Tracheostomy & Laryngectomy Cheat Sheet
Bedside emergency equipment, sterile suctioning, cuff management and stoma care — plus the critical ventilation differences for the NCLEX-RN.
What's in this cheat sheet
A tracheostomy bypasses the upper airway but keeps it connected to the nose and mouth, while a total laryngectomy permanently separates the airway. This cheat sheet covers tracheostomy components and the three core focus areas (dislodgement prevention, sterile suctioning, communication and nutrition), then laryngectomy care, post-op hemorrhage monitoring, and the life-or-death ventilation rules for each.
Tracheostomy Basics
Tube components, cuff inflation balance, indications and why humidified oxygen is mandatory.
Airway, Suctioning & Care
Bedside emergency equipment, the dislodgement response, sterile suctioning technique and dressing changes.
Communication & Nutrition
Speaking valves, deflating the cuff to eat or speak, swallow evaluation and aspiration prevention.
Laryngectomy
Total vs partial, hemorrhage monitoring, flap assessment, alternative voice methods and stoma self-care.
Key Takeaways
High-yield facts most likely to appear on the NCLEX-RN.
Keep at the trach bedside: a spare tube (same size + one smaller), obturator, insertion tray, suction equipment, BVM and a 10 mL syringe.
Suctioning: insert the catheter WITHOUT suction, withdraw with suction in a circular motion for ≤10 seconds, hyperoxygenate before AND after each pass.
Cuff care: underinflation → aspiration; overinflation → tracheal necrosis. Deflate the cuff before eating or using a speaking valve.
If a trach dislodges in an unhealed tract (first 5–7 days), do NOT reinsert — call rapid response, cover the stoma, and ventilate over nose & mouth.
After a total laryngectomy the airway is permanently separated — ventilate ONLY through the neck stoma; face-mask ventilation will not reach the lungs.
Swimming is absolutely contraindicated with a laryngectomy stoma; teach clients to wear a medical alert ID as a neck breather.
1. Tracheostomy Basics
A surgically created opening into the trachea that bypasses the upper airway; may be temporary or permanent.
Tube components
- Outer cannula — main body in the trachea
- Inner cannula — removable for cleaning
- Obturator — stylet used only during insertion; remove immediately after
- Cuff — inflated balloon that seals the airway and prevents aspiration
2. Airway, Suctioning & Care
Always keep at the bedside
- Spare tracheostomy tube (same size + one smaller)
- Obturator for the tube in use
- Tracheostomy insertion tray / kit
- Suction equipment (wall suction + catheters)
- Bag-valve mask (BVM)
- 10 mL syringe for cuff management
If dislodgement occurs
- Call the rapid response team immediately
- Do NOT reinsert if the tract is unhealed (first 5–7 days post-op)
- Cover the stoma and ventilate with a BVM over the nose & mouth
- Only a trained HCP performs the first tube change in an unhealed tract
Sterile suctioning procedure
- Hyperoxygenate with 100% O₂ for 30 seconds
- Insert the catheter WITHOUT suction; if resistance, withdraw 1–2 cm
- Apply suction while withdrawing in a circular motion for ≤10 seconds
- Hyperoxygenate after each pass; monitor vitals and skin color
3. Communication & Nutrition
Communication
- Consult speech-language pathology (SLP) early; provide writing boards/apps
- Passy-Muir speaking valve — one-way valve directs air through the vocal cords
- Deflate the cuff before using a speaking valve or eating (an inflated cuff blocks airflow)
Nutrition & swallowing
- SLP performs a formal swallow assessment before oral feeds
- Deflate the cuff before meals to allow normal swallowing mechanics
- Elevate HOB ≥ 30° during and at least 30 min after eating to reduce aspiration
4. Laryngectomy
Surgical removal of the larynx (usually for laryngeal cancer); in a total laryngectomy the airway is permanently separated from the nose and mouth.
Total laryngectomy
Larynx fully removed → permanent neck stoma, no natural voice, airway separated from mouth/nose, cannot smell normally.
Partial laryngectomy
Part of the larynx removed; may retain some voice; usually a temporary trach during recovery.
Post-op priorities
- Monitor for hemorrhage (head/neck highly vascular): tachycardia is an early sign, hypotension a late one
- Position semi-Fowler (30–45°) to reduce swelling and promote drainage
- Provide humidified O₂ and hydration to thin secretions; suction via trach PRN
- Assess skin flaps/grafts hourly (color, capillary refill, drainage)
Voice methods & stoma teaching
- Alternative voice: electrolarynx, tracheoesophageal puncture (TEP) prosthesis, esophageal speech
- Enteral feeding until swallowing is safe (typically 7–10 days)
- Wear high-collared loose clothing; cover the stoma when bathing/shaving
- Use a humidifier; wear a medical alert ID identifying a neck breather
Tracheostomy & Laryngectomy Self-Test
6 quick questions — answers reveal after you submit.
Q1. Which set of equipment must always be kept at the bedside of a client with a new tracheostomy?
Q2. While suctioning a tracheostomy, when should the nurse apply suction?
Q3. A tracheostomy tube becomes dislodged on the second post-operative day. What is the nurse's priority action?
Q4. Before a client with a cuffed tracheostomy eats a meal, what should the nurse do?
Q5. A client who had a total laryngectomy becomes pulseless. Where does the nurse deliver ventilations?
Q6. Which discharge instruction is essential for a client with a permanent laryngectomy stoma?
Answered 0 / 6 — unanswered count as incorrect.