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27.23 HME placement

Essential equipment

  • Skin preparation wipes
  • Skin barrier wipes
  • Gauze pads
  • Light source
  • Saline nebulizer
  • Sterile water
  • Clinically clean tray
  • HME baseplate or laryngeal tube
  • HME filter
  • Single‐use disposable tweezers

Pre‐procedure

ActionRationale

  1. 1.
    Explain and discuss the procedure with the patient.
    To ensure the patient understands the procedure and gives their valid consent
    (NMC [202], C).
  2. 2.
    Settle the patient in a chair or upright in bed and arrange lighting to illuminate the stoma.
    To ensure the patient is comfortable and well supported. E

Procedure

  1. 3.
    Ask the patient to use the nebulizer.
    To loosen secretions in the trachea (Everitt [100], E).
  2. 4.
    Wet the gauze and wipe around the stoma, wiping away from the stoma.
    To ensure the stomal area is clean and prevent water entering the trachea. E
  3. 5.
    Using tweezers, carefully remove any dry crusts in the trachea.
    To ensure breathing is not impeded. E
  4. 6.
    Using the skin preparation barrier, carefully wipe around the stomal area.
    To protect stomal skin (Brewster [29], E).
  5. 7.
    Either place the correct size of laryngeal tube into the airway.
    To provide a holder for the HME filter (Ackerstaff et al. [3], R5).
  6. 8.
    Or place the HME baseplate onto stomal skin, ensuring the skin is stretched to allow a firm seal.
    To provide a holder for the HME filter (Ackerstaff et al. [3], R5).
  7. 9.
    Place the HME filter into either the laryngeal tube or baseplate, ensuring it is clicked into place.
    To ensure the HME is fitted fully into the holder (Ackerstaff et al. [3], R5).
  8. 10.
    Replace the filter throughout the day as it becomes fouled with mucus.
    To ensure breathing is not impeded (Ackerstaff et al. [3], R5).
  9. 11.
    Remove and clean the laryngeal tube at least twice a day.
    To ensure mucus is removed from the tube and breathing is not impeded (Ackerstaff et al. [3], R5).
  10. 12.
    The HME baseplate can remain in place for 72 hours but daily removal and cleaning is recommended.
    Removal allows inspection of the stomal area to ensure skin has not reacted (Ackerstaff et al. [3], R5).
  11. 13.
    Removal of the baseplate requires dampening of the HME baseplate and gentle use of skin removal product, easing the baseplate away from the skin.
    Gentle removal ensures skin is not traumatized (Brewster [29], E).

Post‐procedure

  1. 14.
    Record the procedure including shape and type of HME baseplate and filter type.
    To maintain accurate records (NMC [201], C).
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