Bedside Tracheostomy Checklist
Prior to
procedure:
□
The patient has at least two
functioning 20g or larger PIV or has central venous access
□
Bronchoscopy cart with RT is available
at bedside
□
Surgical tracheostomy kit is present at
bedside
□
Size 6 and 8 percutaneous tracheostomy
kits are present at bedside
□
Sterile suction tubing and hard yaunker
is readily available
□
Chest tube kit is readily available
□
Intubation kit is readily available
□
Caps, gowns, sterile gloves, and drape
are present
□
Vasopressor and fluid bolus is hanging
at the bedside for sedation-related hypotension
Procedure:
□
Attending physician is present
□
Time out performed
□
Vital sign monitoring is every 2
minutes
□
The ventilator has been set at 100%
FiO2 for pre-oxygenation
□
Patient is sedated to RASS goal of -3
to -5 prior to paralytic administration
□
The patient is positioned supine in the
bed with the neck hyperextended exposing the trachea
□
The patient was cleaned with chlorhexidine
or iodine
Nurses should be placing a nurse driven order set (NUR Post Tracheostomy Orders) for every trach as well that covers standard trach care, education, speech pathology and RT consult.
All fresh trachs should be sutured with two sutures, preferably at the top end of the base plate.
Sutures should be secure but not tight enough to cause tissue injury.
All trachs should have a layer of polymem or white mepilex foam under the bottom of the trach plate to protect from moisture and pressure.
With the exception of ENT patients, nurses will remove sutures on day 3.
Per provider judgement we do sometimes see 4 sutures with the following types of patients:
- BMI ≥ 36, thick, short neck
- Significant anatomic variation of the neck (e.g., tortuous trachea, low tracheal stenosis, etc.)
- Concerns for upper airway obstruction and/or fresh laryngeal surgery (e.g., T3, T4 glottic carcinoma, subglottic stenosis)
- Acute neck surgery (e.g., free flap or pec flap reconstruction, etc.)
Published 1/7/18 (A Bernard); Reviewed 1/9/24 (A Bernard);
