patient may request slightly deeper suctioning at his discretion. In general, the

· M.I.E. replaces the need for deep suctioning.




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