- Welcome back to part two of Tracheostomy Care.
Next up, we're going to clean the inner cannula
of the tracheostomy and clean around the site.
The supplies that you need in order to perform
tracheostomy care include
a new set of trach ties or a trach collar,
some sterile normal saline,
hydrogen peroxide for cleaning,
and a sterile tracheostomy kit.
And I need two pairs of sterile gloves.
I'm now gonna open my table to give me
a larger working surface.
I have already identified the patient, I've washed my hands,
and I've also told the patient what we're gonna do.
I wanna go ahead and loosen the mist collar,
so that it's easier to remove.
I'm gonna loosen the cap of my sterile normal saline
and I'm gonna loosen the hydrogen peroxide as well.
I'm gonna open up my tracheostomy kit.
So remember the one-inch border around my sterile field
is considered non-sterile.
Next, I'm gonna place my gloves on.
And I'm just gonna put one glove on
and arrange my supplies on my field,
pour my solutions, and then put my second glove on.
Gonna move this out of my way without
turning my back on my field or my patient.
I'm right-handed,
so I'm gonna actually put my right glove on.
And I don't have a problem pouring with my left.
If you have a problem pouring with your left,
then you'd wanna make sure that you put your left glove on,
so that you're able to pour with your right hand.
I'm gonna put my
right hand on.
Step away.
Okay.
I now need to arrange my supplies on my sterile field.
The first thing on the top of your trach kit is actually
a sterile drape in order to put on the patient's chest.
I'm gonna go ahead and move my mist collar.
And I'm gonna drape my patient.
The shiny side goes down.
I don't wanna lean over my field.
I can touch in the middle of the field, but not
around the one-inch border.
So I'm now gonna arrange the supplies on my field.
I'm gonna pull out my pipe cleaners,
which you're gonna use for drying the tracheostomy.
These are little sterile tweezers that you can use to help
place the new dressing underneath the trach collar.
This is the brush to clean inside the tracheostomy tube.
New twill tape for securing the tracheostomy.
We're actually gonna use the velcro trach collars
instead of the ties.
There are some sterile four-by-fours
that you can use for drying the tracheostomy.
Actually, I'm gonna put these supplies up at the top here.
There is also the new drain sponge
for
under the trach.
Then I also have three
Q-tips for cleaning around the skin and the trach.
There are three containers.
It's a little hard to get the two undone sometimes.
So in the first container,
we're gonna pour the hydrogen peroxide.
The second container is gonna be
the sterile normal saline for drying.
And then the third container is gonna have
some sterile normal saline in in order to clean
around the stoma and on the face of the trach.
I'm gonna walk around the table without leaning
over any of my sterile fields.
And I'm gonna come around
to get my hydrogen peroxide.
Hydrogen peroxide is the first container.
So I need enough hydrogen peroxide in order to clean
the entire trach tube.
And we're just cleaning the inner cannula.
Again, I'm not turning my back on my field
and we now need...
Actually, I'm gonna just put that out of the way
since I don't need it anymore.
And then I have my sterile normal saline.
Loosen my cap.
And I'm gonna put my cap facing up.
When you first pull out your supplies,
you wanna make sure that this bottle has not expired.
If you are the first one to open this bottle,
you wanna make sure that you label it with your initials,
the date, and the time that the bottle was opened.
Most institutions have a 24-hour policy.
After 24 hours, this is no longer considered sterile.
Gonna go ahead and pour into my second container
and then into my third container.
I wanna avoid splashing.
If you splash and wet your sterile field,
it is considered non-sterile.
Replace my cap.
I no longer need this bottle,
so I'm gonna put it to the side.
Next, I'm gonna put on my second sterile glove.
Oop, and this time, I did not get my fingers in correctly.
There you go, okay.
I cannot reach below my wrist.
If I touch below my wrists,
then I have contaminated my gloves.
What I need to do now is remove the inner cannula
of the tracheostomy.
And then I will remove the old dressing
that is around the tracheostomy.
You wanna twist and remove.
I'm gonna go ahead and put the inner cannula inside
the hydrogen peroxide.
I'm then going to remove the old dressing from
underneath the trach face plate.
To look for any drainage, I'm gonna wrap the old dressing
in my gloves and discard my gloves.
Without turning my back on my sterile field and my patient,
I'm gonna go ahead and hand sanitize.
So the only time you have to wash the inner cannula
or remove it and clean it, is for someone that has
a non-disposable inner cannula.
If the patient has a disposable inner cannula,
all you do is remove the old one,
replace it with the clean, new, sterile inner cannula,
and then clean around the face plate,
and replace the gauze dressing.
