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Comprehensive Tracheostomy Care and Support Policy

1. Purpose

The purpose of this policy is to provide clear guidance on the safe and effective care of residents with a tracheostomy at {{org_field_name}}, ensuring compliance with Care Inspectorate Wales (CIW) regulations, The Nursing and Midwifery Council (NMC) Code of Practice, and The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Tracheostomy care is a specialised procedure requiring clinical competency, infection prevention, and emergency response readiness. This policy ensures that residents with a tracheostomy receive safe, person-centred, and dignified care, promoting their well-being, independence, and quality of life while maintaining strict clinical governance.

2. Scope

This policy applies to all staff involved in the care of residents with a tracheostomy, including nurses, care staff, agency workers, external healthcare professionals, and visiting families. It covers:

• Routine tracheostomy care and suctioning procedures.
• Monitoring and risk assessment for tracheostomy-related complications.
• Emergency management of tracheostomy blockages or accidental decannulation.
• Staff training and competency assessments in tracheostomy care.
• Infection control and hygiene practices for tracheostomy management.
• Resident dignity, autonomy, and communication needs.

3. Principles of Tracheostomy Care

At {{org_field_name}}, tracheostomy care is based on the following principles:

• Resident-Centred Care: All tracheostomy management is tailored to the resident’s needs, comfort, and preferences.
• Clinical Excellence: Only trained and competent staff perform tracheostomy-related procedures.
• Safety First: Rigorous risk assessment, monitoring, and emergency preparedness are in place.
• Dignity and Respect: Residents are supported with communication aids, privacy, and personal choice in care delivery.
• Multi-Disciplinary Approach: Collaboration with GPs, respiratory specialists, speech and language therapists (SALT), and district nurses ensures holistic tracheostomy management.

4. Tracheostomy Management Procedures

4.1 Initial Assessment and Care Planning

Upon admission, a comprehensive tracheostomy care plan is developed in consultation with specialist healthcare professionals and the resident’s family. The plan includes:

• The type of tracheostomy tube (cuffed/uncuffed, fenestrated/non-fenestrated).
• The resident’s ability to manage secretions and their suctioning needs.
• The required humidification method (heat moisture exchanger or nebulisation).
• Speech and swallowing assessments, including SALT recommendations.
• Emergency protocols tailored to the resident’s risks.

Each resident’s tracheostomy care plan is reviewed regularly and updated as their condition changes.

4.2 Daily Tracheostomy Care Routine

To maintain airway patency and infection prevention, routine tracheostomy care is conducted as follows:

• Tube Inspection: Staff check for signs of infection, redness, swelling, or discharge.
• Cleaning and Dressing: The stoma site is cleaned daily with sterile saline and gauze, and dressings are changed as needed.
• Inner Cannula Care: If the tracheostomy tube has an inner cannula, it is removed, cleaned, and replaced according to manufacturer guidelines.
• Tube Patency Check: Suctioning is performed only when clinically indicated to prevent unnecessary trauma.
• Humidification Maintenance: Humidifiers or HMEs (heat moisture exchangers) are used to prevent secretion build-up.

4.3 Suctioning Procedure

Suctioning is performed only when required, as excessive suctioning can damage the airway. The procedure includes:

• Explaining the procedure to the resident to reduce anxiety.
• Hand hygiene and PPE use (sterile gloves, apron, and mask).
• Using a sterile suction catheter (appropriate size) inserted no deeper than necessary.
• Applying suction only during catheter withdrawal to minimise trauma.
• Monitoring oxygen saturation levels before, during, and after suctioning.
• Documenting frequency, secretion characteristics, and resident tolerance.

4.4 Tracheostomy Tube Change

A tracheostomy tube change is performed by a competent registered nurse or trained healthcare professional in accordance with the resident’s care plan and manufacturer’s guidelines. The process includes:

• Pre-procedure oxygenation if required.
• Sterile preparation of new tracheostomy tube and securing ties.
• Minimal disruption to airway patency during tube replacement.
• Post-procedure monitoring for complications, including respiratory distress.

4.5 Monitoring and Risk Assessment

Continuous monitoring is essential to detect complications early. Staff must:

• Check for difficulty breathing, increased secretions, or signs of infection.
• Monitor oxygen saturation levels and respiratory effort.
• Identify early signs of tracheostomy blockage or displacement.
• Report any bleeding, discomfort, or abnormal findings immediately.

5. Emergency Tracheostomy Management

5.1 Blocked or Dislodged Tracheostomy Tube

If a resident experiences sudden difficulty breathing due to a blocked tube:

1. Call for emergency assistance immediately (dial 999 if necessary).
2. Attempt suctioning to remove secretions.
3. If unsuccessful, replace the tracheostomy tube (if trained to do so).
4. Administer oxygen and monitor vital signs while awaiting emergency response.

5.2 Accidental Decannulation (Tube Dislodgement)

If a tracheostomy tube is accidentally removed:

1. Assess airway patency – ensure the resident is breathing.
2. Attempt reinsertion of the tracheostomy tube if trained to do so.
3. Call emergency services immediately if re-insertion is not possible.
4. Provide oxygen and continuous monitoring.

Emergency procedures are drilled regularly to ensure staff competence.

6. Infection Control Measures

To prevent infection:

• Hand hygiene must be performed before and after tracheostomy care.
• Sterile gloves and equipment must be used for suctioning and dressing changes.
• Residents with tracheostomies must be monitored closely for respiratory infections.
• Regular deep cleaning of the resident’s environment and equipment must be maintained.

7. Staff Training and Competency Requirements

Only trained and competent staff may provide tracheostomy care. Training includes:

• Mandatory annual tracheostomy care training.
• Competency assessment and supervision before independent practice.
• Emergency response training for blocked or dislodged tracheostomy tubes.

Staff training records are audited regularly to ensure compliance.

8. Resident Well-Being and Communication Support

Residents with a tracheostomy may experience communication difficulties. To support them:

• SALT involvement to assess speech and swallowing capabilities.
• Communication aids, including writing boards, electronic devices, and gesture support.
• Psychosocial support, ensuring emotional well-being and reducing anxiety related to tracheostomy management.

9. Related Policies

This policy should be read in conjunction with:

• Safe Care and Treatment Policy (CHW11) – ensuring high standards of clinical care.
• Infection Prevention and Control Policy (CHW17) – for hygiene and infection risk management.
• Risk Management and Assessment Policy (CHW18) – identifying and mitigating tracheostomy-related risks.
• Medication Management and Administration Policy (CHW21) – for oxygen and nebulisation therapy.

10. Policy Review

This policy will be reviewed annually or sooner if regulatory updates or operational changes occur. Staff will be informed of any revisions.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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