Saturday, January 28, 2017

Sensitisation program for primary physicians to win over tobacco and cancer 28.1.2017

Sensitisation and awareness to win over tobacco and cancer
Place- uberoi Anand Bareilly
Participants- 44 doctors of NIMA BAREILLY

Speaker- Dr Pawan Gupta Mch
Cancer surgeon


Sunday, November 20, 2016

Win over tobacco and cancer tutorial by Dr Pawan Gupta with rural doctors at Jewar 19.11.2016

Win over tobacco and cacner tutorial by Dr Pawan Gupta with rural doctors at Jewar 19.11.2016
Expert  -Dr Pawan Gupta
Date - 19.11.2016
No. of Doctors present - 11
Co hosts - JAYPEE hospital

Emphasised on how to advice patients to quit tobacco and not just telling them to quit tobacco.
The book be smart do not start was shared with all of them.
Early signs and symptoms of oral cancer and of breast was discussed

Saturday, July 9, 2016

CANCER WINNER - A unique person

CANCER WINNER - A unique person
Dr Pawan Gupta M.Ch. – Cancer Surgeon, Social Activist and Author
A person who has experienced Yama (the GOD of Death) from close quarters, knocking the door -  but  had to leave empty handed.
A new Life! A new beginning.
A sudden realisation of what is life and a motivation to do something for the society.
A unique turn in life, Life which has now a new meaning.

CANCER WINNER – A term coined by Dr Pawan Gupta in 2006. This term is used to describe a cancer patient who has undergone the treatment and is living with a positive spirit. This was used by him to change the attitude towards cancer, from “fight against cancer” to “win over cancer”, till then these patients were described as cancer survivors.
The Cancer Winners encourage the new cancer patients in their respective areas to undergo treatment and live with a positive spirit and become a winner like them.  The cancer winners share success stories and also issues related to the disease and life beyond cancer.

Winning is an attitude. Winners are not immortals. But they live in a positive spirit.  There are two ways of living HA HA.. (positive) and hai hai (poor thing always cursing). The choice is yours. Positive people are happy, loving, generous, giving, helping, serving people. So they develop magnetic personality and are honored, loved, respected and even worshipped.

By joining this platform of Cancer Winners you will have an opportunity to guide someone who looks forward to be a cancer winner him/herself, you share your experience and motivate others, you guide the doctor community as a whole as to what they are required to deliver,  you spread messages to common public for lifestyle modification, prevention and early detection, you are an inspiration to many others to live in a positive spirit.

Categories of “Cancer Winners”
1. Who have suffered through the disease, has or wishes to achieve a positive state of mind - the spirit of ‘I CAN WIN’
2. Care taker of a cancer patient, who wishes to make her/him a winner.
3. A social person who wishes to be cancer aware and propagate cancer awareness in the society.
4. An Oncologist, physician, surgeon or other professionals who believes in winning over cancer and not just fight against cancer.

The ONCOLOGIST by his body language lets the patient know that – I CAN CARE. Together we can.
There is a positive life beyond cancer.

