Stoma care and ties

Secretions that collect above the cuff may ooze out of the stoma site and cause wetness around the tracheostomy site, this can cause irritation leading to skin maceration and excoriation. The stoma site should be inspected daily and should include assessment of the ties and skin underneath. The back of the neck should also be inspected for signs of redness/soreness from the ties. 

Changing the tracheostomy ties and dressing should always be a two person technique.

Equipment required

  • Dressing trolley

  • Sterile dressing pack

  • Tracheostomy wipes/ gauze

  • Saline

  • Tracheostomy ties

  • x1 foam dressing (e.g. lyofoam tracheostomy dressing)

Procedure: Changing tapes

This is a sterile non-touch technique:

Explain/discuss the procedure with the patient and gain consent

To reduce the risk of coughing, assess the patients need for suctioning and carry out suctioning if required. This procedure must be repeated whenever the dressing becomes soiled or every 24 hours.

  • Wash hands, put on gloves and apron and visor

  • Lay out dressing pack and prepare the normal saline and dressing in a sterile area

  • Two nurses are required: one supports the tube for the duration of the procedure, while the other removes the tapes and removes the soiled dressing

    Remove soiled gloves, gel hands and replace gloves

  • Observe the condition of the skin and the stoma, swab site if required

    Clean around the stoma with sterile gauze using 0.9% saline or Trachi wipes. Apply barrier cream if the skin is at risk of breakdown due to moisture.

    If sutures are in place, identify if these are necessary to maintain tube position and remove if not required for security (liaise with max facs prior to this).

  • Apply Trache dressing underneath the tracheostomy flange, ensuring the flange is not against the skin

    Secure the trachesotomy tube using a velcro strap. Ensure the trache ties are pulled tight enough to allow one finger to slide under the ties.

  • Record assessment and procedure in patient’s records

 

Please watch the video below from NTSP demonstrating how to safely change a tracheostomy dressing: