What are the orders for tracheostomy (trach) tube care?

From the Guidelines

Tracheostomy tube care should be performed at least 8 hourly to daily, including securing the tube, checking and cleaning the inner cannula, and checking cuff pressure, to prevent infection and ensure proper functioning 1.

Key Elements of Tracheostomy Care

• Clean the inner cannula at least once daily using hydrogen peroxide or sterile saline, followed by thorough rinsing and drying before reinsertion
• Suction the tube as needed using sterile technique with a catheter no larger than half the inner diameter of the trach tube, applying suction for no more than 10-15 seconds at a time
• Change tracheostomy ties when soiled or loose, ensuring they're secure but allow one finger's width between the tie and neck to prevent pressure injuries
• Clean the stoma site daily with sterile saline or mild soap and water, then pat dry and apply a pre-cut tracheostomy dressing
• Humidify inspired air to prevent mucus from becoming thick and difficult to clear
• Monitor for signs of infection including increased or discolored secretions, foul odor, stoma redness, or fever

Emergency Equipment

• Ensure emergency equipment is always available, including a spare tracheostomy tube of the same size, one size smaller, obturator, suction equipment, and self-inflating bag 1
• Have a bedside equipment checklist to ensure all necessary equipment is available

Additional Considerations

• Use appropriate PPE by all staff remains a priority, even in emergencies
• Plan airway interventions when possible to minimize aerosol generation
• Use a cuffed, non-fenestrated tube with ‘in-line’ (closed) suction to mitigate aerosol generation
• Review care frequency daily and adjust as needed to minimize unnecessary interventions
• Consider the role of the respiratory physiotherapist in maintaining chest clearance and the use of mucolytic drugs or saline nebulisers as needed 1

From the Research

Tracheostomy Tube Care Orders

The following are the orders for tracheostomy (trach) tube care:

• Respiratory assessment of the patient should be carried out to identify when tracheal suction is required 2
• Suction pressure of 80-120mmHg is recommended, and suction should last no longer than 15 seconds 2
• Reassurance and support should be given to the patient to minimize any discomfort and distress that might result from tracheal suction 2
• Timely suctioning or replacement of the tube is essential to prevent immediate mortality in patients with a tracheostomy tube 3
• Classification of breathing sounds into three categories (normal breathing sounds, vibrant breathing sounds, and sharp breathing sounds) can help decide whether to suction or change the tracheostomy tubes 3
• Use of tracheostomy bundles, tracheostomy teams, and protocol-directed care can decrease time to decannulation, length of stay, tracheostomy-related adverse events, and other tracheostomy-related outcomes 4
• Weaning/decannulation protocol can guide weaning and removal of the tracheostomy tube to improve time to decannulation 4

Additional Considerations

• Inhaled antibiotics may be prescribed to treat or prevent respiratory tract infections in patients with tracheostomy tubes, but the practice varies widely 5
• Endotracheal tube with subglottic suction line can be effective in stopping tracheostomy bleeding in critical patients 6