Thursday, December 24, 2015


Dr Pawan Gupta M.Ch. – Cancer Surgeon, Social Activist and Author
Doctor – An oncologist has a great role to play to make a cancer patient, a cancer survivor, a winner.
Hand holding, through the darkest hours of a cancer patient life, during the period of transformation and thereafter, and how the doctor does it will determine whether a patient be just a survivor or a winner.
A cancer patient lives in fear, an unknown fear of life, a life which no one else can experience.
Early detection, prompt treatment and quick rehabilitation are the mantra for cancer patient to become a cancer winner. An oncologist has to understand that rehabilitation is as much important as treatment, and he has a great role to play in this.
The following are the important elements of a Good oncologist
Oncologist has the power to change course of life of a cancer patient.
The truth is that they have an enormous ability to help their patients and create a positive impact in their life, which is why they command so much respect. The problem is that today's oncologists think of themselves primarily as being intellectual scientists, whose job is to order the right tests, make the right diagnosis, and provide the right treatment. Believe their work ends here!
This in reality is a very small part of what an oncologist do to help patients become a winner – Oncologists’ important tasks are far more intangible, and one need to use the heart much more than the heads to do them well ! He is the bedrock of support whom the patient can fall back on when she is going through a rough patch in her life - someone she can trust and depend on during her darkest hours.
The way we talk, the way we smile, the way we hold our patient's hands, and the way we connect with her has a far greater impact on the patient's life than just providing the right diagnosis or the right treatment. This is something which one should not underestimate.
During times of crisis - and every illness can be filled with stress and loneliness and angst, a patient needs to know that there is someone she can depend on - someone who know her, cares for her, and will hold her hand during her darkest moments - someone who will provide her a shoulder to cry on, and a human connection.
This is the kind of support which a doctor is privileged to be able to provide, and we need to understand the significance of this role which we can play in our patient's lives, which far outweighs anything we can do as regards diagnosis and treatment. We are far more than technicians , and while we cannot always cure our patients, we can always provide support and succour!
We are blessed to be in this privileged position, where we are privy to another human's innermost fears and desires - let's learn to wield this power with care and compassion
The ONCOLOGIST by his body language lets the patient know that – I CAN CARE. Together we can.
There is a positive life beyond cancer.

Saturday, December 5, 2015

Vaginal Dilators

Gentle self-treatment for women receiving
1. pelvic radiotherapy for Carcinoma of cervix, Endometrial carcinoma, Carcinoma of vagina, vulva, other pelvic tumors
2. Post surgery – Hysterectomy, radical vulvectomy, other pelvic surgery. Abdomino pelvic resection

I CAN Care vaginal dilators is a range of dilators designed to help women alleviate medical conditions affecting the vaginal structure, following radiotherapy to the vagina, cervix or pelvis. Radiotherapy can cause some internal scarring (adhesions) to the treated area and make the vagina narrower, drier and less elastic.
I CAN Care vaginal dilators help to reduce the risk of scarring and offer an effective way for patients to take an active role in their treatment.
Preventing the formation of scar tissue within the vagina helps ensure that the vagina remains supple so that sexual intercourse and vaginal examinations can be performed without discomfort or pain.
I CAN CARE Vaginal Dilator is available in three graduated diameter sizes of 2cm, 2.5 cm and 3 cm to make insertion and removal easier.
  • Effective treatment for use in the comfort of the home
  • Treatment pace is directed by the user
  • Three graduated sizes to help users to progress gradually
  • Designed to help build confidence

After menopause, the vagina becomes dry, less elastic, narrower, and shorter. Some cancer treatments can also cause these changes within the vagina. To help you with these changes, your healthcare provider has suggested that you use a vaginal dilator and start doing vaginal dilator therapy. Vaginal dilator therapy is a resource you can use throughout your life.

It will help to:
1.       Allow your healthcare provider to perform a more thorough pelvic exam.
2.       Make it more comfortable for you to be examined.
3.       Prevent your vagina from becoming too narrow.
4.       Keep your vagina more elastic.
5.       Allow you to have vaginal sex with less discomfort.

As a result of your recent treatment, your vagina may have become narrowed and shortened due to the formation of scar tissue. I CAN CARE vaginal dilators have been designed to greatly reduce your risk of scarring and assist you in keeping your vagina supple. This will help reduce any long term discomfort from follow up examinations, further treatments and sexual intercourse.

Please read these instructions fully before using I CAN CARE vaginal dilators for the first time

Before You Begin – Prior to first-time use, wash dilators and handle in warm, soapy water, rinse thoroughly and allow to dry.

Privacy – Use the dilators in a private, comfortable setting where you will be undisturbed.

