Care of Tracheostomy
site
Linda Armour
7th October 2011
Key Points
• Patients with a tracheostomy are at
increased risk of infection.
• Effective management of the stoma will
aid the prevention of peristomal infection
and irritation.
• Management of a Tracheostomy site
remains the same for hospital
environment as in the community.
Cleaning the stoma site
• Always prepare everything you require
before starting.
• Site should be cleaned once a day, more
often if needed.
• Cotton wool should never be used to clean
the site due to the risk of inhalation of
fibres from it.
• While cleaning the site and surrounding
skin its condition should be assessed.
Equipment needed
• Emergency Equipment
ie suction, spare tube and spare
smaller tube
• Gauze swabs
• Cotton buds may also be used
• Normasol sachet or sterile water
• Tracheostomy tape and scissors
• Small blanket or towel roll
• Towel to wrap the infant in
Action
Rational
• Clean around the
stoma site and neck
with gauze soaked in
normasol/sterile
water.
• To remove secretions
and crusts
• To maintain healthy
skin
• Dry the stoma site
thoroughly.
• To reduce the risk of
infection and
irritation.
• Assess the need for a
barrier film, eg
Cavilon, if the site
looks red and inflamed
• To reduce the risk of
further damage to the
skin
Common Problems
• Inflammation
Check correct tape tension, ie not too tight or too loose. The use of trachy
bibs particularly when feeding or infant is teething. Lack of general
hygiene procedures.
• Infection
A swab should be taken and treated accordingly. If excessive exudate
present an absorbent dressing should be applied ie non adhesive Lyofoam
dressing.
• Candida
This can be treated with antifungal cream. Cavilon can be applied over this
to keep the antifungal cream in place.
• Overgranulation
Apply Haelan C/ 1% Hydrocortisone cream. The use of Polyurethane
dressing such as Lyofoam or Transorbant foam aids compression of
overgranulated tissue.
Granulation tissue
Conclusion
Result should be a happy contented
baby with healthy peristomal skin.
References
Docherty B, Bench S (2002)
Tracheostomy
management for patients in general ward
settings. Professional Nurse, 18, 2, 100-104.
St George’s Healthcare NHS Trust (2000)
Guidelines for the Care of Patients with
Tracheostomy Tubes. London, St George’s
Healthcare NHS Trust.
Serra A (2000) Tracheostomy care. Nursing
Standard. 14, 42, 45-55.