SF Nursing Trach Care   Part  2 Change Wash Inner Cannula
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SF Nursing Trach Care Part 2 Change Wash Inner Cannula

– Welcome back to part
two of Tracheostomy Care. Next up, we’re going to
clean the inner cannula of the tracheostomy and
clean around the site. The supplies that you
need in order to perform tracheostomy care include a new set of trach ties or a trach collar, some sterile normal saline, hydrogen peroxide for cleaning, and a sterile tracheostomy kit. And I need two pairs of sterile gloves. I’m now gonna open my table to give me a larger working surface. I have already identified the
patient, I’ve washed my hands, and I’ve also told the
patient what we’re gonna do. I wanna go ahead and
loosen the mist collar, so that it’s easier to remove. I’m gonna loosen the cap
of my sterile normal saline and I’m gonna loosen the
hydrogen peroxide as well. I’m gonna open up my tracheostomy kit. So remember the one-inch
border around my sterile field is considered non-sterile. Next, I’m gonna place my gloves on. And I’m just gonna put one glove on and arrange my supplies on my field, pour my solutions, and then
put my second glove on. Gonna move this out of my way without turning my back on my field or my patient. I’m right-handed, so I’m gonna actually
put my right glove on. And I don’t have a problem
pouring with my left. If you have a problem
pouring with your left, then you’d wanna make sure that
you put your left glove on, so that you’re able to
pour with your right hand. I’m gonna put my right hand on. Step away. Okay. I now need to arrange my
supplies on my sterile field. The first thing on the top
of your trach kit is actually a sterile drape in order to
put on the patient’s chest. I’m gonna go ahead and
move my mist collar. And I’m gonna drape my patient. The shiny side goes down. I don’t wanna lean over my field. I can touch in the middle
of the field, but not around the one-inch border. So I’m now gonna arrange
the supplies on my field. I’m gonna pull out my pipe cleaners, which you’re gonna use for
drying the tracheostomy. These are little sterile
tweezers that you can use to help place the new dressing
underneath the trach collar. This is the brush to clean
inside the tracheostomy tube. New twill tape for
securing the tracheostomy. We’re actually gonna use
the velcro trach collars instead of the ties. There are some sterile four-by-fours that you can use for
drying the tracheostomy. Actually, I’m gonna put these
supplies up at the top here. There is also the new drain sponge for under the trach. Then I also have three Q-tips for cleaning around
the skin and the trach. There are three containers. It’s a little hard to get
the two undone sometimes. So in the first container, we’re gonna pour the hydrogen peroxide. The second container is gonna be the sterile normal saline for drying. And then the third container is gonna have some sterile normal saline
in in order to clean around the stoma and on
the face of the trach. I’m gonna walk around
the table without leaning over any of my sterile fields. And I’m gonna come around to get my hydrogen peroxide. Hydrogen peroxide is the first container. So I need enough hydrogen
peroxide in order to clean the entire trach tube. And we’re just cleaning the inner cannula. Again, I’m not turning my back on my field and we now need… Actually, I’m gonna just
put that out of the way since I don’t need it anymore. And then I have my sterile normal saline. Loosen my cap. And I’m gonna put my cap facing up. When you first pull out your supplies, you wanna make sure that
this bottle has not expired. If you are the first
one to open this bottle, you wanna make sure that you
label it with your initials, the date, and the time
that the bottle was opened. Most institutions have a 24-hour policy. After 24 hours, this is no
longer considered sterile. Gonna go ahead and pour
into my second container and then into my third container. I wanna avoid splashing. If you splash and wet your sterile field, it is considered non-sterile. Replace my cap. I no longer need this bottle, so I’m gonna put it to the side. Next, I’m gonna put on
my second sterile glove. Oop, and this time, I did not
get my fingers in correctly. There you go, okay. I cannot reach below my wrist. If I touch below my wrists, then I have contaminated my gloves. What I need to do now is
remove the inner cannula of the tracheostomy. And then I will remove the old dressing that is around the tracheostomy. You wanna twist and remove. I’m gonna go ahead and put
the inner cannula inside the hydrogen peroxide. I’m then going to remove
the old dressing from underneath the trach face plate. To look for any drainage, I’m
gonna wrap the old dressing in my gloves and discard my gloves. Without turning my back on my
sterile field and my patient, I’m gonna go ahead and hand sanitize. So the only time you have
to wash the inner cannula or remove it and clean it,
is for someone that has a non-disposable inner cannula. If the patient has a
disposable inner cannula, all you do is remove the old one, replace it with the clean,
new, sterile inner cannula, and then clean around the face plate, and replace the gauze dressing. You do not have to use hydrogen peroxide to clean the cannula. You just insert a new one. In my right hand is a
disposable inner cannula and in my left hand is the
non-disposable inner cannula. Okay, so I’m gonna put on my
second pair of sterile gloves. There we go. Okay. Now, I’m ready to clean. So I’m gonna grab the brush to clean the tube. You wanna clean around the outside. You wanna put the brush inside to clean. Once you have gotten all of the crusty mucus off, you’re gonna go ahead and
put the tracheostomy into the sterile normal saline. And this is for rinsing, so you
wanna make sure that you get the normal saline through the tube. I am then gonna dry my
tracheostomy over my sterile field. That’s just in case I drop it that it doesn’t land
on something unsterile. I want my sterile four-by-fours to dry the outside. I can dry inside by
using the pipe cleaners. You can usually fit one or
two through there at a time just one way. I’m gonna do that one more time. So those are considered not sterile now, because I threw them off of the field. I’m just gonna use the
third one just to make sure that it’s sterile. I wanna observe the trach
just to make sure that I don’t see any obvious
damage or any lint inside. If I need to dry one more time, I can. We are now ready to replace
the tracheostomy tube into the tracheostomy in the patient. I’m now gonna replace the inner cannula and lock it in place. You wanna turn the tube until it locks. And you can see on the
tube, there is a blue dot for this cannula that
is on the inner cannula and then there is a blue dot on the part that is in the patient, and you wanna match those up to make sure that they are locked. You can also feel a little
click and hear a little click when it clicks into place. We’re now gonna clean
around the face plate. So I need the three Q-tips. And we’re gonna be using that last basin that has the sterile normal saline. I’m gonna make sure the Q-tips are moist. And then I’m gonna use the first one. You wanna clean around the tracheostomy. You wanna clean the face plate. Okay, so I’m cleaning the face plate. I’m gonna get rid of
that, the dirty Q-tip. I also need to clean
underneath the face plate, around the stoma. I’m gonna get rid of that Q-tip. So I used three Q-tips for cleaning. Before your procedure, if
you notice that the patient’s face plate and around the
stoma has a lot of discharge or is very dirty, you
can add some additional sterile Q-tips to your
field at the beginning to make sure you have enough
in order to clean properly around the site. So now, I’m gonna reach for my
forceps and my drain sponge. If you look at the drain
sponge, you can see that it has a cut. And there are no frayed edges, so you don’t have to worry
about any of the frayed edges getting into the patient’s airway. So the cut is gonna slide up
underneath the face plate. You want the sealed part at the bottom of the tracheostomy. So if you have any drainage,
the skin will be protected. So during this part, you are
gonna become contaminated. There’s just no way around
trying to put gauze sponges underneath the face plate. You try your best to
make sure that this part does not touch anything, so that it is as sterile as
possible around the stoma. You can use the forceps to help you reach. Okay. So now that I have the dressing back underneath the face plate, I need to change the trach ties. If you are alone, you do not wanna remove the other trach ties until you
have the new ones in place. If you have a second
person with that can hold the tracheostomy in
place, you could remove the old tracheostomy ties. You never wanna have your trach unsecured because if the patient coughs, that trach could be dislodged. This is not a sterile
part of the procedure. The sterile part ended when
we started to put the dressing underneath the face plate. Since I am alone, I am going to put my new trach collar on at the same time as I have my old trach collar on. Gonna reach behind your
neck here to get the new trach collar in. And I need to tighten this one. This one’s a little loose for the patient. So I have both sides secured, but now, I need to make sure
it’s in the correct position and tight enough. This is looking a little loose. When I have the trach collar
in the correct position, I should be able to get two
fingers, one to two fingers between the trach collar
and the patient’s skin. If you have more fingers between… You can fit more fingers
between the trach collar and the patient’s skin,
it means that your collar is too loose. I’m gonna go ahead and
remove the old trach collar. Okay, I can discard that. So now that I have the
trach collar in place, I’m gonna double-check I can fit one to two fingers comfortably, but I wouldn’t be able to fit a third without hurting the patient. I wanna replace my mist collar. There you go. So that concludes the end
of the tracheostomy video, sectioning as well as tracheostomy care. I still need to dispose of my gloves and dispose of my supplies. To leave my patient, I
need to make sure that the side rail is up, they have their coli, and they are in a comfortable position. Thank you so much for joining us and I hope to see you next time.

