Advanced Clinical Procedures

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b. Open other sterile supplies as needed including sterile applicators,

suction kit and tracheostomy care kit (dressing kit).
Enhances performance phase of procedure. Protects the nurse.
c. Put on face mask and eye shield.
7. Don sterile gloves. Place sterile towel on patient's chest. Maintains aseptic technique.
Removes secretions.
8.
Suction the full length of tracheostomy tube and pharynx thoroughly.
9. Rinse the suction catheter and discard it.
10. Hydrogen peroxide moistens and locftens dried secretions.
Unlock the inner cannula (if present) and remove it by gently pulling it
out towards you in line with its curvature. Place the inner cannula in the
bowl with hydrogen peroxide solution (Applicable for tubes having
inner and outer cannula).

11. Remove the soiled tracheostomy dressing, discard the dressing and
gloves.
12. Don a second pair of sterile gloves.
13. Using the applicator or gauze once only, avoids contaminating
Clean the flange of the tube using sterile applicators or gauze moistened
with hydrogen peroxide and then with normal saline. Use each a clean area with a soiled gauze.
applicator once only.
14.
Clean the stoma area with gauze (make only a single sweep with each
gauze sponge before discarding)
Half strength hydrogen peroxide (mixed with normal saline) may be
used. Hydrogen peroxide helps to loosen dry crusted secretions.
Thoroughly cleanse area using gauze squares moistened with sterile Hydrogen paroxide is irritating to the skin and inhibits
normal saline. healing if not removed thoroughly.
15. Dry the stoma with dry sterile gauze
An infected wound may be cleaned with gauze saturated
with an antiseptic solution, then dried.
A thin layer of antibiotic ointment may be applied to the stoma with a
cotton swab.
Helps prevent wound infection.
16.

Cleaning the inner cannula

Remove the inner cannula from the soaking solution.
Clean the lumen and entire cannula thoroughly using the brush.
Rinserthe cleaned cannula by rinsing it with sterile normal saline Thorough rinsing is important to remove hydrogen peroxide
(agitating the cannula in the container with saline cleans it well).
from inner cannula.
Gently tap the cannula against the inside of the sterile saline
container after rinsing Removes solution adhering on the cannula.
17.
Replace the inner cannula and secure it in place
Insert the inner cannula by grasping the outer flange and pushing in
the direction of its curvature.
Lock the cannula in place by turning the lock (if present) into This secures the flange of the inner cannula to the outer
position. cannula.
18.
Apply sterile dressing
Open and refold a 4 x 4 gauze dressing into a 'V' shape and place Avoid using cotton-filled 4x4 gauze. Cotton or gauze fiber can
under the flange of the tracheostomy tube. be aspirated by the patient potentially creating a tracheal
Do not cut gauze pieces (Figure 11.15(a)). abscess.
Ensure that the tracheostomy tube is securely supported while Excessive movement of the tracheostomy tube irritates the
applying dressing. trachea.
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