| 👀 Tracheostomy Care – Managing tracheostomy and preventing infections 👀 Suctioning – Procedures for secretion removal and safe execution 👀 Oxygen Therapy – Proper oxygen usage and application to patients (Nasal Cannula, Simple Oxygen Mask, and Partial Rebreather Mask) 👀 Nebulizer Therapy – How to use nebulizers for drug delivery and their application |
Scene: Tracheostomy Tube Inner Cannula Management
Nurse:
Good morning, Mrs. Lee. My name is Sarah, and I’ll be your nurse today. I’m here to perform routine tracheostomy care to ensure your tube stays clean and functions properly. I’ll guide you through each step so you know exactly what I’m doing. If you experience any discomfort or have questions during the procedure, please let me know right away. Your safety and comfort are my top priorities.
Patient:
Good morning, Sarah. Thank you for explaining. I have to admit, I’m a little nervous since I’ve never had this done before.
Nurse:
That’s completely understandable. Many patients feel that way at first, but I’ll go slowly and make sure you’re as comfortable as possible. I’ll begin by performing hand hygiene and setting up a sterile field. I’ll also gather everything I need, including sterile gloves, a tracheostomy care kit, saline solution, hydrogen peroxide, a long sterile cleaning brush, sterile gauze, and a sterile container for soaking the inner cannula.
(Nurse performs hand hygiene and opens sterile supplies using aseptic technique.)
Nurse:
I’m now putting on sterile gloves. This step is essential to prevent infection while I handle your tracheostomy equipment. Next, I’ll stabilize the outer cannula with one hand and gently unlock and remove the inner cannula with my other hand.
(Nurse removes the inner cannula and places it into the hydrogen peroxide solution.)
Nurse:
The inner cannula is now soaking in the hydrogen peroxide to loosen any dried mucus or secretions. This helps make the cannula easier to clean and prevents obstruction, which can interfere with breathing. I’ll now use this long sterile brush to scrub the inside and outside of the cannula carefully.
(Nurse gently but thoroughly scrubs the cannula, ensuring all visible debris is removed.)
Nurse:
Now that the cannula is clean, I’m rinsing it with sterile saline solution to remove any remaining peroxide or debris. It’s important to rinse thoroughly because peroxide can be irritating to tissue if not completely removed.
(Nurse rinses and then dries the cannula using sterile gauze.)
Nurse:
I’m drying the cannula completely with sterile gauze to prevent any residual moisture from promoting bacterial growth. Now I’ll reinsert the clean inner cannula and ensure it’s securely locked in place.
(Nurse carefully re-inserts the cannula and checks that it is locked.)
Nurse:
The cannula is securely back in place. How are you feeling now, Mrs. Lee?
Patient:
I feel fine. That wasn’t as scary as I thought it would be. Thank you.
Nurse:
I’m glad to hear that. You did really well. That completes the inner cannula cleaning. We’ll now move on to cleaning the tracheostomy site to keep the surrounding skin healthy and prevent infection.
Scene: Tracheostomy Site Cleaning
Nurse:
Before I begin cleaning around the tracheostomy site, I’m going to suction any visible secretions from the stoma area. This ensures the area is clear and easier to clean. Let me know if you feel any discomfort during suctioning.
(Nurse uses a suction catheter and clears secretions around the stoma.)
Nurse:
Next, I’ll remove the used Y-gauze dressing from underneath your tracheostomy tube and dispose of it properly.
(Nurse discards the old gauze using aseptic technique.)
Nurse:
Now, using a sterile swab moistened with normal saline, I’ll gently clean the skin around your tracheostomy. I’ll clean in a circular motion, starting closest to the tube and moving outward. This technique helps prevent introducing bacteria into the site.
Patient:
Will this sting or hurt?
Nurse:
You might feel a bit of coolness from the saline, but it shouldn’t sting. If you feel pain or discomfort, let me know immediately.
(Nurse gently cleans the skin using sterile technique, being careful not to dislodge the tracheostomy tube.)
Nurse:
The area looks healthy, with no signs of redness, swelling, or discharge—those are things we always watch out for as they could be signs of infection. Now, I’m gently patting the area dry with a sterile gauze pad to remove any moisture.
(Nurse pats the area dry.)
Nurse:
Finally, I’m placing a fresh, sterile Y-gauze underneath your tracheostomy tube to help absorb any secretions and keep the area clean. This type of dressing also provides a bit of cushioning and helps reduce skin irritation.
(Nurse completes dressing application and removes gloves.)
Nurse:
I’ve now completed the entire tracheostomy care process. I’ll finish by performing hand hygiene again and documenting the procedure.
(Nurse removes gloves and washes hands thoroughly.)
Post-Care Discussion and Documentation
Patient:
Thank you so much. How often do I need this kind of care?
Nurse:
We usually perform tracheostomy care like this at least once every shift or more often if there’s increased secretion buildup. Consistency is key to preventing complications. I’ll document everything we did today, including the amount and appearance of the secretions, the condition of your stoma, and your response to the care.
Patient:
That sounds great. I really appreciate your gentle approach and clear explanations.
Nurse:
You’re very welcome, Mrs. Lee. Don’t hesitate to press the call bell if you feel any discomfort, have difficulty breathing, or notice anything unusual like redness or swelling around the site. And if you ever want me to walk you through the steps again, I’d be happy to do so.
Educational Notes (for nursing students):
- Rationale: Regular tracheostomy care reduces the risk of infection, prevents tube blockage, and promotes skin integrity.
- Infection control: Aseptic technique is critical throughout the procedure to prevent hospital-acquired infections.
- Patient education: Explaining the process step-by-step helps reduce anxiety and builds patient trust.
- Documentation: Should include secretion characteristics (amount, color, odor, consistency), skin condition, patient's tolerance, and any abnormalities observed.
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