In the United States, there are more than 100,000 tracheostomy procedures performed each year. While less than 20% of these are permanent and will be discharged home with the patient, all tracheostomies will initially be cared for by the medical professional, namely nursing staff. A tracheostomy is a tube placed through the cricothyroid membrane, directly into the trachea to assist with breathing when it is necessary to bypass a portion of the airway. This is common in head and neck trauma where mechanical ventilation is necessary, severe facial trauma, laryngectomy, or a severely blocked upper airway — common in anaphylaxis or smoke inhalation. Proper care and management are critical to the health of the patient and prior to the stoma healing, trach care can be very uncomfortable. Join us in today’s post as we discuss some ways that the healthcare professional can make the care of the tracheostomy as comfortable as possible for their patients.
1. Explain everything.
One of the most important tools in your patient comfort toolbelt is communication. You can never over-explain anything. Trach patients are likely to be vulnerable and feeling scared and exposed. Especially in the early stages, adjusting to a tracheostomy can be full of anxiety. A nurse who explains themself as they are working on the patient provides a level of comfort that cannot be matched with any marvel of modern medicine.
Explain what you will do before you begin, you can explain your supplies and tools used to reduce fear when you are near their neck, messing with their airway. Then, explain what you are doing as you are doing it. While you are cleaning up, you can review what you did, in a manner that would encourage educating and empowering your patient to do it for themselves in the future, what to expect, and what to notify you of if they experience — e.g. pain, reduced airway movement, or the need to be suctioned.
Yes, we highly suggest that you even perform this level of explanation to the unconscious or comatose patients. Research has shown that some patients do remember voices and what was said to them and around them while the are unconscious, even during CPR events.
2. Be gentle, yet swift.
As with every invasive procedure, it is important to be gentle. Being gentle reduces pain, tissue trauma, and helps to reduce patient anxiety. However, being gentle should not come at the price of extending the amount of time you are performing the procedure. By no means are we suggesting you rush through any medical task, but you should always be mindful of how long your patient is experiencing the task. The majority of your time should be spent with the setup and preparation, the procedure itself should be quick, and then clean up may take a few minutes.
Prior to touching the patient or the tracheostomy site, ensure that you have gathered all of your supplies and they are readily available. It is always a good idea to have extra supplies on hand in case something happens that requires a new piece. Prepare your hands and the site prior to touching the patient. Next, perform a thorough visual inspection of the site. Once you have a good idea of what is going on and your supplies are prepared, it is time to begin. The total time it should take to replace a tracheostomy tube, including cleaning the site, should be less than a minute.
Supplies you’ll need.
- Sterile gloves
- A clean basin
- Hydrogen peroxide
- 4×4 gauze
- Normal saline
- Cotton-tipped swabs
- Small brush
- Clean washcloth and towel
- Trach tube ties
- Clean scissors
- Single-use surgical lubricant packet
Performing trach care.
Caring for a tracheostomy is not a complicated process, but it does require some attention to detail and cleanliness. Before beginning the procedure, remember to be very acutely aware that you are dealing with a direct portal to your patient’s airway. This should affect the way you deliver your care.
- Gather all supplies and prepare them for use.
- Wash your hands and don sterile gloves.
- Suction the trach. *Remember, never suction on insertion, only on removal of the suction tubing!
- Prepare the new tracheostomy tube (obturator and outer cannula) with a small amount of water-based lubricant — just enough to ease insertion, without compromising the airway.
- Remove the tracheostomy tube and immediately insert the new, lubricated tube — remember that your patient cannot breathe while you do this, so time is of the essence.
- Remove the obturator immediately.
- If the tube has an inner cannula, remove it and clean it with liberal amounts of hydrogen peroxide.
- Use the small brush to scrub the inner cannula and thoroughly rinse with normal saline.
- Use the 4×4 gauze pads to completely dry the inner cannula.
- Reinsert the inner cannula and lock it into place.
- Remove the soiled gauze dressing and trach tube ties around the stoma and throw it away.
- Inspect the stoma and surrounding skin. Observe for redness and signs of infection.
- Use the cotton-tipped swabs in a half-and-half mix of hydrogen peroxide and normal saline. Gently, but thoroughly, clean the stoma and surrounding skin.
- Use the clean washcloth dipped in normal saline to clean away the hydrogen peroxide mix.
- Use a clean towel to thoroughly dry the entire area.
- Replace the trach tube tie and gauze dressing.
- Assess for the need to suction again — this step may not be required.
*Please reference your facility’s protocols for all steps in the process and familiarize yourself with the supplies you will be using. This information is for general use and does not supersede facility protocol.
3. Use the right lube.
When preparing the tracheostomy tubing, using the right lubricant can make all the difference. Using a latex-free, water-based sterile lubricant like Surgilube® Surgical Lubricant can help make the insertion of the tube smoother and prevent infection. Water-based surgical lubricants should be used so as to not cause damage to the tissue or causing breakdown of the tracheostomy tubing. A sterile, bacteriostatic medical lubricant will prevent introducing infection into the stoma site, which is important in such a sensitive area.
At HR Pharmaceuticals, our surgical lubricant, Surgilube, is water-based, sterile, bacteriostatic, and latex-free, among other medical features that benefit patients. Our medical lubricants are available in single-use FoilPac®. Surgilube has owned the mark of assurance and consistency for nearly 85 years. Our goal is to ease the discomfort during invasive procedures and reduce the risk of infection. For all of your medical lubricant needs, visit our medical supply shop online today.