About Bill McCormick

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19 thoughts on “SF Nursing Trach Care Part 2 Change Wash Inner Cannula

  1. I have noticed that the younger the demonstrator is the worse the grammar. e.g. "this concludes the end of the demonstration" I believe that good grammar in the U.S. has got up and went!

  2. Why dont you go until resistance is met? I dont see any harm in a little poke…surgeons do far worse from what ive seen? Have there been doccumented cases of people doing harm during teach care by gently meeting resistance and backing out a few mm and then suctioning?? Generally the real icky stuff tends to be deeper anyway. How do you get that icky stuff if you only go the distance of the trache? Just questions😊 great video👍👍 cheers!

  3. Good video but she contaminates her sterile gloved hand at 4 min into the video by flipping the drape, grabbing the corner of the drape with her contaminated hand and then with her sterile gloved hand. She then continues to contaminate the rest of her equipment with her contaminated glove.

  4. Just Don sterile gloves , set up your sterile field , then use non dominant ( clean hand now) to pour, keep clean hand to hold tip of cannula

  5. I had to grow up with a tracheotomy too since I was age 7 and others from adults thought it was a paedophile voice it not it actually from a tracheotomy that makes me speak like that I get done for that I can't help speaking like that I speak it 24/7 not putting it on as some think it is and guess what who does that at me I found there hollowgrams cause my bike went right through them. I don't call my self bad things I see my self as a good person innocent when doing things.

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