Policy Manual sample

MDT Home Health Care Agency, Inc. 126 TRACHEOSTOMY CARE PURPOSE: Tracheostomy care is performed by trained professionals to keep the tracheostomy tube and the surrounding area clean, prevent infection of the airways and the area around the tracheostomy tube and to prevent breakdown of the skin around the tracheostomy tube. RESPONSIBLE PERSONNEL: RRT, CRTT, RN, LPN EQUIPMENT: Trach care kit, hydrogen peroxide, saline or sterile water, suction kit, disposable inner cannula (if ordered) SPECIAL CONSIDERATIONS: The physician should be notified for any sign or symptom of infection, bleeding, shortness of breath, puffiness and/or cracking of the skin around the tracheostomy tube, chest pain, difficulty in replacing the tracheostomy tube or the inner cannula, difficulty in passing a suction catheter or the inability to keep the cuff inflated. PROCEDURE: 1. Assemble equipment. 2. Wash hands and explain the procedure to the patient. 3. Assess the patient's cardiopulmonary status and suction the patient before beginning this procedure as needed. Remember to change gloves. 4. Open the trach care kit and arrange the sterile field aseptically. If using the disposable inner cannula, open and drop onto the sterile field. 5 . Drape the patient's chest with sterile drape provided in the kit and apply sterile gloves. 6. Fill one basin or basin chamber with sterile water and the other two with hydrogen peroxide. 7. Unlock and remove the inner cannula placing it in the peroxide using clean hand. 8. Clean inner cannula using wire brush and pipe cleaners and rinse with water. 9. Dry and replace clean inner cannula. 10. Remove old drain sponge and discard. 11. Clean around the stoma with gauze soaked in hydrogen peroxide. Work from inner area closest to stoma to outer area away from stoma. 12. Rinse with gauze and sterile water again moving outward from stoma. Use cotton tipped applicators to clean close to the stoma and face plate of trach tube. 13. Dry the area with gauze pads and replace drain sponge. 14. Change the trach ties at this time if needed following agency procedure. 15. Dispose of trash and replace equipment. 16. Wash hands. DOCUMENTATION: Document the date and time of the procedure and patient's tolerance on the Clinical Visit Note. Document any skin irritations or s/s of infection and report to physician. Document physician contact and whether or not additional orders are received.