Reusable inner cannulas require careful cleaning.
1. Perform hand hygiene with soap and water for 15 seconds.
2. Don a face shield and sterile gloves, and maintain aseptic technique during the procedure.
3. Unlock (by pressing the flanges) and remove the inner cannula and place it in a solution of equal parts hydrogen peroxide and 0.9% sodium chloride. These two ingredients normally come with trache care tray.
4. Remove encrusted secretions from the cannula lumen with sterile pipe brush cleaners. Scrub thoroughly until all dry encrusted secretions are gone.
5. After cleaning the inner cannula, rinse the cannula thoroughly with sterile 0.9% sodium chloride solution. Make sure all peroxide containing solution is rinsed away as this may cause irritation.
6. Carefully Reinsert the inner cannula avoiding any contamination and securely lock it into place.
7. While providing tracheostomy care, inspect the underlying skin for signs of irritation or infection, such as redness (erythema), pain, or discharge. If discharge is noted, notify the provider imediately. Discharge culture may be required to identify the colonizing bacteria, usually Staphylococcus Aureus.
8. Thoroughly assess the skin around the tracheostomy stoma for evidence of skin breakdown related to the tracheostomy device, tube securement device, or mucus and secretions.
9. Clean the area around the tracheostomy tube thoroughly with a noncytotoxic cleanser, usually in tracheostomy care tray, using a sterile cotton-tipped applicator.
10. Make sure to rinse the skin with water and dry it gently with non-fluffy sterile gauze.
11. If any skin breakdown is noted during tracheostomy care, consult a wound/ostomy nurseper your facility policy for further patient assessment.
12. Absorbing secretions around the tracheostomy helps prevent maceration and skin breakdown.
13. Gently place a prepackaged, sterile tracheostomy dressing under the tube flanges.
14. Always use a manufactured split sponge that is lint free/non-fluffy.
15. Never place anything with loose fibers around the stoma or tracheostomy tube because they can be inhalled and cause damage/infections.
16. Inform the healthcare provider if sutures used to secure the tube after insertion are loose, irritating the skin or preventing routine maintenance.
17. Obtain an order from the provider for suture removal 5-7 days after tracheostomy tube insertion or per facility guidelines.
18. If twill tape was used initially, change it to a Velcro-securing device as soon as possible for cmfort reasons and to prevent skin abrasion.
19. Clean up your work area and make sure to leave the patient comfortable after procedure. Assess for pain and medicate as needed.
20. Document your procedure in nurses notes detailing your procedure, any drainage, color odor, skin color and how the patient tolerated. Make sure tracheostomy care is part of your nursing careplan
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