Positioning – The recommended position to use the dilators is to lie flat on your back with your knees bent at a 45 degree angle and legs slightly apart. Alternatively, you may stand with one leg raised on a chair.  Make sure you can easily touch the opening of your vagina. Practice Kegel exercise.

Progression – Start with the smallest dilator and, once you can comfortably insert it, progress to the next size up. You may find when you first use the dilators that you can only tolerate the tip of the dilator. With persistent use you will be able to gradually progress to full insertion, then larger sizes. When transitioning sizes, move from the smaller dilator to the next size in the same session, as vaginal muscles will already be relaxed and the transition will be easier. The time it takes to progress from size to size varies by individual.

Inserting a Vaginal Dilator -- 1. Apply water-based lubricant (like K-Y jelly), to the tip of the dilator and to your vaginal opening. Do not use petroleum jelly (like Vaseline) 2. Relax as best as possible. Using controlled breathing, slowly ease the dilator into the vagina going as deeply as is comfortable. Continue to insert the dilator until you feel slight discomfort or muscle tension and then stop. Since the vagina slants upwards and towards your back, the dilator should be angled upwards and in the direction of your back during insertion.  3. Once the dilator is inside the vagina move the dilator in a forward and backward motion, then a left to right motion and if possible, gently rotate the dilator in position by twisting the handle.4. Do a set of Kegel exercises. These Exercises will help you relax your pelvic floor muscles and insert the dilator a little further.  If it is still difficult to insert the dilator after doing Kegel exercises, take some deep breaths. Then, refocus on relaxing your pelvic floor muscles and try to insert the dilator a little further. Don’t worry if you can’t insert the dilator completely. Over time, you may be able to get the dilator in a little bit further. 5. Leave the dilator in place for 5 to 10 minutes. 6. Gently push it back and forth to stretch the length of your vagina. 7. Gently rotate the dilator in wide circles to stretch the width of your vagina. Repeat this at the back, middle, and opening of your vagina. Some women find it helpful to work with more than one size dilator. 8. Remove gently and slowly while rotating.

After You Are Done You may have a small amount of bleeding when you use the dilator. This is normal. A panty liner will be enough to manage this. If you have a lot of bleeding, such as bleeding that soaks up a sanitary napkin, call your healthcare provider. If you get urinary tract infections (UTIs) often, you may want to urinate after dilator therapy. If you have any questions or problems, talk with your healthcare provider at your next appointment.

Duration & Frequency – You should practice dilator therapy several times per week (i.e., every other day). The more you do it, the more you will benefit. Duration and frequency of dilation may range from three minutes twice a week up to ten minutes and twice daily*. Please consult with your Healthcare Professional.

Cleaning InstructionsI CAN CAREvaginal dilators, should be washed after each use. Wash in warm, soapy water, rinse thoroughly and allow to dry before storing in in a clean bag. Ensure all traces of soap are removed to avoid irritation. Remember to wash the dilator handle if it has been used.
Warnings and Precautions
 These instructions are intended as a guide. Further advice may be obtained from your Healthcare Professional.

Return Policy: We are not able to accept returns on the vaginal dilator product. For health and safety reasons, vaginal inserts, vaginal dilators that have been sold to a consumer cannot be restocked and are prohibited from resale.I CAN CARE Vaginal Dilators

