The nurse who is performing care for a client with a new tracheostomy needs to change the ties. What is the best method for changing these ties?
1. Remove the old ties, clean the area well, and then put on new ties.
2. Attach the new tape and tie with a square knot behind the client's neck.
3. Have an assistant hold the tracheostomy tube in place, remove the soiled ties, and replace the ties.
4. Remove the outer cannula, replace the soiled ties, and reinsert.
Correct Answer: 3
Rationale 1: Removing the ties without an assistant could allow the tracheostomy tube to become dislodged.
Rationale 2: The knot for securing the tracheostomy tube should be tied at the side of the neck to prevent an area of pressure development.
Rationale 3: Since these ties are very soiled, it is likely that they must be removed before new ties are attached. The safest way to perform this intervention is to have an assistant hold the tracheostomy tube flange in place while the nurse removes the old ties and replaces them.
Rationale 4: The outer cannula is not removed in a new tracheostomy.
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