Place a towel/Chux across patient chest if needed.
Perform trach suctioning if necessary.
Open trach care kit, create sterile field, and apply sterile gloves. Arrange sterile items on sterile field and begin preparation for trach care on bedside table. (Ensure your saline bottle cap is open and ready to use prior to applying sterile gloves)
With non-dominant hand, lip saline then pour into each part of the trach care kit basin. Remember to keep dominate hand sterile.
Remove inner cannula with non-dominate hand, touching only the outer aspect of the tube, and place into normal saline basin. (Remember, there is a small locking mechanism to keep cannula in place)
While holding on to external part of inner cannula (with non-dominate hand), clean the inner cannula with the brush in sterile saline (with dominate hand) to remove secretions inside and outside of cannula.
Rinse in the second portion of basin and if needed, dry with sterile pipe cleaner in sterile hand.
Replace and secure with locking mechanism.
Using normal saline-saturated cotton swabs and 4X4 gauze, clean exposed areas of the outer cannula surfaces and tracheal stoma under faceplate extending 5-10 cm (2-4 inches) in all directions from stoma. Clean in circular motion from stoma site outward. Do not go over previously cleaned area.
Use a dry 4X4 inch gauze to lightly pat dry.
Replace trach ties. If patient can assist or another nurse to help hold trach in place you can remove both sides. If you are alone thread new ties through trach collar with old ties in place. Once new ties are secure you can remove old trach ties.
Place new precut trach dressing under faceplate and clean ties.
Reconnect oxygen source if needed and evaluate respiratory status.