Policy Manual sample

MDT Home Health Care Agency, Inc. 127 TRACHEOSTOMY TIE CARE PURPOSE: Tracheostomy ties will be changed in a safe and consistent manner under the order of a physician. The physician should be notified of any of the following problems: • The tracheostomy tube becomes dislodged and it is not possible to replace it. (If airway patency is compromised, seek emergency medical attention.) • Puffiness and/or redness of the skin under the ties. • Neck lacerations. Tracheostomy ties are used to hold the tracheostomy tube in place. The ties must hold the tube tight enough so it cannot be coughed out or dislodged, yet loose enough to be comfortable and not restrict the airway with position changes. Tracheostomy ties that are too tight, or stiff and dirty can create lacerations around the neck area. The ties should be changed: • If they become loose. • If they become soiled and stiff. • If they are positioned or tied incorrectly. RESPONSIBLE PERSONNEL: RN EQUIPMENT: Tracheostomy care kit with scissors, tweezers, gauze pads, tape and pre-cut bib-gauze; gloves PROCEDURE: 1. Assemble equipment. Have suction source and catheters available if suction is needed. 2. Wash hands with soap and water; don gloves. 3. Sit comfortably in front of a mirror in a well-lighted area (if patient is doing the procedure with assistance). 4. Cut 2 pieces of twill tape, each one long enough to go more than halfway around the neck. 5. Fold each piece of the twill tape under about 1 inch from one end. 6. With the scissors, cut a small slit in the center of the fold. 7. While holding the tracheostomy tube firmly in place cut off the old ties. 8. Using the tweezers, insert one piece of tape into the slot on one side of the tracheostomy tube flange and the second piece into the other slot. 9. Push the uncut end of the tape through the slit cut. 10. Pull tape through cut to secure it to the tracheostomy tube. 11. Tie the two pieces of tape together in a square knot on one side of the neck. DO NOT tie a bow. Make sure there are no twists or kinks in the tape. 12. Check tightness of the tape by inserting two fingers between the tape and the neck. Two fingers under the tape usually indicate a proper fit. 13. Make sure the knot is secure, but not too tight. 14. Place pre-cut bib gauze under both sides of the flange, pulling ends up under tape.