Sunday, October 4, 2015

Tracheostomy Humidification

Tracheostomy Humidification

The nose and mouth provide warmth, moisture and filtration for the air we breathe. Having a tracheostomy tube, however, by-passes these mechanisms so humidification must be provided to keep secretions thin and to avoid mucus plugs. To keep the environment at an optimal humidity level, follow the procedures below.
Attach a mist collar (trach mask) with aerosol tubing over the trach with the other end of tubing attached to the nebulizer bottle and air compressor. Sterile water goes into the nebulizer bottle (do not overfill, note line guide). Oxygen can also be delivered via the mist collar if needed.
Heated mist may be ordered. Heated mist is accomplished by an electric heating rod that fits into the nebulizer bottle. Extra care should be taken to be sure the bottle does not go dry, which could melt plastic. Many of these heating elements do not have automatic shut-offs and this could be a potential fire hazard. Also, more moisture will accumulate in the aerosol tubing with heated mist. Moisture that accumulates in the aerosol tubing must be removed frequently to prevent occlusion (blocking) of the tube and/or accidental aspiration (inhalation). Disconnect tubing at the trach end, empty into a container and discard. Do not drain fluid into the humidifying unit. Fluid traps (or drainage bags) are helpful in preventing occlusion and aspiration. These collection devices also need to be emptied frequently. Position the air compressor and tubing lower than the patient to help prevent aspiration from moisture in the tubing. A mist collar can also be worn during the day when mucus is thick or blood tinged. Sterile saline drops can be instilled into the trach tube if secretions become thick and difficult to suction. A saline nebulizer treatment is also helpful to loosen secretions if the patient has a nebulizer machine. Additional fluid intake also helps to keep secretions thinner.

Secretions can be kept thin during the day by applying a Heat Moisture Exchanger (HME) to the trach tube. An HME is a humidifying filter that fits onto the end of the trach tube and comes in several shapes and sizes (all styles fit over the standard trach tube opening). There are also HME’s available for portable ventilators. Bedside ventilators have built-in humidifiers. HME’s also help prevent small particles from entering the trach tube. Change HME daily and as needed if soiled or wet.
Source -

Tracheostomy Equipment

Tracheostomy Equipment

Tracheostomy Supplies

Tracheostomy tubes of the appropriate type and size
Tracheostomy tube (one size smaller)
Trach tube ties or velcro strap
Dressing supplies, gauze
Hydrogen peroxide, sterile water, normal saline
Water soluble lubricant such as Surgilube or KY Jelly
Blunt-end bandage scissors
Tweezers or hemostats
Sterile Q-tips
Trach care kits and/or pipe cleaners (double-cannula trach tubes)
Luer lock syringes for cuffed trach tubes

Suction Equipment

Portable battery-powered suction machine
Suction connecting tubing
Suction catheters
Normal saline solution
Sterile jars with screw tops (sterile specimen containers or sterilized baby food jars work well)
Saline ampules (“bullets“)
Bulb syringe
DeLee suction trap or syringe with catheter
Hand-powered Suction Devices  A simple yet efficient suction unit for first responders, and a reliable backup for emergency healthcare providers.
YanKauer Suction Handle
Sims Connector

Humidification System

Air compressor
Nebulizer bottles
Tracheostomy mask
Aerosol tubing
Water trap
HeatMoisture Exchanger  (HME) (If you don't have an HME, use a room humidifier)
Room humidifier
Sterile water
Mist heater (if ordered)
Croup or mist tent (rarely ordered today)

Other Supplies That You May or May Not Need

Hand washing supplies
Cleaning supplies
Mucus traps for sputum specimens
Sterile or clean paper cups
Manual resuscitation (Ambu) bag with mask and trach adapter
Intercom, baby monitor or video monitor
Disposable Gloves (powder free)
Trach scarf or bib
Rolled-up towel
Other Possible Equipment Needs
Speaking valves
Trach guard
Cardiac/Apnea monitor
CO2 monitor
Pulse oximeter
Oxygen Concentrator
Oxygen Supply tubing
Nebulizer Equipment (Aerosolized medication delivery system)
Dura-neb Portable Compressor/Nebulizer
DeVilbiss® Pulmo-Aide® Compact Compressor/Nebulizer
AeroTrach Plus™
Pressure manometer to check trach cuff pressure on cuffed tubes
Extra smoke detectors and a fire extinguisher suitable for electric as well as regular fires.
Consider an emergency generator if you have frequent power failures.

