nursing practice For more nursing practice information log on to nursingtimes.net and NT Clinical and Archive
pracTical procedures Keywords RespiRatoRy caRe tRacheostomy DRessing patient safety This arTicle has been double-blind peer-reviewed
Fig 1. The assisting nurse secures the Fig 2. When secure, loosen the Fig 3. Cleanse tracheostomy with Fig 4. Apply a barrier film, if indicated Fig 5. Slide the T-shaped dressing Fig 6. Recommence oxygen therapy
tracheostomy position fixation device sterile saline solution under the tracheostomy flanges for the patient if required
Tracheostomy care 3 – dressing
patient is suctioned or expectorates sputum. pressure damage, while if it is too loose the reFereNces
the area under the tracheostomy flanges tracheostomy is left unsecured. nurses are
should be cleaned by swabbing or irrigating advised to seek local policy/guidelines if docherty, B., Bench, s. (2002)
This final article outlines the procedure for changing a tracheostomy dressing with 0.9% saline solution. cotton wool, traditional-style tracheostomy tapes are used. tracheostomy management for patients in
which fragments easily, should not be used general ward settings. Professional Nurse;
(serra, 2000). Barrier films may be used eQuipment ReQuiReD 18: 2, 100–104.
Author Dan Higgins, RGN, ENB100, improvement scotland, 2007); the stoma is a may not be secure. this means that around the stoma site to protect the skin the following equipment is needed:
ENB998, is senior charge nurse, critical potential route of infection and the proximity changing the dressing always requires two (nhsQis, 2007). gloves and apron; NHs Quality improvement scotland
(2007) Best Practice Statement – Caring
care, University Hospitals Birmingham of secretions can increase infection risk. people, one to secure the position of the standard dressing pack;
for the Patient With a Tracheostomy.
NHS Foundation Trust. device while the other performs the dressing DRessing types swabs;
is DRessing inDicateD? itself. this should only be undertaken in an gauze and similar materials should be sterile 0.9% saline;
this final article in the series on care of in some patients, dressing may not be area where emergency and safety equipment avoided as they shed fibres that can stick to tracheostomy dressing;
serra, a. (2000) tracheostomy care.
patients with a tracheostomy outlines the indicated as it creates an ideal environment (see part 1) is present. the wound and be inhaled (serra, 2000). tracheostomy tube fixation device.
Nursing Standard; 14: 42, 45–52.
procedure for changing a tracheostomy for bacterial colonisation. if the patient is receiving oxygen therapy, specific slimline tracheostomy dressings
dressing. most tracheostomies require some the decision to dress a tracheostomy disruption should be kept to a minimum. the are recommended (nhsQis, 2007). these the pRoceDuRe
form of dressing to absorb secretions and should be based on clinical need, and second practitioner may need to provide usually have a ‘t’ shape cut into them – if explain the procedure to the patient, For more practical procedures
protect the surrounding area. should follow a comprehensive stomal oxygen flow during the dressing procedure. not, one can be cut with sterile scissors. reassure them and gain informed consent. log on to nursingtimes.net and
a tracheostomy is a surgical wound and it assessment and consideration of patient they have a foam and a mat side; the mat Wash hands and don plastic apron. click on Nt Clinical and Archive
is vital to prevent infection (Docherty and comfort and respiratory secretions. cleaning the stoma side should be placed against the skin. prepare dressing field/equipment.
Bench, 2002). tracheostomy patients have the frequency of dressing and cleaning of once the old dressing is removed, the stoma Wash/clean hands with gel, apply gloves. apply skin barrier film if indicated, allow
increased risk of infection (nhs Quality the site will vary, depending largely on the must be inspected for colour and amount of secuRing the tuBe ask the second nurse to temporarily to dry (fig 4).
amount of secretions or soiling. there has secretions, and indicators of infection, which Devices for tube fixation usually have two remove any oxygen delivery device. With the second nurse securing the
been debate about the need for aseptic include: purulent discharge; pain around the holders. the shorter one is fixed through a With the second nurse securing the tube tracheostomy, slide the dressing under
techniques when dressing tracheostomies; site; odour; abcesses; and cellulitis or hole in the tracheostomy flange on the side (fig 1), loosen the fixation device (fig 2). each flange (fig 5).
nhsQis (2007) advocates a clean technique discolouration (Docherty and Bench, 2002). that the nurse is performing the dressing; the Remove dressing and dispose of it. Reapply tube fixation device.
This procedure should be undertaken as the skin is colonised with organisms. if infection is suspected, a swab should be longer one is fixed, in the same way, on the observe the stoma as outlined above. assess the patency of the airway.
only after approved training, supervised nurses should refer to local policy. taken from the site or discharge for analysis. same side as the assistant; this is then Remove gloves, wash or clean hands Recommence oxygen therapy if
practice and competency assessment, While some tracheostomies are sutured in any suspicion of infection should be drawn underneath the patient’s neck and with alcohol gel, apply fresh gloves. required (fig 6).
and carried out in accordance with local place, dressing any tracheostomy carries a reported immediately. if infected respiratory fixed to the shorter holder, using a Velcro- using sterile 0.9% saline clean the stoma Dispose of equipment, wash hands.
policies and protocols. significant degree of risk, particularly as the secretions are suspected, a sputum type fastener. and the surrounding skin (fig 3). Document the dressing change, fixation
fixation device is temporarily adjusted and specimen should be taken the next time the if the holder is too tight it will cause allow to dry. device change and all observations. n
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