PROCEDURE CHECKLIST: Chapter 35: Performing Tracheostomy Care

PROCEDURE CHECKLIST:
Chapter 35: Performing Tracheostomy Care

Check (9) Yes or No

PROCEDURE STEPS Yes No COMMENTS
1. Places the patient in semi-Fowler’s position.
2. Places a towel or linen-saver pad over the
patient’s chest.
3. Dons sterile gloves (alternatively, puts a sterile
glove on the dominant hand and a clean glove on the
other hand).
4. Suctions the tracheostomy (see Procedure
Checklist Chapter 35: Performing Tracheostomy or
Endotracheal Suctioning).
5. Removes and discards the soiled tracheostomy
dressing in a biohazard receptacle; then removes and
discards gloves.
6. Place the tracheostomy care equipment on the
over-the-bed table and prepares the equipment using
sterile technique:

a. Pours hydrogen peroxide into one of the sterile
solution containers and pours normal saline
solution into the other one.
b. Opens three 4×4 gauze packages; wets the
gauze in one package with hydrogen peroxide;
wets the gauze in another package with normal
saline; keeps the third package dry.
c. Opens 2 cotton-tipped applicator packages.
Wets the applicators in one package with normal
saline solution and wets the applicators in the
other package with hydrogen peroxide.
d. Opens the package containing a new disposable
inner cannula, if available.
e. Opens the package of Velcro tracheostomy ties
or cuts a length of twill tape long enough to go
around the patient’s neck two times. Makes sure to
cut end of the tape on an angle.
7. Dons sterile gloves (or sterile on dominant and
clean on nondominant hand); keeps the glove on the
dominant hand sterile. Handles the sterile supplies
with the dominant hand only.
8. With the nondominant hand removes the oxygen
source, if the patient has been receiving supplemental
oxygen.
9. Unlocks and removes the inner cannula with the

Copyright © 2007, F. A. Davis Company, Wilkinson & Van Leuven/Procedure Checklists for Fundamentals of Nursing

nondominant hand and cares for it accordingly:
a. Disposable Inner Cannula: Disposes of the inner
cannula in the biohazard receptacle according to
agency policy.
b. Reusable Inner Cannula: Places the inner
cannula into the basin filled with hydrogen
peroxide.

10. Attaches the oxygen source to the outer cannula, if
possible.
11. Cares for the inner cannula:

a. Variation: Disposable Inner Cannula: Picks up
the new disposable inner cannula, holding it by the
outer locking portion.
b. Reusable Inner Cannula:

1) Picks up the reusable inner cannula from the
container of hydrogen peroxide and scrubs it
with the sterile nylon brush, using the dominant
hand.
2) Immerses the inner cannula in the container
of sterile normal saline and agitates it until it is
thoroughly rinsed.
3) Taps the inner cannula against the side of the
container to remove excess fluid.
12. Removes the oxygen source, using nondominant
hand, (if the patient requires supplemental oxygen)
and reinserts the inner cannula into the patient’s
tracheostomy in the direction of the curvature.
13. Following manufacturer instructions, locks the
inner cannula in place securely.
14. Reattaches the oxygen source, if indicated.
15. Cleans the stoma under the faceplate with the
cotton-tipped applicators saturated with hydrogen
peroxide, using a circular motion from the stoma site
outward.
16. Uses each applicator only once and then discards
it.
17. Cleans the top surface of the faceplate and the skin
around it with the gauze pads saturated with hydrogen
peroxide. Uses each gauze pad only once, and then
discards it.
18. Repeats steps 15, 16, and 17, using the cotton-
tipped applicators and gauze pads saturated with
normal saline.
19. Dries the skin and outer cannula surfaces by
patting them lightly with the remaining dry gauze
pads.

Copyright © 2007, F. A. Davis Company, Wilkinson & Van Leuven/Procedure Checklists for Fundamentals of Nursing

20. Removes soiled tracheostomy stabilizers:
a. Variation: Velcro Tracheostomy Holder: With
an assistant stabilizing the tracheostomy tube,
disengages the Velcro on both sides of the soiled
holder and removes it gently from the eyes of the
faceplate. Discards the Velcro holder in the
nearest biohazard receptacle.
b. Variation: Twill Tape Tracheostomy Ties: With
the assistant stabilizing the tracheostomy tube,
cuts the soiled tracheostomy ties using bandage
scissors. Avoids cutting the tube of the
tracheostomy balloon. Removes the ties gently
from the eyes of the faceplate and discards them in
the nearest biohazard receptacle.

21. Has the patient flex his neck and applies new
tracheostomy stabilizers.

a. Variation: Velcro Tracheostomy Holder:
1) Unfastens the Velcro; threads one end of
the tracheostomy holder through the eyelet of
the faceplate, and fastens the Velcro.
2) Brings the holder around the back of the
patient’s neck and threads the remaining end
of the tracheostomy holder through the empty
eyelet of the faceplate. Fastens the Velcro,
making sure the holder fits securely.
3) Places one finger under the holder to make
sure the holder is securing the tracheostomy
effectively, but is not too tight.

b. Variation: Using Twill Tape:
1) Threads one end of the twill tape into one of
the eyelets on the tracheostomy faceplate;
continues to thread the twill tape through the
eyelet, bringing both ends of the tape together.
2) Brings both ends of the twill tape around
the back of the patient’s neck.
3) Threads the end of the twill tape that is
closest to the patient’s neck through the back
of the eyelet on the faceplate.
4) Has the assistant place one finger under the
tape while tying the two ends together in a
square knot.

22. Inserts a precut, sterile tracheostomy dressing
under the faceplate and new tracheostomy stabilizers.
23. Disposes of used equipment/supplies in the
appropriate biohazard receptacle, according to agency
policy.

Copyright © 2007, F. A. Davis Company, Wilkinson & Van Leuven/Procedure Checklists for Fundamentals of Nursing

Recommendation: Pass ______ Needs more practice ______

Student: Date:

Instructor: Date:

Copyright © 2007, F. A. Davis Company, Wilkinson & Van Leuven/Procedure Checklists for Fundamentals of Nursing