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Comment on this procedure
* The tracheal tube will be secured in the midline position.
* Aseptic technique to be used when changing tracheostomy dressing.
* Dressing to be changed for the first time 24hrs post procedure.
* Dressing to be changed thereafter once a shift or PRN when soiled.
* tie tapes holding tracheostomy tube will not be secured so tight around neck as to occluded patients circulation.
OUTCOMES:
* Complication of tracheal stenosis and erosion are minimised by securing the tracheal tube in midline position.
* The patient tracheostomy site will remain infection free during his or her stay in hospital.
EQUIPMENT: Basic dressing pack Normal saline
2 pack sterile gauze 10x10cm 2 x _ in white cotton tape x 1m lengths
PROCEDURE:
* Explain the procedure to the patient prior to procedure.
* Aseptic preparation prior to commencing procedure.
* Prepare dressing pack at bedside prior to positioning patient.
* Suction patient (refer to Suctioning of patient with tracheostomy tube).
* Arrange for second nurse to hold the tracheostomy tube.
R : 22.1
* Remove old dressing and ties.
* Swab around tracheal stoma with normal saline until the area is cleaned.
* Fold sterile gauze squares in half and place on under each flange of the tracheostomy tube.
* Attach cotton tape to tracheostomy tube flange by passing doubled cotton tape up through opening in flange then threading loose ends up through loop. The end result should have two tails extending out from flange, one tail being 15cm of the one metre length. Repeat procedure for the side of the flange.
* Threat the two long portions of the cotton tape behind the patients head.
* The long cotton tape are then to be tied to the shorter tied leaving at least a two finger space between patient and tie tapes.
* Ensure patients comfort with new dressing.
* Test cuff press with cuffed tracheostomy tubes. Pressure should be <25cm H2O.
Reviewed November 1995
R : 22.2
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