Patient Self-Care of Tracheostomy

Patient education begins on admission to the inpatient postoperative unit. Throughout the typical course of stay, the patient must be taught to adequately perform self-cares in order to safely return home with his/her tracheostomy.

1. Post-operative day 1
   • Patient will be provided with mirror to explore and become familiar with his/her own tracheostomy/stoma site.
   • Patient will observe nursing staff drop normal saline and suction tracheostomy.
   • Patient will be instructed on how to maintain skin integrity of stoma site.
   • Patient will watch Tracheostomy Self-Care dvd provided by nursing staff.
   • Patient will be given to Tracheostomy Home Care Booklet to review throughout inpatient stay.
     • See Tracheostomy Home Care Booklet
2. Post-operative day 2
   • Patient will begin performing self-cares, including dropping saline and suctioning, with support of nursing staff.
   • Patient will begin performing stoma site care, with support of nursing staff.
   • Patient will successfully demonstrate to nursing staff proper technique for airway clearance and stoma site care.
3. Post-operative day 3:
   • Patient will perform all self-cares independently.
   • Nursing staff will be available at all times to assist patient with cares in event of questions/concerns.

Nursing Management of the Tracheostomy Patient Throughout Self-Care Education Process

Although the patient must learn how to care for his/her trachesotomy, it is nursing's responsibility to ensure that the airway does not become compromised post operatively.

1. Frequent assessment of airway exchange and/or trach displacement.
   • Monitor for crepitus, skin integrity, viscosity of secretions.
2. Airway intervention may be necessary, especially in early post operative phase, before patient is fully educated on how to care for trach.
   • Ensure trach is suctioned at least Q8 hours.
   • Ensure NS is instilled at least Q4 hours.
   • Ensure that inner cannula is cleaned or changed at least Q8 hours, minimally, and PRN.
   • Ensure that crusting/drainage is removed from trach site Q8 hours and PRN to preserve skin integrity and prevent infection at the site.
3. Airway precautions must be followed throughout patient stay.
   • Suction hooked up at head of bed at all times.
   • Obturator at head of bed at all times.
   • Cuffed tracheostomy tube at head of bed at all times.
   • No kleenex or water to the trach site.
   • Airway beds are to be located near the nurse's station at all times.

See Tracheotomy - Tracheostomy

All information provided above courtesy of 2JCP Staff Nurse Orientation Manual and Otolaryngology Clinic Nursing.