Pre‐procedure

ActionRationale

1. 1.Show
   This is a clean procedure.
   To ensure patient safety (NTSP [206], C).
2. 2.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [198], C).
3. 3.Show
   Cleanse hands with soap and water or an alcohol‐based handrub.
   To minimize the risk of infection (NHS England and NHSI [179], C).
4. 4.Show
   Help the patient to sit in a semi‐recumbent position with the neck slightly extended.
   To ensure patient comfort. Extending the neck will allow easy access to the laryngectomy stoma (NTSP [206], C).
5. 5.Show
   Prepare a dressing tray or trolley for the procedure. Open the sterile procedure pack and any additional equipment required (tube, baseplate etc.). Pour the cleaning solution over the low‐linting gauze.
   To ensure all equipment required is prepared prior to starting the procedure. E

Procedure

1. 6.Show
   Cleanse hands using an alcohol‐based handrub and apply disposable plastic apron, gloves and eye protection.
   To minimize the risk of infection (NHS England and NHSI [179], C).
2. 7.Show
   Clean around the stoma with 0.9% sodium chloride using low‐linting gauze. If required, use Tilley's forceps to remove any dried secretions or crusts from around the stoma. Allow the stoma to air dry.
   To remove wet or dried secretions from the stoma site. E
3. 8.Show
   Measure the laryngectomy stoma and document the size in the patient's laryngectomy passport.
   To check for tracheal stenosis (Sharma et al. [253], C).
4. 9.Show
   If required, insert a laryngectomy tube. (The speech and language therapist will determine what size to use and document this in the patient's laryngectomy passport.)
   To maintain patency or to help shape the laryngeal stoma (Everitt [76], E).
5. 10.Show
   A baseplate may also be considered. This can be inserted around the stoma to house a HME cassette. A humidification bib or scarf is another alternative.
   To facilitate phonation and/or humidification (Everitt [76], E; NTSP [206], C).
6. 11.Show
   Remove apron, gloves and eye protection and dispose of them in the clinical waste. Cleanse hands with soap and water or an alcohol‐based handrub.
   To minimize the risk of infection (NHS England and NHSI [179], C).

Post‐procedure

1. 12.Show
   Monitor the patient's respiratory status and observations/NEWS. Escalate any concerns or deterioration in condition/NEWS immediately.
   To identify any concerns or clinical deterioration early, and ensure timely escalation to senior staff if required (RCP [230], C).
2. 13.Show
   Discuss any concerns with the multidisciplinary team.
   To ensure the multidisciplinary team is involved in all aspects of the care of patients with a laryngectomy (NTSP [206], C).