1. Explain procedure to patient, engage his co-operation and provide privacy.
  2. Prepare trolley and send to the bedside.
  3. Wear disposable gloves and suction the tracheostomy tube.
  4. Remove the inner tube by turning the lock about 90o counter clockwise with the dominant hand and the non-dominant hand removes the inner cannula by gently pulling it out.
  5. Soak inner cannula in hydrogen peroxide for five (5) minutes and suction the outer cannula.
  6. Remove gloves, wash hands and put on sterile gloves.
  7. Remove inner tube from hydrogen peroxide solution into the sterile bowl with saline solution and brush the lumen and entire cannula thoroughly.
  8. Rinse the inner tube in a clean saline solution and dry the inner side of cannula with gauze squares twisted together.
  9. Re-insert inner cannula into outer cannula and turn 90o clockwise to lock.
  10. Clean the stoma using square on forceps or with sterile cotton buds with saline solution. If there are debris, clean with hydrogen peroxide before saline solution.
  11. Apply a sterile dressing and change the tie tapes, check tightness of tracheostomy tie.
  12. Thank patient, discard and decontaminate equipment.
  13. Wash and dry hands.
  14. Document procedure and findings in nurses’ notes.