2. Objectives Define Tracheostomy Procedure. Discuss changing tracheostomy dressing and tie tapes thoroughly utilizing video presentation and demonstration. Perform the procedure through return - demonstration correctly. 2
3. Tracheostomy A surgical incision in the trachea just below the larynx. A curved tracheostomy tube is inserted to extend through the stoma into the trachea. Tracheostomy tubes may either be plastic or metal and are available in different sizes. 3
9. Procedure Verify the doctor’s order. Apply alcohol based hand rub upon entering the client’s room. 9
10. Prepare the client. Introduce self to the patient. Check the patient’s identification. Explain the procedure. Position the patient in Semi-Fowler’s position. 10
11. Procedure Prepare the equipment. Disposable face mask Clean gloves Moisture – resistant bag Normal saline solution Hydrogen peroxide Bandage scissors Equipment & supplies for suctioning and for mouth care 11
12. For Cleaning a Non – Disposable Inner Cannula and Providing Site Care Prepackaged commercial tracheostomy care set Sterile pads (sterile field and patient’s chest) Sterile nylon brush Sterile gloves Disposable pick – up forceps Sterile 6” (15cm) pipe cleaners Cotton applicator Trache tie - twice the neck circumference plus 4 inches of tracheostomy twill tape 4” x 4” gauze pads Pre – cut 4” x 4” gauze dressing 12
17. Procedure Wear face mask. Prepare a moisture-resistant bag. Open a pre - packaged commercial tracheostomy care kit. Discard few drops of the hydrogen peroxide and sterile normal saline solution pour them in each container. 17
18. Procedure Put on clean gloves. Remove the dressing and check the site for signs of infection and maceration. Remove and soak the inner cannula. Unlock the inner cannula by rotating it in a counter clockwise direction while your other hand supports the faceplate of the outer cannula. Gently remove the inner cannula by pulling it toward you in line with its curvature. Soak the inner cannula in the hydrogen peroxide solution . 18
19. Procedure Change to sterile gloves and clean the cannula. Place each of the sterile pads across the patient’s chest and on the table. Remove the cannula from the soaking solution. (Use disposable pick-up forceps, if available) Clean the lumen and the entire inner cannula thoroughly using the nylon brush moistened with sterile saline. Inspect the cannula for cleanliness. If encrustations are evident, repeat cleaning. 19
20. Procedure Rinse the cannula thoroughly by agitating in the sterile saline solution. After rinsing, gently tap it against the inside edge of the sterile solution container. 20
21. Procedure Dry the lumen of the cannula using the pipe cleaners. Insert the inner cannula and secure it. Grasp the outer flange of the inner cannula, and insert the cannula in the direction of its curvature. Lock the inner cannula in place by turning the lock in clockwise direction. Gently pull the inner cannula to ensure that is secure. 21
24. Procedure Apply a sterile dressing. Use a commercially prepared sterile dressing if available or open and refold a 4X4 gauze. Avoid using a cotton-filled gauze squares, and avoid cutting the 4x4 gauze. While applying the dressing, ensure that the tracheostomy tube is securely supported. 23
25. Change the tie tapes. Fasten the clean ties before removing the soiled ties. Apply the tie tape as follows… 24
26. Apply the tie tape as follows Thread one end of the tape into the upper half of the slot on one side. Bring both ends of the tape together, and take them around the client’s neck, keeping them flat and untwisted. Ask the client to flex the neck, if conscious and coherent. 25
27. Apply the tie tape as follows Thread one piece of tape closest to the client’s neck from back to front through the other slot. Place one finger underneath the tie tape before tying. Tie it with a double - square knot. Cut off any long ends and the old trache tie. Check for tautness of the tracheostomy site. 26
28. Procedure Perform after care. Document all relevant information. Date, time and size of trachea Characteristics of secretions (color, odor, amount, and consistency) Patient’s tolerance to procedure Teaching and the patient’s level of understanding. 27
Incision 1 cm below the cricoid or halfway between the cricoid and the sternal notch.
The thyroid isthmus lies in the field of the dissection.Typically, the isthmus is 5 to 10 mm in its vertical dimension, mobilize it away from the trachea and retract it, then place the tracheal incision in the second or third tracheal interspace
