Skill Check-Off Competency:

Tracheostomy Care

Step / Action / Acceptable
OR
Unacceptable
(A/U)
Suctioning
Patient education / Explains procedure to patient and what to expect
Assists patient to semi-Fowler’s position, raises bed to appropriate height, places a towel on patient’s chest
Equipment / Gathers appropriate supplies
Performs hand hygiene and applies face shield
Connects suction tubing to suction and places other end near work area, turns on suction to appropriate pressure level
Hyper oxygenates patient while encouraging deep breathing
Prepares suction catheter kit while maintaining sterile technique fills sterile basin with 100 ml of NS
Places sterile drape on patient’s chest, does not touch catheter to any unsterile surface
Applies sterile gloves
Connects suction tubing to catheter and suctions small amount of NS from basin to assure system function
Removes oxygen delivery device and gently and quickly inserts catheter into airway until resistance is met or the patient coughs
Pulls back 1 cm and applies intermittent suction while slowly withdrawing catheter and rotating tube
Replaces oxygen delivery and encourages patient to deep breath
Rinses catheter with NS until clear
Assesses patient’s cardiopulmonary status
Performs oropharyngeal suctioning if necessary
Disconnects catheter from suction tubing, coils catheter around fingers, and removes glove with catheter inside of glove, removes other glove over first glove and discards
Discards soiled supplies and readjusts oxygen to original level
Removes face shield and performs hand hygiene
Documentation / Records amount, consistency, color and odor of secretions and patient’s response to suctioning in nurses’ notes
Records cardiopulmonary status before and after suctions in nurses’ notes
Cleaning Inner Cannula and Changing Ties
Hand Hygiene / Performs appropriate hand washing, applies gloves and face shield (if applicable)
Suctions tracheostomy if necessary (see above checklist)
Removes soiled tracheostomy dressing and discards
While patient is replenishing oxygen stores after suctioning, opens sterile trach. kit
Dons sterile glove to nondominant hand and places all supplies in kit on sterile field out of basins
Fills one basin ½ inch full of NS and the other ½ inch full with hydrogen peroxide
Leaves 2, 4x4’s dry, puts one in NS, puts one in hydrogen peroxide, puts one cotton-tipped swab in NS and the other in hydrogen peroxide
Applies sterile glove to dominant hand and keeps dominant hand sterile throughout process
Applies oxygen source loosely over tracheostomy
Removes the inner cannula with nondominant hand
Moves oxygen source over tracheostomy
While working quickly, scrubs inside and outside of inner cannula with small brush
Rinses cannula in NS, dries, and replaces cannula by locking in place.
Reapplies oxygen source
Cleans outer cannula surfaces and stoma under face place with hydrogen peroxide cotton swab and gauze in circular motion
Rinses hydrogen peroxide from tracheostomy tube and skin surfaces with NS gauze and cotton swab and dries skin and tube surfaces with dry gauze
Tie replacement / Pushes ties to upper part of faceplate and inserts one end of tape in to lower portion faceplate eyelet and pulls ends even
Slides both ends of tape behind head to other eyelet and inserts one tie through eyelet and pulls until snug
Ties ends in double square knot allowing for 2 snug finger widths and cuts and removes old tie
Inserts clean tracheostomy dressing under faceplate
Positions patient for comfort and assesses respiratory status
Removes gloves and face shield and discards and discards soiled supplies
Performs hand hygiene
Documentation / Records extent of care, condition of skin and stoma, and patient tolerance in nurses’ notes

Tracheostomy Suctioning Skill Performance (circle one):

PASS FAIL

Instructor’s initials and date: ______

Student’s initials: ______

*Automatic failure if sterile technique is broken and not caught by student

*More than 3 unacceptable actions results in failure of skill

Cleaning Inner Cannula and Changing Ties Skill Performance (circle one):

PASS FAIL

Instructor’s initials and date: ______

Student’s initials: ______

*Automatic failure if sterile technique is broken and not caught by student

*More than 3 unacceptable actions results in failure of skill