Tracheostomy care is an essential nursing skill that involves cleaning and maintaining a tracheostomy tube to prevent infection and other complications. Here's a step-by-step guide explaining each procedure with its rationale. Note that disposable gloves are to be worn at all times and changed as often as needed to maintain a sterile work environment, and to protect both patient and healthcare worker.

Step 1: Perform hand hygiene, and put on personal protective equipment: gown, gloves, mask and eye protection. If necessary, suction the tracheostomy using a sterile suction catheter to prevent occluding the outer cannula while the inner cannula is removed. Remove gloves.

Step 2: Put on clean gloves and open the package with the new disposable inner cannula and other supplies without contaminating them.

Step 3: Change gloves.

Step 4: Stabilize the outer cannula and faceplate of the tracheostomy and remove the inner cannula.

Step 5: Discard gloves, put on sterile gloves, and insert the new inner cannula into the outer cannula. Reapply oxygen source if needed.

Step 6: Remove the oxygen source if necessary and clean the stoma under the faceplate with a saline-dipped applicator or gauze sponge.

Step 7: Pat skin gently with a dry 4x4 gauze sponge to remove excess moisture.

Step 8: Slide commercially prepared tracheostomy dressing or pre-folded non cotton-filled 4x4 dressing under the faceplate.

Step 9: Obtain the assistance of a second individual to hold the tracheostomy tube in place while the old collar is removed and the new collar is placed.

Step 10: Open the package for the new tracheostomy collar to allow access to the new collar.

Step 11: Change gloves.

Step 12: One nurse holds the faceplate while the other removes the collar.

Step 13: The first nurse holds the tracheostomy faceplate to prevent accidental extubation.

Step 14: The other nurse places the collar around the patient's neck and secures the Velcro tabs on the tracheostomy holder.

Step 15: Check the fit of the tracheostomy collar. You should be able to fit one finger between the neck and the collar. If necessary, reapply the oxygen source.

Step 16: Remove gloves, assist the patient to a comfortable position, raise the bed rail, and lower the bed.

Step 17: Remove the gown, face shield or goggles and mask. Perform hand hygiene.

Step 18: Reassess the patient's respiratory status, including respiratory rate, effort, oxygen saturation, and lung sounds. These determine the effectiveness of interventions and identify complications.