1. Care of Tracheostomy site Linda Armour 7 th October 2011

2. Key Points Patients with a tracheostomy are at increased risk of infection. Effective management of the stoma will aid the prevention of peristomal infection and irritation. Management of a Tracheostomy site remains the same for hospital environment as in the community.

3. Cleaning the stoma site Always prepare everything you require before starting. Site should be cleaned once a day, more often if needed. Cotton wool should never be used to clean the site due to the risk of inhalation of fibres from it. While cleaning the site and surrounding skin its condition should be assessed.

4. Equipment needed Emergency Equipment ie suction, spare tube and spare smaller tube Gauze swabs Cotton buds may also be used Normasol sachet or sterile water Tracheostomy tape and scissors Small blanket or towel roll Towel to wrap the infant in

5. Action Rational Clean around the stoma site and neck with gauze soaked in normasol/sterile water. Dry the stoma site thoroughly. Assess the need for a barrier film, eg Cavilon, if the site looks red and inflamed To remove secretions and crusts To maintain healthy skin To reduce the risk of infection and irritation. To reduce the risk of further damage to the skin

6. Common Problems Inflammation Check correct tape tension, ie not too tight or too loose. The use of trachy bibs particularly when feeding or infant is teething. Lack of general hygiene procedures. Infection A swab should be taken and treated accordingly. If excessive exudate present an absorbent dressing should be applied ie non adhesive Lyofoam dressing. Candida This can be treated with antifungal cream. Cavilon can be applied over this to keep the antifungal cream in place. Overgranulation Apply Haelan C/ 1% Hydrocortisone cream. The use of Polyurethane dressing such as Lyofoam or Transorbant foam aids compression of overgranulated tissue.

7. Granulation tissue

8. Conclusion Result should be a happy contented baby with healthy peristomal skin.

9. References Docherty B, Bench S (2002) Tracheostomy management for patients in general ward settings. Professional Nurse, 18, 2, 100-104. St George’s Healthcare NHS Trust (2000) Guidelines for the Care of Patients with Tracheostomy Tubes. London, St George’s Healthcare NHS Trust. Serra A (2000) Tracheostomy care. Nursing Standard. 14, 42, 45-55.