Nursing Prioritization Delegation Assignment Q 46
You are supervising a student nurse who is performing tracheostomy care for a patient. For which action by the student should you intervene?
A. Suctioning the tracheostomy tube before performing tracheostomy care
B. Removing old dressings and cleaning off excess secretions
C. Removing the inner cannula and cleaning using universal precautions
D. Replacing the inner cannula and cleaning the stoma site.
E. Changing the soiled tracheostomy ties and securing the tube in place.
Correct Answer: C. Removing the inner cannula and cleaning using universal precautions
When tracheostomy care is performed, a sterile field is set up and sterile technique is used. Standard precautions such as washing hands must also be maintained but are not enough when performing tracheostomy care. The presence of a tracheostomy tube provides direct access to the lungs for organisms, so sterile technique is used to prevent infection. All of the other steps are correct and appropriate.
Option A: Suctioning of the tracheostomy tube is necessary to remove mucus, maintain a patent airway, and avoid tracheostomy tube blockages. The frequency of suctioning varies and is based on individual patient assessment. It is recommended that the episode of suctioning (including passing the catheter and suctioning the tracheostomy tube) is completed within 5-10 seconds.
Option B: The tracheal stoma in the immediate post-operative period requires regular assessment and wound management including once daily dressing change following cleaning of the stoma area or more frequently if required.
Option D: Care of the stoma is commenced in the immediate postoperative period, and is ongoing. Clean stoma with cotton wool applicator sticks moistened with 0.9% sodium chloride. Use each cotton wool applicator stick once only taking it from one side of the stoma opening to the other and then discard in waste.
Option E: The frequency of a tracheostomy tube changes is determined by the Respiratory and ENT teams except in an emergency situation. This can vary depending on the patient’s individual needs and tracheostomy tube type. It is imperative that the first tracheostomy tube change is performed with both nursing and medical staff who are competent in tracheostomy management and the tracheostomy kit is available at the bedside.