You do not have to use hydrogen peroxide
to clean the cannula.
You just insert a new one.
In my right hand is a disposable inner cannula
and in my left hand is the non-disposable inner cannula.
Okay, so I'm gonna put on my second pair of sterile gloves.
There we go.
Okay.
Now, I'm ready to clean.
So I'm gonna grab the brush
to clean
the tube.
You wanna clean
around the outside.
You wanna put the brush inside to clean.
Once you have gotten all of the
crusty mucus off,
you're gonna go ahead and put the tracheostomy into
the sterile normal saline.
And this is for rinsing, so you wanna make sure that you get
the normal saline through the tube.
I am then gonna dry my tracheostomy over my sterile field.
That's just in case I drop it
that it doesn't land on something unsterile.
I want my
sterile four-by-fours
to dry the outside.
I can dry inside by using the pipe cleaners.
You can usually fit one or two through there at a time
just one way.
I'm gonna do that one more time.
So those are considered not sterile now,
because I threw them off of the field.
I'm just gonna use the third one just to make sure
that it's sterile.
I wanna observe the trach just to make sure that
I don't see any obvious damage or any lint inside.
If I need to dry one more time, I can.
We are now ready to replace the tracheostomy tube
into the tracheostomy in the patient.
I'm now gonna replace the inner cannula
and lock it in place.
You wanna turn the tube until it locks.
And you can see on the tube, there is a blue dot
for this cannula that is on the inner cannula
and then there is a blue dot
on the part that is in the patient,
and you wanna match those up
to make sure that they are locked.
You can also feel a little click and hear a little click
when it clicks into place.
We're now gonna clean around the face plate.
So I need the
three Q-tips.
And we're gonna be using that last
basin that has the sterile normal saline.
I'm gonna make sure the Q-tips are moist.
And then I'm gonna use the first one.
You wanna
clean around the tracheostomy.
You wanna clean the face plate.
Okay, so I'm cleaning the face plate.
I'm gonna get rid of that, the dirty Q-tip.
I also need to clean underneath the face plate,
around the stoma.
I'm gonna get rid of that Q-tip.
So I used three Q-tips for cleaning.
Before your procedure, if you notice that the patient's
face plate and around the stoma has a lot of discharge
or is very dirty, you can add some additional
sterile Q-tips to your field at the beginning
to make sure you have enough in order to clean properly
around the site.
So now, I'm gonna reach for my forceps and my drain sponge.
If you look at the drain sponge, you can see that it has
a cut.
And there are no frayed edges,
so you don't have to worry about any of the frayed edges
getting into the patient's airway.
So the cut is gonna slide up underneath the face plate.
You want the sealed part
at the bottom of the tracheostomy.
So if you have any drainage, the skin will be protected.
So during this part, you are gonna become contaminated.
There's just no way around trying to put gauze sponges
underneath the face plate.
You try your best to make sure that this part
does not touch anything,
so that it is as sterile as possible around the stoma.
You can use the forceps to help you reach.
Okay.
So now that I have the dressing
back underneath the face plate,
I need to change the trach ties.
If you are alone, you do not wanna remove
the other trach ties until you have the new ones in place.
If you have a second person with that can hold
the tracheostomy in place, you could remove
the old tracheostomy ties.
You never wanna have your trach unsecured
because if the patient coughs,
that trach could be dislodged.
This is not a sterile part of the procedure.
The sterile part ended when we started to put the dressing
underneath the face plate.
Since I am alone, I am going to
put my
new trach collar on at the same time as
I have my old trach collar on.
Gonna reach behind your neck here to get the
new trach collar in.
And I need to tighten this one.
This one's a little loose for the patient.
So I have both sides secured,
but now, I need to make sure it's in the correct position
and tight enough.
This is looking a little loose.
When I have the trach collar in the correct position,
I should be able to get two fingers, one to two fingers
between the trach collar and the patient's skin.
If you have more fingers between...
You can fit more fingers between the trach collar
and the patient's skin, it means that your collar
is too loose.
I'm gonna go ahead and remove the old trach collar.
Okay, I can discard that.
So now that I have the trach collar in place,
I'm gonna double-check I can fit
one to two fingers comfortably,
but I wouldn't be able to fit a third
without hurting the patient.
I wanna replace my mist collar.
There you go.
So that concludes the end of the tracheostomy video,
sectioning as well as tracheostomy care.
I still need to dispose of my gloves
and dispose of my supplies.
To leave my patient, I need to make sure that
the side rail is up, they have their coli,
and they are in a comfortable position.
Thank you so much for joining us
and I hope to see you next time.