Can the licensed practical nurse change or reposition a tracheostomy tube?

It is within the scope of practice of an appropriately trained and competent licensed practical nurse to perform routine and non-complex tracheostomy care under the direction of an authorized health care practitioner, or under the direction and supervision of the registered nurse, following clinical practice standards including:

• Suctioning of a non-established or established tracheostomy stoma. The licensed practical nurse may assist an authorized health care practitioner or the registered nurse in suctioning a fresh tracheostomy stoma;
• Changing, repositioning, or reinserting a tracheostomy tube in an established tracheostomy tract, (Decannulation before a mature tract is an emergency situation as well as a complex procedure and is not within the scope of the licensed practical nurse. The licensed practical nurse may assist an authorized health care practitioner or the registered nurse in reinsertion of a tracheostomy tube if the decannulation occurs before the tract is established.);
• Tracheostomy site care and dressing changes; and
• Inflation and deflation of cuff in a healed and established stoma.

The licensed practical nurse should use the Scope of Practice Decision Tree to determine if the activity is within the nurse's legal and individual scope of practice. Standing orders may be used. See the Nursing Care Quality Assurance Commission's Neonatal Intubation and Related Procedures Advisory Opinion for additional information.