Skill 77
Tracheostomy Care
A tracheostomy is a 51- to 76-mm (2- to 3-inch) curved metal or plastic tube inserted into a stoma through the neck and into the trachea to maintain a patent airway. Some patients with a tracheostomy tube are able to cough secretions out of the tube completely, whereas others are only able to cough secretions up into it. Standards for care include properly securing the tube, inflating the cuff to an appropriate pressure, maintaining patency by suctioning, and providing oral hygiene. A tracheostomy tube can cause granulation tissue to form on the vocal cords, epiglottis, or trachea secondary to inappropriate cuff inflation.
Delegation Considerations
The skill of performing tracheostomy care is not routinely delegated to nursing assistive personnel (NAP). In some settings, patients who have well-established tracheostomy tubes may have the care delegated to an NAP. The nurse is responsible for assessing a patient and evaluating for proper artificial airway care. The nurse directs the NAP to:
▪ Immediately report any dislodgment or excessive movement of the tracheostomy tube.
▪ Immediately report abnormal color of tracheal stoma and drainage.
