Use a Checklist

When working with a tracheostomy tube it may work best to come up with a systematic way of caring for the equipment and the individual so that nothing important gets missed.  Marking off items on a checklist may help if you are new to tracheostomy care.

Starting with emergency equipment.  Check that all stand-by equipment is properly gathered and ready.  A kit should be made that includes items for emergency replacement of the tracheostomy.  The obturator should be ready at hand and visible for all care givers. from the patient and working towards all of the equipment is one way to ensure nothing is missed.  The obturator is a very important piece of equipment that should be on hand and visible.  Most of the time it is taped to the wall.

An example of a systemized pattern is as follows:
Upon entering the room immediately scan the patient and assess their comfort level.  Are they breathing normally? Are they coughing? Do you hear any abnormal noises from the trach?  Each of these “first impression” items could signal that this is an area that needs attention.

Going further in the assessment.  You would want to listen to breath sounds, do a spot check with a pulse oximeter.  Each of these will indicate the need to suction or to check an oxygen delivery device. Note the respiratory rate, heart rate, and the way the individual is breathing.

Tracheostomy Equipment

Next, look at the tracheostomy tube that is in place.  Note the brand, and tracheostomy tube size.  This will be important to both chart and also if the patient needs suctioning you’ll want to know the inner diameter.  If this is the first encounter with the patient you’ll want to assess the stoma site.  Remove the drain sponge/gauze and inspect the skin around the stoma.  Record your findings.  Replace the trach sponge with a new one if it is soiled.

Check the cuff pressure if the patient has a tracheostomy tube with a cuff.

If it was indicated that your patient needed suctioning than you should prepare to perform this procedure.  Note the secretions (color, amount, consistency).

Humidity
This is also a good chance to assess the status of humidification that is being provided to the patient. If the sputum is unusually thick this is probably an indication that the patient is either dehydrated or the humidification system is not functioning properly.

Oxygen

Check the equipment that is providing humidity for proper functioning and

The oxygen delivery system is, in most cases, linked to the delivery of the humidity.  It is a good idea to check that oxygen delivery systems are functioning properly.  This includes the equipment such as oxygen concentrators, and oxygen tanks.

Here’s a break-down of the “To-Do” items when caring for a tracheostomy.

• Check Stand-by Equipment
• Patient assessment
• Tracheostomy tube assessment (including size, and stoma)
• Cuff pressure
• Airway Clearance
• Humidity Therapy
• Oxygen Equipment