Saturday, October 3, 2015

Decannulation of Tracheostomy

Decannulation of Tracheostomy

The process whereby a tracheostomy tube is removed once patient no longer needs it.
When the initial indication for a tracheostomy no longer exists.
A patient is considered a candidate for decannulation once the following conditions are met.
1.     Patient is alert and oriented and responsive to commands.
2.     Patient is no longer dependent on a ventilator for assisted breathing.
3.     The frequency requirement for tracheal suctioning is less than once a day. (This is not always the case. Check with your physician)
4.     Patient has met the criteria for decannulation outlined below.
Criteria for decannulation
1.     Patient should not be dependent on a ventilator.
2.     Patient’s mental status should be to the level of alert and responsive and should be able to manage their oral secretions without a risk of aspiration.
3.     Should not require frequent suctioning for tracheal secretions.
4.     Patient should be able to cough and clean his/ her tracheal secretions.
5.     The patient should have their tracheostomy tube downsized to a size 4 Shiley or similar tracheostomy tube and they should not have breathing difficulty in the presence of this tube.
6.     The size 4 Shiley or similar tube should be occluded (with a trach plug/ cork) for twelve hours during the day with close monitoring by the nursing staff  with no evidence of respiratory difficulty or requiring of suctioning of the trach tube.
7.     Once the patient is seen to tolerate the steps in item # 6 above, their trach is plugged for twenty four hours and they are monitored for respiratory difficulty or suction requirement.
Once all of the above criteria are met, the patient is informed that their trach tube is going to be removed. They are instructed that they may experience a sensation of shortness of breath for a few minutes once they are decannulated.
Arrangements should be made for back-up personnel (RT or RN) to be available in case of emergency. Decannulation is usually not done at home.
The patient is placed supine (flat) on their bed, the tube is removed and the opening into the neck is covered with sterile gauze and a tape is placed over the gauze.

The patient is instructed to occlude the gauze with their finger tip every time they cough or speak so that air does not leak. They should change the gauze and the tape at least once a day (more often as needed) until the hole in the neck heals itself closed over the next few days to weeks. In a minority of patients (<10 %), the opening into the neck skin has to be surgically closed.

Making sterile salt water (saline) for home suctioning/use

Making sterile salt water (saline) for home suctioning/use

Start with clean hands, pans, containers and spoon
1.     Put saline storage jar and lid in one pan and cover with tap water.
2.     Put 4 ¼ cups of tap water in a second pan.
3.     Boil both pans for ten minutes.
4.     Add two level teaspoons of table salt to plain boiled tap water and stir to dissolve.  Cool both pans to room temperature.
5.     Remove storage jar and lid touching only the outside.
6.     Pour cooled salt water directly into storage jar.  Place lid tightly on jar.  Store in refrigerator.
7.     Pour off the amount needed for each cleaning or suctioning session into a smaller container.  Do not dip anything into the large supply of saline.

8.     Make a new batch every day.

Tracheostomy Stoma Care

Tracheostomy Stoma Care

The buildup of mucus and the rubbing of the tracheostomy tube can irritate the skin around the stoma. The skin around the stoma should be cleaned at least twice a day to prevent odor, irritation and infection. If the area appears red, tender or smells badly, stoma cleaning should be performed more frequently. Call your surgeon’s office if a rash, unusual odor, and/or yellowish-green drainage appears around the stoma.


  • Face cloth
  • Cotton-tipped applicators
  • Hydrogen peroxide (1/2 strength - equal parts peroxide and water)
  • Normal saline
  • Vaseline guaze 2x2 dressing (optional)
1.     Wash your hands.
2.     Remove any dressing around the tracheostomy (if applicable). The tube should not have to be removed to clean the stoma.
3.     Dip the cotton tip applicators in the hydrogen peroxide (saline can be used if the peroxide is too irritating) and use it to clean around the stoma site. Start as close as possible to the tracheostomy tube then work away from it.
4.     Repeat the process until debris and/or mucus is removed.
5.     Use a dry cotton tip applicator or face cloth to dry the skin.
6.     No gauze should be placed under the trach tube unless recommended by the treating physician.  A dry dressing is helpful if the patient has areas of skin irritation or secretions. 

