Caring for Tubes with Inner Cannulae

Inner Cannula Care

 

In an effort to decrease the time that is required in the nursing care of the tracheostomy patient and to help reduce the infection rate that is associated with tracheostomies, SIMS Portex Inc. has designed two tubes with disposable inner cannula: the D.I.C.™ tracheostomy tube and the Flexible D.I.C. tracheostomy tube. Lo-Profile™, a low-profile, rigid tracheostomy tube with a reusable inner cannula, has also been developed for the patient that will be discharged home with a tracheostomy tube in place.

D.I.C. and Lo-Profile tracheostomy tubes are available in five sizes; the D.I.C. tubes come with color-coded inner cannulae for ease of identification.

Changing the D.I.C. Inner Cannula

Supplies:

1. Disposable inner cannula |correct size)

2. Two vinyl examination gloves

3. Two sterile gloves.

Procedure:

1. Gather supplies.

2. Explain procedure to the patient.

3. Wash hands well with surgical soap and water.

4. Open disposable inner cannula package, maintaining sterility.

5. Glove, with nonsterile vinyl gloves, and gently remove old inner cannula.

NOTE: Place thumb and index finger on tracheostomy tube to prevent movement,- using free hand, grasp small plastic ring of inner cannula and remove.

6. Discard gloves and cannula.

7. Glove, using sterile gloves.

8. Insert new sterile disposable inner cannula into tube.

NOTE: Place thumb and index finger on tracheostomy tube to prevent movement; using free hand, insert sterile inner cannula. The cannula should click into place.

Cleaning Reusable Inner Cannula

The inner cannula is one of the most important parts of the three-part tracheostomy tube. Its presence in the outer tube ensures that the tube is kept clear of secretion buildup, since it can be removed and . cleaned. Generally, it should be removed and cleaned every two to three hours for the first two days after tracheostomy and at least every four hours thereafter. For patients that are unable to tolerate being off the ventilator during the time which is required for cleaning, Lo-Profile tracheostomy tubes are designed with the 15 mm ventilator connector as an integral part of one of the inner cannulae.

 

Inner cannula care always requires strict aseptic technique.

Changing the Tracheostomy Tube

The initial tracheostomy tube changes are usually done by the physician until the stoma and tracheal tract are well established. After the tract is established, changes are performed as the physician specifies. If the tracheostomy tube comes out, the patient's tracheostomy site should be sealed by placing sterile gauze over it and the patient may then be ventilated by bag/mask if necessary. It also may call for the patient to be intubated orally before the tracheostomy tube is reinserted.

Routine tracheostomy tube changes are frequently carried out by the nursing or respiratory care staff after the tracheal tract is established. This procedure should be performed according to hospital protocol.

Supplies:

1. Sterile tracheostomy tube of the correct size and type

2. Twill ties or a Velcro® tracheostomy tube holder

3. Sterile gloves

4. Sterile towel or drape

5. Water-soluble lubricant

6. Sterile gauze pads (4 x 4)

7. Scissors

8. 10 cc syringe

9. Precut tracheostomy dressing.

Procedure:

1. Gather all equipment and supplies.

2. Explain the procedure to the patient.

3. Wash hands well with surgical soap and water.

4. Glove with sterile gloves.

5. Remove the tracheostomy tube from the package and remove the inner cannula using aseptic technique.

6. Thread the outer cannula with neck tapes.

7. Test inflate the cuff on cuffed tubes.

8. As you are deflating the cuff, taper back the cuff to ease insertion.

9. Place the obturator into the outer cannula.

10. Lubricate the tip of the tube and the obturator with water-soluble lubricant to ease insertion.

11. If the patient has a cuffed tube in place, deflate the cuff before removing the tube.

12. When the new tube is fully ready for insertion, cut the tapes on the old tube.

13. Grasp the old tube by the neck flange and remove it in a downward motion.

14. When the old tube is out, immediately insert the new tube using gentle inward pressure.

15. IMMEDIATELY remove the obturator, inflate cuff, and record volume used.

16. Secure the neck tapes with a square knot with enough space between neck and tie to allow

1 7. Insert the new inner cannula and lock in place.

Decannulation Procedure

When the patient is being wcaned form mechanical ventilation or tracheostomy tube may facilitate the decannulation procedure.

The design of the tube allows the patient to gradually become used to handling secretions and breathing on his/her own. The tube can also provide the protection of a cuff if the patient should require supportive ventilation.

When it is desired to have the patient breathe through his/her upper airway, the inner cannula is removed, the cuff deflated, and the outer cannula occluded by the decannulation cap. The capped outer tube with the cuff deflated will assist the patient to speak. ALWAYS REMEMBER TO DEFLATE THE CUFF, AS TOTAL AIRWAY OBSTRUCTION WILL OCCUR IF CUFF IS NOT DEFLATED! (See figure 4.)

 

Procedure:

1. Suction the airway.

2. Remove the inner cannula.

Always deflate the cuff.