Tracheostomy Maintenance
Tracheostomy care should be performed with droplet-level precautions (gloves, gown, mask/eye protection) at a minimum. Tracheostomy in COVID-19 positive patients should utilize closed-circuit suction, heat and moisture exchanger (HME) if not ventilated, and in-line HEPA filtration if ventilated. Cuff inflation is preferred in patients with known COVID-19 disease until viral shedding has subsided. The frequency of tracheostomy changes should be reduced to every 1-3 months for all patients, except for down-sizing and cuff related issues that are determined to be clinically urgent. Tracheostomy changes should be avoided in COVID-19 positive patients until viral clearance has been achieved to minimize unnecessary healthcare worker exposure.