Daily Care

Rubbing of the trach tube and secretions can irritate the skin around the stoma. Daily care of the trach site is needed to prevent infection and skin breakdown under the tracheostomy tube and ties. Care should be done at least once a day; more often if needed. Patients with new trachs or on ventilators may need trach care more often. Tracheostomy dressings are used if there is drainage from the tracheostomy site or irritation from the tube rubbing on the skin.
It may be helpful to set up a designated spot in the home for equipment and routine tracheostomy care.
  • Sterile cotton tipped applicators (Q-tips) 
  • Trach gauze
  • Sterile water
  • Hydrogen peroxide (1/2 strength with sterile water)
  • Trach ties and scissors (if ties are to be changed) 
  • Two sterile cups or clean disposable paper cups
  • Small blanket or towel roll

1.     Wash your hands. 
2.     Make sure the patient is laying in a comfortable position on his/her back with a small blanket or towel roll under his/her shoulders to extend the neck and allow easier visualization and trach care.
3.     Open sterile cotton, trach gauze and regular gauze.
4.     Cut the trach ties to appropriate length (if trach ties are to be changed).
5.     Pour 1/2 strength hydrogen peroxide into one cup and sterile water into the other.
6.     Clean the skin around the trach tube with sterile cotton soaked in 1/2 strength hydrogen peroxide. Using a rolling motion, work from the center outward using 4 swabs, one for each quarter around the stoma and under the flange of the tube. Do not allow any liquid to get into trach tube or stoma area under the tube.  Note: We recommend cleaning with just soap and water in home care, using hydrogen peroxide only to remove encrusted secretions. This is because daily use of hydrogen peroxide might irritate the skin, especially in cases with small children.
7.     Rinse the area with cotton soaked in sterile water.
8.     Pat dry with gauze pad or dry sterile cotton.
9.     Change the trach ties if needed.
10.   Check the skin under the trach ties.
11.   For tracheostomy tubes with cuffs, check with your surgeon’s office for specific cuff orders. Check cuff pressure every 4 hours (usual pressure 15 - 20 mm Hg). In general, the cuff pressure should be as low as possible while still maintaining an adequate seal for ventilation.
12.   Monitor skin for signs of infection. If the stoma area becomes red, swollen, inflamed, warm to touch or has a foul odor, or if the patient develops a fever, call your surgeon’s office.
13.   Check with the doctor before applying any salves or ointments near the trach. If an antibiotic or antifungal ointment is ordered by one of our doctors, apply the ointment lightly with a cotton swab in the direction away from the trach stoma.

14.   Wash your hands after each trach care.

Tracheostomy Suctioning

Tracheostomy Suctioning

The upper airway warms, cleans and moistens the air we breathe. The trach tube bypasses these mechanisms, so that the air moving through the tube is cooler, dryer and not as clean.  In response to these changes, the body produces more mucus.  Suctioning clears mucus from the  tracheostomy tube and is essential for proper breathing. Also, secretions left in the tube could become contaminated and a chest infection could develop.  Avoid suctioning too frequently as this could lead to more secretion buildup.

Removing mucus from trach tube without suctioning

1.     Bend forward and cough. Catch the mucus from the tube, not from the nose and mouth.
2.     Squirt sterile normal saline solutions (approximately 5cc) into the trach tube to help clear the mucus and cough again.
3.     Remove the inner tube (cannula).
4.     Suction.
5.   If still the breathing is not adequate
6.     Remove the entire trach tube and try to place the spare tube.
7.     Continue trying to cough, instill saline, and suction until breathing is normal or help arrives.

