This is the act of replacing the holder or tie of a tracheostomy tube of a child by a paediatric nurse/nurse. This procedure is done when the tracheostomy tie is soiled, loose, tight and dirty. However, it is also changed every 24hours or based on the ward protocol.
Aims
· Provide comfort
· Prevent accidental decannulation
· Prevent infection
Requirements
· Suction machine with catheters
· A clean tracheostomy tie/holder
· Sterile tracheostomy tube
· Sterile gloves
· A pair of scissors
· Soap and water
Steps
1. Establish rapport (Refer to steps)
2. Explain procedure (Refer to steps)
3. Ensure child has eaten 2 hours before the procedure
4. Provide privacy
5. Perform five moments of hand hygiene
6. Arrange needed items and send to bedside
7. Call for assistance
8. Keep an extra tube in case the inserted one comes out
9. Place infant on the back with rolled blanket/towel and a semi-Fowler’s position in older children for better access to the neck
10. Suction tracheostomy tube if necessary
11. Ask assistant to secure tracheostomy tube in place
12. Remove the old tie/holder on one side
13. Wash skin on one side with soap and water
14. Observe for breakdown of skin, colour, odour and dryness
15. Slip one side of the tie/holder facing up through the flange on the tracheostomy tube
16. Repeat steps 12-14 on the other side of the neck
17. Ensure tracheostomy tube is in the middle of the neck, lined up with the belly button and the nose
18. Secure ties/holders on the back by overlapping the straps
19. Tighten to allow only one or two fingers between the tracheostomy tie and child’s neck
20. Encourage caregiver on the need for frequent change of ties/holders
21. Express appreciation to child and caregiver
22. Dispose off, decontaminate and clean all used items
23. Document all findings manually/electronically
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