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An Urban Experience
Tracheostomy tube care
Tracheostomy tube care should be provided every 1 – 4 hours depending on the amount of secretions produced.
1. Preoxygenate with 100% oxygen.
2. Aseptically prepare hands and wear sterile gloves.
3. Remove the inner cannula if present. Clean the inner lumen of the tracheostomy tube with sterile cotton buds +/- 0.05% chlorhexidine solution. Clean the outside of the tube with sterile swabs +/- chlorhexidine solution.
4. Humidify the airways with a humidifier for 3 – 5 minutes. This will help loosen secretions. If a humidifier is not available, small volumes (0.5 – 3mL) of sterile saline can be instilled into the tracheostomy tube instead, however there is risk of introducing bacteria into the lungs.
5. Preoxygenate the patient with 100% oxygen for 1 minute.
6. Aseptically place a suction cannula attached to a suction unit. Most suction cannulas have a thumb port to control suctioning. Place the cannula down
to the tracheal bifurcation without occluding the thumb port. Suction by occluding the thumb port, and rotating in a circular movement while gently withdrawing the cannula. Suctioning should not take greater than 10 seconds. Once completed administer 100% oxygen again for 1 minute. If large amounts of secretions are produced, repeat the procedure.
7. If an inner cannula was present replace the inner cannula with a new or sterile cannula. Clean the used cannula with 0.05% chlorhexidine, and keep bathed in a 0.05% chlorhexidine solution so the two tubes can be used alternatively. Before replacing the inner cannula, rinse with sterile saline or sterile water.
8. Tracheostomy tubes without a cannula should be changed every 24 hours. Preoxygenate the patient with 100% oxygen, keep the trachea open using the cranial and caudal stay sutures. Remove the old tube and replace with a new tube immediately.
Removal of tracheostomy
If the upper airway disease is improving/resolved, and you think the patient can breath through their oropharynx again, the tracheostomy tube may be removed. To test if this is possible, occlude the tracheostomy tube opening with a sterile gloved finger for several minutes. If the outer diameter of the tube is small enough, the patient should be able to breath around the tracheostomy tube. If the tube is a snug fit, then replace with a smaller tube for the occlusion test. If there is a cuff, the cuff must be deflated. Once removed, the tracheostomy site is left open. Suturing the site can cause pneumomediastinum and subcutaneous emphysema. The wound should be cleaned regularly. When discharging the patient home, strict instructions should be given not to place a collar around the neck, no baths, and ensure there are no areas of water the patient may accidentally place their neck (e.g. large water bowls, ponds, etc.).
References are available upon request.

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