Cleaning Tracheostomy Stoma

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Considerations:

  • When caring for a student who has a tracheostomy, the nurse should always know the reason for the tracheostomy, the child’s underlying health conditions and whether the child needs the tracheostomy to breathe
  • The frequency of stoma care and the care of the surrounding skin is based on the individual student’s current skin condition and associated factors, such as the amount of secretions and the degree of skin folds around the neck
  • Attempt to provide the student with as much privacy as possible, given the urgency of the situation
  • Should always have Emergency Travel Bag accessible when completing any tracheostomy procedure

Supplies:

Emergency Travel Bag Equipment:
The essential equipment to be kept with the student at all times is as follows:

  • gloves
  • portable oxygen (if ordered) with appropriate sized Ambu-bag
  • appropriate size Ambu-bag facemask (for emergencies when unable to reinsert a new tracheostomy tube
  • portable suction machine that can operate with battery or electricity
  • sterile suction catheters
  • sterile saline vials
  • water-based lubricant
  • two spare tracheostomy tubes — one the size the student currently uses and one that is a size smaller in the event that the tube needs to be changed and there is difficulty passing it through the stoma
  • obturator, if applicable
  • spare tracheostomy ties
  • blunt scissors
  • emergency phone numbers
  • pulse oximeter — may be optional if student is not on oxygen or mechanical ventilation

Additional Needed Supplies:

  • Student’s Individualized Health Plan (IHP) and/or healthcare provider’s order
  • Gauze
  • Cotton tip applicators
  • Mild soap
  • Water
  • Saline
  • Medicine cup
  • Stethoscope
  • Personal protective equipment
    • gloves
    • goggles
    • mask

procedure download skill competency

  1. Gather supplies
  2. Review Individualized Health Plan and healthcare provider’s orders
  3. Position student providing as much privacy as possible
  4. Explain the procedure to the student at his/her level of understanding
  5. Wash hands
  6. Put on gloves
  7. Ensure that tracheostomy ties are secure
  8. Remove dressing if applicable, dispose of per school policy
  9. Observe stoma for
    •increased secretions or change in consistency,
    •color or odor of secretions,
    •redness or crusting,
    •bleeding or
    •pain to stoma site
  10. Use gauze sponges and cotton-tipped swabs per IHP and healthcare provider’s orders
  11. Dip cotton dip applicator in saline and mild soap mixture per healthcare provider’s order
  12. Support the tracheostomy tube with your finger during cleaning
  13. Use cotton tip applicator to clean outer portion of tracheostomy tube and surrounding skin start as close as possible to the tracheostomy tube then work away from it
    • Make only one sweep with each cotton tip applicator before discarding
  14. Repeat the process until debris and/or mucus is removed
    • Minimize direct moisture to the tracheostomy ties
  15. Use a dry cotton tip applicator to dry skin surrounding stoma starting at inner most part and moving outward
    • Drying the skin is vital to maintaining skin integrity
  16. Place dressing on tracheostomy site, if ordered by healthcare provider
  17. Dispose of used supplies per school policy
  18. Remove gloves
  19. Wash hands
  20. Document assessment, intervention and outcomes in student’s healthcare record
  21. Follow up with parent/guardian and healthcare provider, as needed

References:

American Thoracic Society. (2000). Care of the child with a chronic tracheostomy. American Journal of Respiratory & Critical Care Medicine, 1, 297-308.

Bowden, V. R., & Greenberg, C. S. (2012). Pediatric nursing procedures (Third Edition). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Children’s Hospital of Wisconsin. Caring for Kids with Tracheostomies: Cleaning the Skin Around the Trach Tube.

Cincinnati Children’s Hospital Medical Center. (2011). Best evidence statement (BESt). Basic pediatric tracheostomy care. Available at: http://www.cincinnatichildrens.org/WorkArea/DownloadAsset.aspx?id=78219

Connecticut State Department of Education. (2012). Clinical Procedure Guidelines for Connecticut School Nurses. Available at:
http://www.sde.ct.gov/sde/lib/sde/pdf/publications/clinical_guidelines/clinical_guidelines.pdf

Porter, S., Haynie M.D., Bierle, T., Caldwell, T. & Palfrey, J. (1997). Children and Youth Assisted by Medical Technology in Educational Settings. Guidelines for Care. Second Edition. Paul H. Brookes Publishing Co., P.O. Box 10624, Baltimore, MD 21285-0624


Acknowledgment of Reviewers:

Marcia Creasy, BSN, RN
Retired School Nurse

Cynthia C. Griffith, RN, BSN
Nurse Clinician
Tracheostomy/Home Ventilator Program
Children’s Hospital of Wisconsin

Mary Kay Kempken, RN, BSN, NCSN
School Nurse
Randall Consolidated School

Cecilia Lang, MSN, CCRN, PNP-BC
Tracheostomy/Home Ventilator APN
Children’s Hospital of Wisconsin

Carole Wegner, MSN, RN
Clinical Nurse Specialist
Tracheostomy/Home Ventilator Program
Children’s Hospital of Wisconsin


Page last updated: April 6, 2015
Page last reviewed: November 10, 2015