| Procedure for field change of tracheostomy tube
- Put on the appropriate body substance isolation.
- Open a sterile burn sheet as your sterile field
- Open sterile supplies and place on sterile field
- Put dominant hand into a sterile glove.
- Check the cuff: insert 10 cc of air in the cuff and check for leaks.
- Deflate the cuff of the new trach tube and do not contaminate the tube by touching anything.
- Remove the inner cannula and replace with the obturator.
- Lubricate the tube tip with a water-soluble sterile lubricant. Do not use any petroleum-based products.
- Suction patient as needed.
- If the patient has a cuff, deflate it by pulling all air out with syringe.
- Remove the trach dressing and holder.
- Wipe the neck to clean skin as needed with sterile 4 x 4 and sterile water.
- If the patient is connected to a ventilator, disconnect patient from the ventilator.
- Remove the tracheostomy tube using a forward and posterior motion.
- Using your sterile hand, carefully insert the new tube with the obturator in place.
- Remove the obturator immediately.
- Insert the inner cannula into the tracheostomy tube.
- Inflate the cuff using minimal leak technique or a cuff manometer.
- Ventilate the patient using the bag-valve-mask; looking for chest rise.
- Attach waveform capnography. (ALS ONLY)
- With the tube in place, stabilize it with one hand and secure with a tube holder.
- Continue to assist ventilations as necessary.
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