This is an activity performed by a paediatric nurse/nurse to replace the inner tube of a tracheostomy. Tracheostomy tube without an inner lumen is usually changed every 5-7 days. However, children with excessive secretions require more frequent tube changes. The nurse ensures the presence of an anaesthetist or doctor on call for the first tube change or if a difficult airway is anticipated.
Aims
· Ensure patency
· Promote hygiene
· Minimize the risk of respiratory infections
· Decrease granulation tissue formation
Requirements
a. Suction machine with catheters
b. Sterile tracheostomy tube with obturator
c. Small sizes tracheostomy tube
d. Tracheostomy tie
e. A pair of scissors
f. Self inflating bag/mask
g. Sterile gloves
h. Mackintosh cape with towel
i. Pulse oximeter
j. Sterile water/normal saline
k. Water-based lubricant
l. Rolled towel/blanket
m. Sterile swabs and gauze
n. Stoma dressing
o. A small cup for water
p. Topical medication if necessary
q. Paediatric stethoscope
r. Syringes and needles (Cuffed tube only)
s. Cardiac monitor
t. Protective eye shield
u. Trachea dilators
Steps
1. Establish rapport (Refer to steps)
2. Explain procedure (Refer to steps)
3. Obtain informed consent
4. Provide privacy
5. Perform five moments of hand hygiene
6. Arrange needed items and send to bedside
7. Call for assistance
8. Place infant on the back with rolled blanket/towel and a semi-Fowler’s position in older children for better access to the neck
9. Wear sterile gloves
10. Aspirate NG tube if present or maintain nil per os 2-3 hours prior to tracheostomy tube change
11. Deflate cuff with an empty syringe if there is a balloon at the end of the tip
12. Place air or sterile water back into the cuff after inserting it into the neck opening
13. Clean around the neck with a warm and soft cloth before removing the old tracheostomy tube
14. Suction if necessary
15. Squeeze a water-based lubricant onto a tracheostomy tube and place on a sterile gauze
16. Hold tracheostomy tube in place with two fingers on the face plate
17. Remove old tracheostomy tube holder/tie from one side of the tube to avoid stoma collapse
18. Position hand under infant’s jaw carefully
19. Count one to three and remove tube swiftly from stoma
20. Pick up the new tracheostomy tube with an obturator in place
21. Insert new tracheostomy tube from a side angle, rotate in a correct position while pushing
22. Withdraw obturator immediately after insertion
23. Assess for child’s breathing
24. Inflate the cuff inside if ordered
25. Place sterile tracheostomy dressing
26. Secure tracheostomy tube with a tie/holder
27. Connect the child to oxygen with a humidifier
28. Clean obturator and place in a clean bag with space tubes
29. Ensure obturator is readily available for next use
30. Express appreciation to child/caregiver
31. Clean and sterilize old tracheostomy tube
32. Dispose off, decontaminate and clean other items
33. Document findings manually/electronically
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