Tracheostomy Tube Management for BLS Providers

In-hospital Tracheostomy Care:

After washing hands with a clinical or surgical scrub, perform the following steps:

  1. Open the cleaning kit and spread the sterile field on the work area
  2. Pour hydrogen peroxide in one tray and pour sterile water in the other side
  3. Place sterile glove on dominant hand
  4. Remove items from kit with sterile gloved hand and place on sterile field
  5. Suction patient
  6. Disconnect patient from ventilator using non-sterile hand.
  7. Unlock and remove inner cannula with the non-sterile hand and place in the tray of hydrogen peroxide to soak, if it is non-disposable.*
  8. To unlock the inner cannula, turn it counter clockwise. If there are flanges, pinch the clips and remove inner cannula   
  9. Insert a clean inner cannula into tracheostomy tube
  10. Reconnect patient to the ventilator
  11. Suction patient if needed.
  12. Remove soiled tracheostomy dressing with non-sterile hand.
  13. Clean skin with gauze pad moistened in sterile water and dry with 4 x 4.
  14. Apply clean tracheostomy dressing and change tube holder if required.
  15. Dispose of disposables
  16. Wash hands.

* If the inner cannula is not disposable, then after soaking in hydrogen peroxide you should use the sterile brush to clean the inner cannula, and rinse with sterile water. Use a 4 x 4 to dry the inner cannula and store it in a clean covered container. (1)