Hey, guys. Welcome to the skill tracheostomy care.
So before we move forward, let's talk about the tracheostomy.
What this means is that there's an artificial airway
that we have to create to protect the patient's airway.
So we will take an incision and place it in the patient's trachea so the patient can breathe.
Now this is definitely emergency situation and many times
this results due to trauma such as a motor vehicle accident.
Now, take a look at this slide.
I don't mean to scare you here, guys, especially as a new student.
But remember back to our basics, ABCs. First of all, airway.
So this is important to protect our airway
and this is some of the equipment we need to have readily available.
You definitely want to know where this is on our unit.
So the main reason why we're going to need some of these equipment
is because the patient may dislodge their trach for example
or there may be a lot of mucus that get stuck down in the airway
and that patients can't breathe. That can be really dangerous.
So let's take a look at this first one, which is a resuscitation bag.
If you've done your CPR, then you know this helps to give breath to our patient.
We may also need an oxygen source to provide supplemental oxygen,
and also if the patient dislodges their trach,
we need a sterile one to replace just in that case that occurs.
And, lastly, we were talking about all the mucus that can come out at trachs
that's actually really common, so you need to have suction equipment to clear the airway nearby.
Now let's take a look at some of the equipment we're going to need for routine trach care
and that's what we're going to be talking about today.
We need a holder that's going to fix around the patient's neck on the back side
to help hold that in place.
Bandage scissors and normal saline.
Sometimes you need to get really close in all around that stoma site,
so we like to use sterile cotton tip applicators.
Also we're going to use 4x4 gauze pads to clean around the site,
but one thing I want to tell you is the gauze pad,
if you've ever taken a look at that, you see all that webbing that's on the gauze pads,
that's what we do not want to leave around the patient's airway.
All those little filaments, if you cut into it can get in the patients airway
and that's what we do not want.
We actually have a special gauze pad called either a tracheostomy sponge
or a 4x4 split pad especially for that.
Now before we get started with our procedure,
of course, we want to perform our hand hygiene and provide privacy to our patient.
Now it's important here to explain to the patient, what's going to happen?
Because you're dealing with an artificial airway this can cause some apprehension
with your patient, so fully explain the procedure first.
Then, we want to raise the bed to an appropriate working height
and because we're dealing with an airway,
we want to elevate the patient's head of bed at least about 30 to 45 degrees.
And, again, make sure you have your suction equipment nearby and it's functioning properly.
Now we want to go ahead and perform that hand hygiene again, put on gloves
and any other PPE that may be needed.
This is an important step here, guys, is to assess the patient's baseline respiratory status.
We need to provide assessment here
because we need to see if this is getting better or worse during our care.
And, again, provide that suctioning as necessary
if the patient has too much mucus or they can't breathe appropriately.
So now we can go ahead and apply saline to the gauze itself,
and then we're going to get that prep and ready so we can clean around that site.
Hey, guys. Welcome to the live demo of tracheostomy care.
So, today, we're just going to show you some routine maintenance
when we're talking about an established tracheostomy.
So let's take a moment and take a look at our supplies.
So first here I've got our cleaning solution.
So what I've got is 0.9% sodium chloride.
So sometimes, as nursing students I don't know why we try to make this difficult for you,
but if anybody ask you for normal saline,
this is exactly what they mean, 0.9% sodium chloride.
Again, you're going to hear normal saline all the time,
you're probably never going to hear a nurse say, I need 0.9% sodium chloride.
So if they asked you for a normal saline, this is what we're referring to.
So we're here, this is what we're going to use for our cleansing fluid.
Next, I've got a pack of gauze and this is so helpful
because what we're going to do is you see this nice little container that we've got here?
It's got a little holder.
We're going to take this off and pour our saline inside of it so we have a moisten gauze to clean.
So this is a common pack that many nurses use for tracheostomy care.
The other thing is sometimes you need to get really close
and all around that stoma site so we like to use sterile cotton tip applicators is really helpful.
And next, it's going to depend on what your facility has.
We have this really nice tracheostomy holder so this is the ties that secures that in place.
This is going to go around the back of the patient's neck to keep these flanges down and secure.
So this one as you see has nice little cushion here, it's Velcro.
Some facilities have more like trach ties for example that looks a lot like shoestrings, honestly.
So it's just going to vary on what you're going to have in your facility.
And don't forget, here's one more thing
I want to talk to you or two more things I want to talk to you about.
So this is a tracheostomy split sponge, so this one's really nice
because it's actually got the word tracheostomy on it.
But, not all facilities have one that specifically says that.
What you're looking for is a split or drain sponge.
What we don't want to put is a regular gauze around the tracheostomy site,
because, as you can see here, there's a split.
So for us to make a split in the gauze, we would have to cut it.
We don't want all those loose filaments down the airway of our patient.
So and I'll show you kind of the difference here in a few.
Now, when we put the tracheostomy holder in, sometimes we have to adjust it
because the circumference of the patients neck maybe different,
so sometimes we can cut away a little excess if needed, so don't forget your scissors.
So now that we've talked about that,
let's go ahead and perform our hand hygiene and put on our gloves.
So when we're talking about trach care and we're around this area, just be alert.
Just know you might need additional PPE especially if you have to suction your patient.
Okay, so let me go ahead and put on my gloves,
and this is a great time to assess the patient's baseline respiratory status.
Are they breathing normally? Are they having labored breathing?
How was their oxygen saturation? Are their lips blue?
Do they seem like they're breathing normally?
These are all important points to note before we get started.
Now, sometimes, before we get started and we're dealing with this airway,
we want to make sure we provide tracheal suctioning if necessary.
Now, just remember, if we're suctioning,
because we're sucking all these secretions out of the airway,
you may need additional PPE such as goggles for example.
Okay, so now that we've done that, we've discussed this,
I'm going to go ahead and prep my saline, or prep my gauze.
So I'm going to go ahead and open this up, and I'm going to take my saline
and go ahead and moisten my gauze.
This is why we love these sponges because it's just two in one,
we've got a little container and also our gauze.
So now that we've got that handy, we've got everything here at the bedside for us.
So once we've moisten this, I can go ahead and remove my old gauze here.
Okay, so you can this one is a little bit soiled.
So now that I've taken away my soiled gauze,
I'm going to go ahead and remove my gloves and perform hand hygiene.
So, here's another pro tip, because we're dealing with an airway,
if you have a colleague that can come in the patient's room and help you, that is ideal.
We don't want that to get dislodged, so just keep that in mind.