| Knowledge |
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States Contraindications and Relative Contraindications of procedure.
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| Preparation |
| Clinical Standards for Procedures and Interventions. |
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| Verifies the order or protocol, date and maturity of the tract, tube manufacturer, size, cuff status, inner-cannula type, and whether the inner cannula is disposable, reusable, or nonremovable. |
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| Ensures bedside availability of suction, oxygen, bag-mask ventilation with a tracheostomy interface, an obturator, and replacement tubes of the same size and one size smaller according to facility policy. |
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| Assessment |
| Assesses respiratory status, oxygen saturation, tube patency, secretion burden, cuff and ventilator function when present, stoma and peristomal skin, drainage, bleeding, odor, granulation, and securement. |
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| Preparation |
| Explains the procedure, positions the patient, performs hand hygiene, applies appropriate personal protective equipment, and prepares a clean or sterile field as required by policy and tract status. |
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| Implementation |
| Preoxygenates and suctions only when clinically indicated, then stabilizes the tracheostomy flange throughout manipulation, especially in a fresh or high-risk tract. |
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| Unlocks and removes the inner cannula without dislodging the outer tube; immediately replaces a disposable cannula with the correct new cannula and confirms it is fully seated and locked. |
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| For a manufacturer-designated reusable inner cannula, cleans only with the approved solution and brush, rinses and dries as directed, reinserts, and locks it; does not use caustic solutions or improvised methods. |
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| Cleans the stoma and flange from the least contaminated area outward with the approved solution, removes dried secretions without tissue injury, dries the area, and reassesses the skin. |
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| Applies a manufactured pre-cut tracheostomy dressing only when indicated and does not cut standard gauze around the tube because loose fibers can enter the airway. |
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| Changes wet, soiled, loose, or damaged ties using a second trained person for fresh or high-risk tracheostomies; maintains tube stability and secures ties with approximately one finger of space. |
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| Monitoring & Modifications |
| Reassesses tube patency, air movement, oxygen saturation, ventilator connection, cuff pressure when applicable, securement, stoma condition, and patient comfort; responds immediately to obstruction or displacement. |
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| Post-Intervention |
| Disposes of or reprocesses supplies according to infection-control and manufacturer requirements and documents tube and cannula type, skin and stoma findings, secretions, care performed, securement, response, and escalation. |
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| Post-Intervention Management Steps. |
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