We're going to take the soiled gauze
that's around the patient's tracheostomy site and remove that first.
Now, we want to make sure that we're really careful
about keeping that tracheostomy tube in place.
Go ahead and perform that hand hygiene, put on gloves
and then we're going to use that moistened gauze that we had already prepped
and wipe around the patient's neck and under the trach flanges.
Now, is a good time guys since we removed that old gauze to assess that stoma site,
and to see if there's any signs of infection or if the stoma site looks healthy.
Also a good tip is to use a sterile cotton tip applicators.
This is really helpful because you can really get underneath that trach
and use those sterile gauze pads as indicated to clean that stoma site
and all around the tracheostomy flanges and getting rid of those after every swipe.
Now, once we've done that, we don't want to leave excess moisture underneath that,
so we want to take our sterile gauze and we want to dab and dry that site thoroughly.
Now it's important here that we don't do that and scrub the skin.
Be gentle and pat here.
Then we can go ahead and apply that new sterile tracheostomy dressing,
that 4x4 split gauze pad around the patient's trach.
Now, if you have some extra hands, have a colleague help hold that trach in place,
as you remove that tie and the bandages, that's really helpful.
So, again, it's always helpful if you have it available to grab a buddy.
Now, we want to pull each side of the trach tie out through the little slits on the flanges.
We can thread the new one through,
because we want to replace this and pull that trach tie taut and fasten around each side.
Now, here's a good rule of thumb when we fasten this,
we want to make sure we can probably get at least one or two fingers here.
We want it snug, but not too tight.
So after securing the ties, allow your colleague to release the patient's tracheostomy.
So what I'm going to do with one hand is lift up the flange
and take the other one and use a moistened gauze to help clean the patient's neck.
But a good idea is to go ahead and open up your sterile cotton tip applicators,
because we're going to use this for cleaning as well,
in that way everything is open and ready.
Okay, so I'm going to take this hand and lift up that flange and use my moistened gauze.
Now, if it gets too overly saturated, you kind of want to wring it out.
You don't want too much moisture going down their airway,
so just a little bit damp is great.
So I'm going to take this hand, and use the moistened gauze
and get under there and just wipe the patient's neck.
I'm going to go ahead and use another wipe as well.
So you notice and it's really up to your comfortability,
and also if you have help, I've left the tracheostomy holder on just to stabilize,
but again, totally up to you and especially if you have a partner to help stabilize,
makes it's much easier. But key thing here, we don't want this to dislodge.
I'm going to take down my other side of the flange and clean thoroughly.
Now once I'm doing this and I've taken off that dressing,
we've cleaned, now I can see a little bit better underneath here and assess that stoma site.
Is there any excoriation, weird drainage, signs of infection?
We want to take a moment and take a look here.
Then, just to get all the extra stuff off, the cotton tip applicators are really helpful.
So I like to take one and go around the stoma site and get rid of it.
Sometimes, also I've got to get this and try to get all that stuff underneath the flange.
It's also helpful using a cotton tip applicator here as well.
So now that I've done this, we don't want all that moisture underneath the flange here
because setting here will start excoriating the skin,
so this is a great time to get a dry gauze and just dab the area without scrubbing the skin,
because we don't want to pull that and excoriate it.
So now that it's all cleaned off, this is a great time I can go ahead and replace
that sterile split dressing underneath the flanges here.
So we grab that now.
Okay, I want to take a moment to talk about this.
Seems kind of silly, but, when you open this up,
so what's also neat, you see how there's two, just assess your patient.
Some tracheostomy that are extra gooey, you may need both.
This one just for this demonstration I'm just going to use once split sponge.
Here's a difference I want you to see.
See how the split sponge is literally already split here for you.
Also, do you notice how nice, that and clean these lines are?
This is important because if I'm going around the airway,
I'm not worried about little filaments and loose material getting down the patient's airway,
so this is why we use this here.
So let me go and apply this around and I'm just going to slide this simply underneath the flanges,
and again, it's personal preference, you can loosen up the holder if need be,
but I usually keep this on just to make sure everything's stable
especially since I'm in here by myself,
and I'm just going to fit this around neatly and smooth it down around the tracheostomy site.
Now that I went ahead and apply my sterile tracheostomy dressing.
I want to make sure that I hold on to this.
Now, just know, if you had another set of hands,
that you have a colleague hold that tracheostomy in place for you
as you remove that trach holder,
but again, I'll just kind of show you what I do when I'm alone in my practice.
So I'm holding this steady here and I'm going to go ahead and loosen up this trach tie here.
Now, many times you can just, again, if you had a colleague, you can remove one side,
remove the other, have the colleague hold this in place,
then you can put on the new trach holder.
But, here's just a little tip of what I like to do just to make sure this doesn't dislodge.
So I've loosen this up here, I'm going to go ahead and grab my new one.
Now, sometimes, these trach holders can get really icky if you will,
but this one looks pretty clean and usually, we're pretty lucky
because this is just going around the patient's neck,
but just to make sure this stays in place,
and because, we've got a little room,
I'm going to go ahead and feed the new one through the holder.
So, I've loosened up the one.
I'm putting on the new one.
And sometimes this takes a little bit of finagling just because there's lots to handle,
while we're trying to keep this in place. So I've secured this.
Now, since this is secured down, I know this other side is still secure,
I'm going to go ahead and pull this on the back of the patient's neck
and go ahead and feed it around.
You notice I'm just kind of holding on to pieces here, the holder, and the trach,
just to keep it steady while I'm trying to feed everything through.
Okay, so now I know that the other side's secure.
I've got a hold of my new holder, I'm going to go ahead and remove the tie,
hold on to my trach and I'm going to remove the old one through the slit.
Now, I have my new one here and I can feed it through this other tie
and some of her hair is getting caught through here.
So I'm going to feed it through this respective flange over here,
and then I'm going to go ahead and tighten it.
Now, this one has extra room here, so this is a great time to take your scissors
and go ahead and trim off any excess.
The great thing with this one, I'm just going to cut a little off so it doesn't get in the way.
The great thing about this one, this one has an extender,
and that's just the excess we needed in case the patient had a large neck circumference,
and I'm just remaking sure this is secure.
Now that I know that that's secure, I'm going to take off the old one.
So, again, there's a little bit of variation to this.
Just know, you want to try to keep this as stable as much as possible.
So I fastened each tie in place and then after I've secured this,
we can go ahead and release the patient's tracheostomy if you have a colleague still holding it.