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The purpose of this procedure is to describe tracheostoma skin care.  Proper skin assessment and intervention is important to allow for early detection of medical-device related pressure injuries.  Medical-device pressure injury, in this case, the tracheostomy tube, may be a result of “impaired sensation, moisture under the device, poor perfusion, altered tissue tolerance, poor nutritional status, and edema” (National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance, 2014, p. 119).  The tight sutures underneath can also lead to prolonged pressure on the skin, especially when swelling may be present during the initial phases after a tracheotomy procedure (Dixon et al., 2018).  Finally, patients who are mechanically-ventilated are at increased risk due to the additional weight and position of the ventilator, causing increased pressure.  Additional risk factors for tracheostomy-tube related injuries include (Dixon et al., 2018): • Patients with a high body mass index • Patients with a low-lying larynx • History of radiation treatment • Patients with shorter necks • Increased moistures and humidified oxygen Prevention of these injuries is important, and early assessment and detection will prevent further complications such as wound infection.    IMPORTANT: Tracheostomy skin care should include all of the following to prevent complications.  Routine skin assessment around the stoma and in areas where friction may occur, such as the neck and chin.  Proper cleaning technique: a) around the tracheostoma site, and b) area under neck ties (refer to MUHC protocol Tracheostomy Ties) Appropriate selection of dressing for underneath the tracheostomy neck flange  Appropriate head position  If patient is ventilated, ensure proper support for ventilator tubes to relieve any additional pressure on the tracheostomy tube.