1. Explain procedure to patient.
  2. If tracheostomy tube has been suctioned, remove soiled dressing from around tube and discard with gloves on removal.
  3. Perform hand hygiene and open necessary supplies.

Cleaning A Nondisposable Inner Cannula

  1. Prepare supplies before cleaning inner cannula.
    1. Open tracheostomy care kit and separate basins, touching only the edges. If kit is not available, open two sterile basins.
    2. Fill one basin fraction ½-inch (1.25 cm) deep with hydrogen peroxide.
    3. Fill other basin fraction ½-inch (1.25 cm) deep with saline.
    4. Open sterile brush or pipe cleaners if they are not already in cleaning kit. Open additional sterile gauze pad.

  1. Don disposable gloves.
  2. Remove oxygen source if one is present. Rotate lock on inner cannula in a counterclockwise motion to release it.
  3. Gently remove inner cannula and carefully drop it in basin with hydrogen peroxide. Remove gloves and discard.
  4. Clean inner cannula.
    1. Don sterile gloves.
    2. Remove inner cannula from soaking solution. Moisten brush or pipe cleaners in saline and insert into tube, using back-and-forth motion.
    3. Agitate cannula in saline solution. Remove and tap against inner surface of basin.
    4. Place on sterile gauze pad.
  1. Suction outer cannula using sterile technique.
  2. Replace inner cannula into outer cannula. Turn lock clockwise and make sure that inner cannula is secure. Reapply oxygen source if needed.

Replacing Disposable Inner Cannula

  1. Release lock. Gently remove inner cannula and place in disposable bag. Discard gloves and don sterile ones to insert new cannula. Replace with appropriately sized new cannula. Engage lock on inner cannula.

Applying Clean Dressing and Tape

  1. Dip cotton-tipped applicator in saline and clean stoma under faceplate. Use each applicator only once, moving from stoma site outward.
  2. Apply hydrogen peroxide to area around stoma, faceplate, and outer cannula if secretions prove difficult to remove. Rinse area with saline.
  3. Pat skin gently with dry 4 x 4 gauze.
  4. Slide commercially prepared tracheostomy dressing or prefolded non-cotton-filled 4 x 4 dressing under faceplate.
  5. Change tracheostomy tape.
    1. Leave soiled tape in place until new one is applied.
    2. Cut piece of tape that is twice the neck circumference plus 4 inches (10 cm). Trim ends on the diagonal.
    3. Insert one end of tape through faceplate opening alongside old tape. Pull through until both ends are even.
    4. Slide both tapes under patient’s neck and insert one end through remaining opening on other side of faceplate. Pull snugly and tie ends in double square knot. Check that patient can flex neck comfortably.
    5. Carefully remove old tape. Reapply oxygen source if necessary.
  1. Remove gloves and discard. Perform hand hygiene. Assess patient’s respirations. Document assessments and completion of procedure.

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