PURPOSE

1. To ensure patency of the altered airway and minimize potential for infection.

EQUIPMENT

1. Tracheostomy tube disposable inner cannula (use with Shiley tracheostomy tubes with disposable inner cannulae)
2. Tracheostomy cleaning kit with sterile gloves, pipe cleaners, and tracheostomy brush (use with tracheostomy tubes with nondisposable inner cannula)
3. Twill tape or Velcro tracheostomy tube holder
4. Tracheostomy drain sponge (nonwoven sterile 4 x 4)

PROCEDURE

1. Disposable inner cannula:
   1. Stabilize the neck plate of the tracheostomy tube, unsnap, and remove inner cannula.
   2. Discard soiled inner cannula.
   3. Stabilize the neck plate of the tracheostomy tube, then insert the sterile disposable inner cannula until both snaps lock firmly over the ridge on the outer cannula.
   4. Change the inner cannula as indicated by presence of secretions. Do not clean disposable inner cannulae for reuse.
2. Clean nondisposable inner cannula as indicated by presence of secretions.
3. A tracheostomy tube holder may be used to secure the tracheostomy tube (adjustable holder with Velcro fastening and soft hypoallergenic lining). Check Velcro ties to assure Velcro adheres properly before placing tube holder on patient. Change Velcro tube holder when soiled.
4. If tracheostomy tube is secured with sutures, check for suture integrity and skin irritation. Consult physician to determine when sutures may be removed and ties can be used to secure the tube.