Editing Nursing Skills and Procedures (section)

=== Related airway skills ===
For tracheostomy care, the nurse uses sterile technique, keeps a spare tube of the same size and one size smaller plus an obturator at the bedside, secures new ties before removing old ties, and holds the tube during tie changes. If the tube becomes dislodged, the nurse retracts the stoma with a curved hemostat and attempts reinsertion using the obturator; if the airway cannot be reestablished, the nurse covers the stoma and ventilates with a bag-mask over the mouth and nose while calling for help. Suctioning is applied only on withdrawal, for no more than about 10 to 15 seconds per pass, with hyperoxygenation before and after, and the patient is never suctioned routinely on a schedule but rather when adventitious sounds, secretions, or desaturation indicate need. Saline instillation before suctioning is not recommended.