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Tracheostomy Dressing Care: A tracheostomy is a surgical opening into the trachea and hence a potential route of infection, so the area should be kept clean. Tracheostomies can also cause damage to the surrounding tissues through pressure and the presence of irritant secretions, necessitating regular inspection and appropriate care of the area to prevent tissue damage and wound breakdown. Changing the dressing will ensure that the surrounding skin remains clean, dry and free from irritation and infection.
Indications of Tracheostomy Dressing Care
In some patients, the dressing may not be indicated as it creates an ideal environment for bacterial colonization. Secretions from the stoma can also cause excoriation around the site. The decision to dress a tracheostomy should be based on clinical need, although a thorough assessment of the stoma is indicated for all patients with altered airways (i.e. tracheostomy or laryngectomy). The dressing around the tracheostomy tube can be renewed without removing the tube, which should be done twice a day or more frequently if necessary.
Contraindications of Tracheostomy Dressing Care
Occasionally a surgical team may request that the original dressing remain intact for a period of time, usually 24–48 hours. There may be an increased risk of bleeding associated with the stoma formation and in this instance the dressing should not be changed until consultation with the surgeon has occurred.
Principles of Tracheostomy Dressing Care
Changing the tracheostomy dressing always requires two people: one to secure the tracheostomy and the other to assess and dress the stoma site. When assessing the wound, if the infection is suspected, that is, the area is reddened, excoriated, painful, discoloured or exudate is present, a microbiology swab should be sent for culture.
The stoma should be cleaned thoroughly with 0.9% sodium chloride and an appropriate dressing applied where indicated. This should be a foam dressing, usually manufactured with a cross-shaped incision to fit around the tracheostomy tube. For those patients with secretions that tend to accumulate around the stoma, a specialized barrier product can be used to prevent the skin from becoming red and excoriated.
Soma sutures (secured to the flange of the tracheostomy tube) are removed on day 7 (days 7–10 if the tracheostomy has been inserted using a percutaneous technique). If the patient has previously received external beam radiotherapy to the neck, stoma sutures are removed on day 10.
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Tracheostomy Dressing care Procedure
This procedure requires two nurses: one to hold the tracheostomy in place and the other to change the dressing.
Essential equipment
• Sterile dressing pack
• Tracheostomy dressing or keyhole dressing
• Cleaning solution, such as 0.9% sodium chloride
• Tracheostomy securing tapes
• Bactericidal alcohol hand rub
| Action | Rationale |
| 1 Explain and discuss the procedure with the patient. | To ensure that the patient understands the procedure and gives their valid consent |
| 2 Screen the bed. | To ensure the patient’s privacy. |
| 3 Wash hands using bactericidal soap and water or bactericidal alcohol hand rub, and prepare the dressing tray or trolley. | To minimize the risk of infection |
| 4 Perform the procedure using aseptic technique, i.e. apply apron and gloves. | To minimize the risk of infection. |
| 5 Remove the soiled dressing from around the tube, clean around the stoma with 0.9% sodium chloride using low-linting gauze | To reduce the risk of dressing fragments entering the altered airway and to remove secretions and any crusts. |
| 6 Replace with a tracheostomy dressing or a comfortable foam-backed keyhole dressing | To ensure the patient’s comfort. To avoid pressure from the tube |
| 7 Renew tracheostomy tapes, checking that 1–2 fingers can be placed between the tapes and neck. | To secure the tube. To ensure that the tapes are not too tight or too loose, thus decreasing the chance of necrosis caused by excessive pressure from the tapes. |
| 8 Monitor the patient closely for changes in respiratory rate and pattern of breathing, pulse, and dyspnoea. | Any procedure to the tracheostomy if not managed correctly may lead to possible dislodgement of tube or secretions, leading to respiratory deterioration or distress. |
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Pericardiocentesis: Echocardiography-directed pericardial drainage is required for cardiac tamponade due to excess pericardial fluid and to obtain samples of pericardial fluid for the purposes of investigation.