Fundamentals of Nursing Q 47
A nurse is supervising a student nurse who is performing tracheostomy care for a client. Which of the following actions by the student should the nurse intervene?
A. Removing the inner cannula and cleaning using universal precaution.
B. Suctioning the tracheostomy tube before performing tracheostomy care.
C. Changing the old tracheostomy ties and securing the tube in place.
D. Replacing the inner cannula and cleaning the site of the stoma.
Correct Answer: A. Removing the inner cannula and cleaning using universal precaution.
When performing tracheostomy care, a sterile field is set up and sterile technique is required. Standard precautions such as washing hands must also be maintained but are not enough when performing tracheostomy care. The presence of the tracheostomy tube provides direct access to the lungs for organisms, so sterile technique is used to prevent infection.
Option B: Suctioning of the tracheostomy tube is necessary to remove mucus, maintain a patent airway, and avoid tracheostomy tube blockages. The frequency of suctioning varies and is based on individual patient assessment. The depth of insertion of the suction catheter needs to be determined prior to suctioning. Using a spare tracheostomy tube of the same type and size and a suction catheter insert the suction catheter to measure the distance from the length of the tracheostomy tube 15mm connector to the end of the tracheostomy tube. Ensure the tip of the suction catheter remains within the tracheostomy tube.
Option C: If tie changes are required before the first tube change – it is imperative that the procedure must be undertaken with both medical and nursing staff present who are able to reinsert the tracheostomy tube in case of accidental decannulation and the appropriate equipment is available at the bedside. Tracheostomy tie changes are performed daily in conjunction with stoma care, or as required if they become wet or soiled to maintain skin integrity.
Option D: Care of the stoma is commenced in the immediate postoperative period, and is ongoing. Inspect the stoma area at least daily to ensure the skin is clean and dry to maintain skin integrity and avoid breakdown. Daily cleaning of the stoma is recommended using 0.9% sterile saline solution.