Pre‐procedure

ActionRationale

1. 1.Show
   Explain and discuss the procedure with the patient.
   To ensure that the patient understands the procedure and gives their valid consent (NMC [202], C).

Procedure

1. 2.Show
   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
2. 3.Show
   Ask the patient to use the nebulizer.
   To loosen secretions in trachea (Everitt [100], E).
3. 4.Show
   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
4. 5.Show
   Remove the tape and clean behind the strap; replace with new tape.
   To ensure the stomal area is fully cleaned and the prosthesis is secured. E
5. 6.Show
   Using tweezers, carefully remove any dry crusts from around the prosthesis and trachea.
   To ensure breathing is not impeded. E
6. 7.Show
   Wet the cotton buds and carefully clean the outside of the prosthesis.
   To ensure air can enter the prosthesis. E
7. 8.Show
   Wet the prosthesis brush and carefully insert into the barrel of the prosthesis, turning one way only, and remove. Hold the strap of prosthesis during the procedure. The patient does not need to do anything at this point.
   To ensure the barrel of the prosthesis is clean to allow air flow. To ensure the prosthesis does not become dislodged. E

Post‐procedure

1. 9.Show
   Record the procedure.
   To maintain accurate records (NMC [201], C).