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Key Practice Points

RNs (with current competencies) and RRTs may perform tracheal instillation ONLY when other means to clear the airway have been unsuccessful. Avoid routine and/or frequent instillations.
Minimal Occlusive Volume (MOV) Technique should be performed when the tracheostomy cuff is deflated and re-inflated to prevent tracheal complications.
A cuff pressure manometer should be used to check cuff pressures q8-12h or more often if indicated by RRT.
Use tracheostomy holders on all trachs. Twill ties can be used if a trach holder is not available. Leave a finger width of space under the securement to allow a comfortable fit.
2 Health Care Providers (HCPs) are required for trach holder/tie changes.
Dressing and inner cannula changes are to be completed q12h (once per shift) and prn if dressing becomes wet/soiled. Do not leave a wet dressing as peristomal skin can become macerated and breakdown.
Patients admitted with permanent tracheostomies may have re-usable inner cannulas. Confirm with the patient/family before disposing of inner cannulas. These will need to be cleaned as per the manufacturer’s guidelines.
Non-disposable inner cannulas are cleaned with 0.9% Normal Saline (NS) or ½ strength Hydrogen Peroxide (H2O2), rinsed with 0.9% NS before re-inserting. Do not use H2O2 on metal inner cannulas.
Stoma and peristomal skin are cleansed with NS only. Chlorhexidine solutions should never be used.
Ensure skin under face plate is dried completely to prevent skin breakdown from maceration.
A dressing under the face plate may not be required if there are no secretions or bleeding, or the stoma is healed.
Humidity therapy must always be provided for the patient to prevent secretions from drying out. Dry secretions contribute to an increase in mucous plugs. Exception may be for permanent or home trachs.
Suction tracheostomy prn. Remember to reapply humidity therapy and allow a minimum of 30-60 seconds between passes. In some circumstances, a longer pause may be required.
Rinse catheter between passes with NS or sterile water. Do not insert used catheter into original container. Pour solution into a clean/sterile container to use for rinsing catheter.
Date, time and initials are to be written on NS/sterile water bottles when opened. Discard q24h or more frequently if contamination occurs.
Additional tracheostomy overview information: Tracheostomy Interventions, Adult

Policies and Patient Education

***Coming Soon*** CL-EEO-001 Tracheostomy Umbrella Policy
CL-EEO-001 Tracheostomy/Stoma, Care and Management of Adult Patients with Tracheostomy or Laryngectomy (Umbrella Policy)
CL-EEO-003 Tracheostomy Cuff Care and Pressure Check for Adult Patients
CL-EEO-007 Corking or Capping Tracheostomy Tubes in Preparation for Decannulation of Adult Patients
CL-EEO-004 Tracheostomy Suctioning and Instillation for Adult Patients

Dynamic Health

Nursing Skills and Procedures

Respiratory Therapy Skills and Procedures

Related Learning Modules: Nursing Pathway

Nova Scotia Health Learning Management System (LMS)
You must sign in to search for a course. To sign in, enter your domain\username (e.g. cdha\doej) and password. Once signed in, select Catalogue tab. Copy course title or code, paste it in the Keywords search box and select Search.

NOTE Microsoft Edge is the optimal browser for LMS. More information: The Compass: Learning Management System

Course Title or Series	Code(s)
Introduction to Tracheostomy Care	0235
Tracheostomy Care and Management	0536
Nursing Dynamic Health Skills listed above	LINK
Tracheostomy Exam	1491

Related Learning Modules: RRT Pathway

Nova Scotia Health Learning Management System (LMS)
You must sign in to search for a course. To sign in, enter your domain\username (e.g. cdha\doej) and password. Once signed in, select Catalogue tab. Copy course title or code, paste it in the Keywords search box and select Search.

NOTE Microsoft Edge is the optimal browser for LMS. More information: The Compass: Learning Management System

Course or Dynamic Health Skills	Code(s) or Link(s)
RRT Dynamic Health Skills listed above	LINK