TRACHEOSTOMY CARE GUIDELINES

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.

TRACH TYPE:

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

name, size, cuffed).

CLEANING:

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.

DRESSINGS:

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.