When to suction

Suctioning is important to prevent a mucus plug from blocking the tube and stopping the patient's breathing.  Suctioning should be considered
  • Any time the patient feels or hears mucus rattling in the tube or airway
  • In the morning when the patient first wakes up
  • When there is an increased respiratory rate (working hard to breathe)
  • Before meals
  • Before going outdoors
  • Before going to sleep
The secretions should be white or clear. If they start to change color, (e.g. yellow, brown or green) this may be a sign of infection. If the changed color persists for more than three days or if it is difficult to keep the tracheostomy tube intact, call your surgeon's office. If there is blood in the secretions (it may look more pink than red), you should initially increase humidity and suction more gently. A Artificail humidifier, which is a cap that can be attached to the tracheostomy tube, may help to maintain humidity. The cap contains a filter to prevent particles from entering the airway and maintains the patient's own humidity. Putting the patient in the bathroom with the door closed and shower on will increase the humidity immediately. If the patient coughs up or has bright red blood mucus suctioned, or if the patient develops a fever, call your surgeon's office immediately.

How to suction

Clean suction catheter (Make sure you have the correct size)
Distilled or sterile water
Normal saline
Suction machine in working order
Suction connection tubing
Jar to soak inner cannula (if applicable)
Tracheostomy brushes (to clean tracheostomy tube)
Extra tracheostomy tube
1.     Wash your hands.
2.     Turn on the suction machine and connect the suction connection tubing to the machine.
3.     Use a clean suction catheter when suctioning the patient. Whenever the suction catheter is to be reused, place the catheter in a container of distilled/sterile water and apply suction for approximately 30 seconds to clear secretions from the inside. Next, rinse the catheter with running water for a few minutes then soak in a solution of one part vinegar and one part distilled/sterile water for 15 minutes. Stir the solution frequently. Rinse the catheters in cool water and air-dry. Allow the catheters to dry in a clear container. Do not reuse catheters if they become stiff or cracked.
4.     Connect the catheter to the suction connection tubing.
5.     Lay the patient flat on his/her back with a small towel/blanket rolled under the shoulders. Some patients may prefer a sitting position which can also be tried.
6.     Wet the catheter with sterile/distilled water for lubrication and to test the suction machine and circuit.
7.     Remove the inner cannula from the tracheostomy tube (if applicable). The patient may not have an inner cannula. If that is the case, skip this step and go to number 8.

a. There are different types of inner cannulas, so caregivers will need to learn the specific manner to remove their patient's. Usually rotating the inner cannula in a specific direction will remove it.

b. Be careful not to accidentally remove the entire tracheostomy tube while removing the inner cannula. Often by securing one hand on the tracheostomy tube?s flange (neck plate) one can/ will prevent?accidental removal.

c. Place the inner cannula in a jar for soaking (if it is disposable, then throw it out).
8.     Carefully insert the catheter into the tracheostomy tube. Allow the catheter to follow the natural curvature of the tracheostomy tube. The distance to the location of catheter becomes easier to determine with experience. The least traumatic technique is to pre-measure the length of the tracheostomy tube then introduce the catheter only to that length. For example if the patient?s tracheostomy tube is 4 cm long, place the catheter 4 cm into the tracheostomy tube. Often, there will be instances when this technique of suctioning (called tip suctioning) will not clear the patient?s secretions. For those situations, the catheter may need to be inserted several mm beyond the end of the tracheostomy tube (called deep suctioning). With experience, caregivers will be able to judge the distance to insert the tracheostomy tube without measuring.
9.     Place your thumb over the suction vent (side of the catheter) intermittently while you remove the catheter. Do not leave the catheter in the tracheostomy tube for more than 5-10 seconds since the patient will not be able to breathe well with the catheter in place.
10.   Allow the patient to recover from the suctioning and to catch his/her breath. Wait for at least 10 seconds.
11.   Suction a small amount of distilled/sterile water with the suction catheter to clear any residual debris/secretions.
12.   Insert the inner cannula from extra tracheostomy tube (if applicable).
13.   Turn off suction machine and discard catheter (clean according to step 3 if to be reused).

14.   Clean inner cannula (if applicable).