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Tracheostomy dressing changes promote skin integrity and help prevent infection at the stoma site and in the respiratory system. Typically, healthcare facilities have both formal and informal policies that address dressing changes, although no evidence suggests a particular schedule of dressing changes or specific supplies for secretion absorption must be used. On the other hand, the evidence does show that:
- secretions can cause maceration and excoriation at the site
- the site should be cleaned with NSS
- a skin barrier should be applied to the site after cleaning
- loose fibers increase the infection risk
- the trach tube should be secured at all times to prevent accidental dislodgment, using the two-person securing technique described below under “Securing the tach tube.”
Start by assessing the stoma for infection and skin breakdown caused by flange pressure. Then clean the stoma with gauze or other nonfraying material moistened with NSS. Start at the 12 o’clock position of the stoma and wipe toward the 3 o’clock position. Begin again with a new gauze square at 12 o’clock and clean toward 9 o’clock. To clean the lower half of the site, start at the 3 o’clock position and clean toward 6 o’clock; then wipe from 9 o’clock to 6 o’clock, using a clean moistened gauze square for each wipe. Continue this pattern on the surrounding skin and tube flange. Avoid using a hydrogen peroxide mixture unless the site is infected, as it can impair healing. If using it on an infected site, be sure to rinse afterward with NSS.
Dressing the site
At least once per shift, apply a new dressing to the stoma site to absorb secretions and insulate the skin. After applying a skin barrier, apply either a split-drain or a foam dressing. Change a wet dressing immediately.
Securing the trach tube
Use cotton string ties or a Velcro holder to secure the trach tube. Velcro tends to be more comfortable than ties, which may cut into the resident’s neck; also, it’s easier to apply. The literature overwhelmingly recommends a two person technique when changing the securing device to prevent tube dislodgment. In the two-person technique, one person holds the trach tube in place while the other changes the securing device.
Review trach tube policy and procedures
To achieve positive outcomes in residents with trach tubes, keep abreast of best practices and develop and maintain the necessary skills. Always perform trach care needs based on facility protocol.
To learn more contact you ProMed territory manager, give us a call at (800) 6548-5190 or visit us online at promedsupply.com.
Reference
Tracheostomy care: An evidenced based guide to suctioning and dressing changes. American Nurse Today . Excerpt from http://www.americannursetoday.com/article.aspx. Published July 2011 Vol.6 No. 7. Accessed December 2, 2015.
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