Admission Safety Checklist Extra trach same size Extra

Admission / Safety Checklist: • Extra trach- same size • Extra trach- smaller size • Inner cannulas – same size • Obturator at bedside • Suction catheters • Wall Suction set up • Ambu Bag Call SPD for the trach and inner cannulas upon admission

Assess & Document Q 4 hours • Any trach care performed • Type and size of trach • Stoma assessment. - A trach may cause device related pressure ulcers. Make sure to document on POA if patient presents with breakdown on admission • All safety measures in place • Trach ties assessed (2 fingers underneath/ skin assessed)

How Often is Trach Care Completed? ? • Per policy minimum of q 24 hours/daily – Includes changing inner cannula; site cleaning and dressing change. – Suction is not listed as “daily trach care” • Other units might have a different standard of care (i. e. Trach Care q shift) • Trach Care/Inner Cannula change is usually needed more often especially in with new tracheostomies or pulmonary infections

What happens if the trach is coughed out? • Established Trach: trach has been changed for the first time • Fresh Trach: newly placed trach that has not been changed out. • Accidental decannulation of fresh trach per policy is an emergency situation: call a medical alert • Accidental decannulation of established trach per policy: call RRT, RN or RT are allowed to reinsert an established trach. ** New Trachs are usually changed about 5 -7 days after placement depending on situation**

If your patient is having a hard time breathing: • Call RT • Try suctioning patient / changing inner cannula • During a code situation, remember to bag the patient’s trach