Set of activities performed by the nurse to the patient carrying tracheostomy.
Objectives:
– Keep the airway (laryngeal stoma) permeable. – Prevent respiratory infections. – Maintain the skin surrounding the stoma in optimal conditions. – Educate the patient and family in the management of their tracheostomy.
Equipment:
– See tracheostomy secretion aspiration procedure equipment. – Towel. – Sterile drape.
Material:
– See tracheostomy secretion aspiration procedure material. – Tracheostomy cannula of the appropriate number. – Cotton tape and plastic bib. – Sterile gloves. – 1 Syringe of 5 c.c. sterile. – Physiological saline solution (1 ampoule of 10ml). – Sterile gauze. – Sterile lubricant (cannulas with inflatable balloon). – Antiseptic solution.
– Bag for waste. – Nursing records.
Procedure:
– Perform hand washing. – Prepare the material. – Preserve the patient’s privacy. – Inform the patient of the procedure to follow. -Establish a communication system, such as raising a finger to express pain or discomfort. – Request the collaboration of the patient and family. – Place the patient in the semi-fowler or Fowler position. – Put on non-sterile gloves. – Perform secretion aspiration procedure, if necessary. – Remove soiled cannula. – Remove soiled material. – Clean the area surrounding the stoma with physiological saline solution, cleaning from the inside out. – Dry and apply antiseptic. – Prepare sterile field. – Put on sterile gloves. – If the cannula has a balloon, check the condition of the balloon to verify that it is not punctured. Lubricate the balloon before inserting the cannula. – Insert the clean cannula, keeping the curved portion downwards. – If only the internal cannula is removed, fix the tracheostomy cannula with one hand and with the dominant hand remove the internal cannula and replace it with a clean sterile one. – The cannula should be changed daily. – Place sterile gauze dressings around the cannula to protect the stoma and prevent secretions from macerating the skin. – Protect and monitor the condition of the skin that rubs against the tape to prevent erosion. – Discard probe, mask and gloves. – Leave the patient in a suitable position. – Collect the material. – Remove gloves. – Wash hands. – Record in the nursing documentation: procedure, reason, date and time, incidences, and patient’s response.
Observations:
– Sterile technique. – In partial laryngectomies the change of cannula should be quick and careful to avoid displacement of the trachea. – The patient at discharge should know: care of the cannula, stoma, recommendations regarding personal hygiene, sexuality, emergency care and methods of speech rehabilitation.
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