What do I need at the bedside to care for a patient with a tube?

Bedside Equipment for Tracheostomy Tube Care

Every patient with a tracheostomy requires immediate bedside access to spare tracheostomy tubes (same size and one size smaller), suction equipment with appropriate catheters, scissors or stitch cutters, and emergency airway equipment including oxygen delivery devices and bag-valve-mask resuscitators. 1

Essential Bedside Equipment

Tracheostomy-Specific Supplies

• Spare tracheostomy tubes: One the same size as currently in place and one tube one size smaller 1
• Clean pot for spare inner cannula 1
• Scissors (and stitch cutter if the tracheostomy tube is sutured in place) 1
• Water-soluble lubricating jelly for tube changes 1
• Tracheostomy dressings and tapes for securing the tube 1

Airway Management Equipment

• Humidification equipment to prevent mucus plugging 1
• Suction machine with selection of appropriate suction catheters (sizes 6F through 16F depending on tube size) 1
• Sterile water for cleaning the suction tube 1
• Yankauer suction tip for oral suctioning 1
• Bulb syringe for gentle suctioning 1

Emergency Airway Equipment

• Basic airway equipment: Oxygen masks (both standard and non-rebreathing), self-inflating bags (bag-valve-mask resuscitators in 450-mL and 1000-mL sizes), oral and nasal airways 1
• Advanced airway equipment: Laryngeal mask airways and laryngoscopes with appropriate tubes 1
• Tracheal dilators (institutional preference varies, but should be agreed upon locally) 1
• Bougies for difficult tube replacement 1

Monitoring and Safety Equipment

• Waveform capnography (must be immediately available, ideally at bedside or within minutes on arrest trolley) 1
• Pulse oximeter with appropriate sensors 1
• Stethoscope for breath sound assessment 1
• Nurse call bell (critical as the patient may be unable to call for help verbally) 1
• Communication aids since the patient may not be able to verbalize 1

Personal Protective Equipment

• Gloves, aprons, and eye protection 1
• Sterile gloves for performing deep suction 1
• Sterile dressing pack 1

Documentation and Reference Materials

• Bedside equipment checklist to ensure all supplies are present 1
• Bed-head sign displaying local emergency contact details, airway difficulty grade, and successful airway management techniques 1
• Emergency algorithm (color-coded green for patent upper airway or red for laryngectomy) 1

Critical Safety Considerations

Capnography Requirements

Waveform capnography is invaluable and should be used at the beginning of airway assessment. 1 For mechanically ventilated patients, continuous waveform capnography monitoring is now recommended, as NAP4 study data showed that capnography could have prevented more than 80% of tracheostomy-related deaths in critical care. 1 In non-ventilated but hospitalized patients, capnography should be immediately available even if not continuously connected. 1

Oxygen Delivery

High-flow oxygen should be applied to both the face and tracheostomy simultaneously when the patient is breathing and in distress. 1 This requires two oxygen sources and appropriate delivery devices. 1

Emergency Preparedness

A fibreoptic scope suitable for immediate use should be available for all patients with a tracheostomy—immediately available in critical care and specialist areas, or within minutes (on cardiac arrest trolley) for ward areas. 1 All staff caring for tracheostomy patients must know how to access and operate capnography and fiberoptic scopes around the clock. 1

Common Pitfalls and How to Avoid Them

Equipment must be checked regularly using the bedside equipment checklist to ensure nothing is missing or expired. 1 Most equipment should be kept in a dedicated emergency box at the bedside rather than stored elsewhere. 1

Never rely on equipment being available "somewhere on the unit"—tracheostomy emergencies require immediate intervention, and delays in obtaining equipment contribute to preventable deaths. 1 The bed-head sign should display specific local details of whom to call and how to avoid delays in emergency situations. 1

Ensure two trained adults are available for routine tracheostomy tube changes when possible, though special circumstances may exist in homes with single parents. 1