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Tapes
To ensure the tube remains safely within the airway and prevent excessive movement of the tube, ribbon tapes or Velcro collars are used.
Procedures for changing tapes.
Ribbon Tape - Ribbon tapes are particurlay useful if extra security is required to prevent accidental tube removal.
(Photo of patient with ribbon tapes)
How to use:
- Cut two pieces of tape to the required length [ neck size.]
- Divide the tape into thirds and fold the first third over the remaining two thirds of the ribbon.
- Thread the folded edge through the flange hole and form a loop.
- Thread loose tape ends through the loop and pull tight to secure.
- Repeat process for the other side, Securing the tapes with reef knots on either side of the neck.
Velcro Collars - Velcro tapes or collars are excellent in securing a tracheostomy tube in place and are easy to use and comfortable for the patient. (Photo of patient with Velcro collars)
How to use:
- Thread Velcro narrow tab through slots on either side of the flange and fold back to adhere to the collar.
- Overlap the shorter length of the collar with the longer length of the collar and secure with the Velcro tab.
- Trim any excess length of collar to fit size of patient’s neck.
Tapes must be checked regularly to minimise the risk of the tape becoming loose and then causing a further risk of tube displacement.
Loosely secured tapes can allow the tracheostomy tube to move which can then cause erosion of the stoma walls, however if the tapes are too tight this can cause ulceration to the skin causing the patient discomfort.
A comfortable fitting is to be able to insert 1 or 2 fingers between the collar and the neck. Tapes must always be changed when soiled or wet and this must be performed by two staff at all times in case the patient coughs and potentially dislodges the tracheostomy tube.
One carer holds the tracheostomy tube in place by the flange and the other carer replaces the tape.
Wound Care
The changing of tracheostomy dressing, tapes and care of the stoma requires an aseptic technique:
Equipment required
- Sterile dressing pack
- Tracheostomy dressing or keyhole dressing
- Cleaning solution such as 0.9% sodium chloride
- Tracheostomy Velcro tapes
- Skin protection cream
ACTION |
RATIONALE |
1. Explain and discuss procedure with the patient |
Allows for co – operation and gives reassurance |
2. Two nurse procedure |
Maintain safety |
3. Screen area and assist patient to comfortable position |
Ensures privacy and patient comfort |
4. Prepare dressing trolley items |
For ready use |
5. Wash hands, put on non sterile gloves and plastic apron |
Reduces the risk of infection |
6. Remove the soiled dressing and tapes. Swab site for micro-organisms. [ if needed] |
To send to lab for M,C&S to check for any infection and assist in the choice of treatment should infection be present. |
7. Using aseptic technique wearing sterile gloves clean around the tube with normal saline and sterile gauze. Dry thoroughly |
Removes secretions and prevents infection from any crusting which may have formed. |
8. Assisting nurse to secure tube [ while tapes and dressing are being changed.] |
Prevents tube being coughed out. |
9. Apply clean tracheostomy keyhole dressing |
To ensure patient’s comfort. To avoid pressure from the tube |
10. Flex patient’s neck and secure Velcro tape. One finger should fit between tapes and patient’s neck. |
Ensures tapes are secure without causing skin damage underneath tapes. |
11. Clear away equipment, remove gloves and apron into clinical waste and wash hands effectively. |
Prevents cross infection. |
Dressing Options
Lyofoam T
3M
Trachidress
Kapitex
Metalline
