Everyday charting

Charting the trach on a solo home vent shift

On a solo home vent shift your note is the only witness. This is how to make it say what you actually checked.

7 min read built on 0 cases updated 2026-10-31

Written by a med-surg RN, ten years, day shift. Why there is no name on it · How this guide is made

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You're the only nurse in the house. The kid is on a home vent with a trach, and whatever you chart, nobody else saw it. If the note says trach secure, the next reader learns nothing about what you checked. A week later you won't be able to rebuild it either.

Key points

  • Write what you saw and heard: chest rise on both sides, breath sounds on both sides, SpO2, heart rate.
  • Copy the vent numbers off the screen (peak pressure, exhaled tidal volume, rate). Put the patient's usual range next to them.
  • Say which alarms are on and whether any went off. If one did, write what caused it and what you did.
  • Chart the tie check the same way every time: tie type, finger check, skin under the ties, and whether the stoma dressing is dry and in place.
  • Put a time on every check. Include the emergency kit check and the suction catheter pass, because they show the tube is open as well as in place.

What to write

How it often gets charted What tells the reader something
Trach secure. Vent on.0200 Trach in place, flange midline, ties intact. Chest rise equal bilat with vent breaths. BS clear and equal bilat ant/post. SpO2 97% HR 104. PIP 17 (usual 16-19), exhaled Vt 82 mL (set 85). No alarms since 0000 check.
Ties changed, secure.0915 Cotton ties changed with mother holding tube. One finger fits snug between ties and neck. Skin under ties intact, slight redness L side unchanged from yesterday. Chest rise equal after change, SpO2 96%.
Vent alarmed, resolved.0347 Low pressure alarm. Found circuit disconnected at trach connector. Reconnected within seconds. Trach still in stoma, ties intact. Chest rise equal, SpO2 dipped to 89%, back to 96% by 0350. PIP 17. Alarm cleared and remains active.
Suctioned x1, tolerated well.1130 Suctioned to premeasured depth 7 cm, catheter passed easily. Small amt thin white secretions. SpO2 95% before, 97% after. HR 110 during, back to 102.
Received pt, all equipment checked.1900 Shift start. Report from mother. Go bag at bedside: spare trach same size and one size smaller, obturator, ties, scissors, resuscitation bag, suction catheters. Portable suction tested, working. Vent battery full, high and low pressure alarms on. Pulse ox on, alarm limits per plan.
Dressing C/D/I.2200 Stoma dressing dry, in place under flange. Stoma edges pink, no bleeding, no new drainage. No air leak heard at stoma.

Template

Routine check (each scheduled check)

[TIME] Airway/vent check.
Trach: in stoma, flange [MIDLINE / POSITION], [COTTON / VELCRO] ties intact, [ONE / TWO] finger(s) fit between ties and neck. Skin under ties [INTACT / FINDING].
Stoma dressing: [DRY / DAMP / CHANGED], stoma [FINDING], drainage [NONE / DESCRIBE].
Chest rise: [EQUAL BILAT / FINDING] with vent breaths.
Breath sounds: [FINDING] R, [FINDING] L, ant and post.
SpO2 [SPO2]%, HR [HR], RR [RR] (vent set [SET RATE]).
Vent: mode [MODE], PIP [PIP] (usual [USUAL RANGE]), exhaled Vt [VT] mL (set [SET VT]), PEEP [PEEP], O2 [O2 FLOW OR FIO2].
Alarms: high and low pressure [ON], alarms since last check [NONE / DESCRIBE].
Patient: [ALERT / ASLEEP / BEHAVIOR], color [FINDING], work of breathing [FINDING], compared with baseline [SAME / CHANGE].
[NAME], [CREDENTIAL]

Shift start or handoff

[DATE] [TIME] Shift start. Report received from [NAME / RELATIONSHIP].
Report given: [KEY POINTS: LAST TRACH CHANGE DATE, LAST TIE CHANGE, ANY EVENTS].
Go bag at bedside: spare trach size [SIZE], spare trach size [SMALLER SIZE], obturator, spare ties, scissors, resuscitation bag with trach adapter, suction catheters [SIZE], saline. Missing: [NONE / ITEM].
Portable suction tested: [WORKING / PROBLEM]. Vent battery [FULL / PARTIAL / LOW / ON CHARGER]. Backup O2 [FULL / PARTIAL / LOW].
Pulse ox on, alarm limits [LIMITS PER PLAN].
Initial airway check: see [TIME] entry.
[NAME], [CREDENTIAL]

Alarm or airway event

[TIME] [ALARM NAME OR EVENT] noted.
Found: [WHAT YOU SAW, E.G. CIRCUIT DISCONNECTED AT TRACH CONNECTOR / TUBE PARTLY OUT OF STOMA / CATHETER WOULD NOT PASS].
Action: [WHAT YOU DID, IN ORDER, WITH TIMES].
After: trach [IN STOMA / REPLACED WITH SIZE [SIZE] AT [TIME]], ties [FINDING], chest rise [FINDING], breath sounds [FINDING], SpO2 [LOWEST VALUE] at [TIME], [VALUE] at [TIME]. HR [VALUE]. PIP [PIP], exhaled Vt [VT] mL.
Alarm cleared at [TIME], remains active.
Notified: [NAME / ROLE] at [TIME], response: [WHAT THEY SAID OR ORDERED].
Parent/guardian [NAME] informed at [TIME].
[NAME], [CREDENTIAL]

Words to avoid

Word or phrase Why it hurts Write this instead
trach secureA conclusion with nothing observed under itFlange position, ties intact, finger check, chest rise, breath sounds
vent WNL / vent functioning properlyHides the numbers and any trendPIP, exhaled Vt, rate, compared with usual range
alarms onDoesn't say which ones or whether any firedHigh and low pressure alarms on; no alarms since [TIME]
tolerated wellNothing anyone can checkSpO2 and HR before and after, and what the patient did
no distressToo broad to compare between checksRR, work of breathing, color, behavior compared with baseline
C/D/IShorthand that skips the stomaDressing dry or wet, stoma skin, drainage, leak
equipment checkedNobody can tell what was thereList the go bag items and whether suction was tested

The summary phrase that buries the trend

Trach secure is a conclusion. The observations that should get you there aren't in the note.

On a hospital unit you usually have a flowsheet, an RT, and a second nurse who glanced in. On a private duty shift you have none of that. Your note is the only record of the check.

Say the tube comes out at 0340. Your last entry, at 0300, reads trach secure, vent functioning. Did you look at chest rise? Listen? Read the pressures? Or did you just see the tube sitting in the stoma? Nobody can tell. Months later, you can't either. A tube can look fine from the outside and still be partly out or blocked. The specific findings carry the information. The summary phrase doesn't.

Second problem: vague words hide change. Peak pressure was 18 at 2000 and 11 at 0200, and vent WNL at both checks buries the one trend that mattered. A drop in pressure or exhaled volume can mean a leak, a disconnect, or a tube that has moved. You only see that trend if you wrote the numbers down.

Bottom line

Chart what told you the tube was in: the chest rise, the breath sounds, the numbers, the ties. trach secure only says you thought so.

Official guidance

  • Check tie tension by sliding fingers between the ties and the neck. Sources split on one finger versus two, so go with the number in your patient's care plan and chart the result. (cdss.ca.gov, ohsu.edu)
  • Watching the chest rise and fall is one of the main ways to confirm air is moving through the tube. (cdss.ca.gov, rch.org.au)
  • Listen on both sides and compare them. (childrenscolorado.org, respiratorytherapyzone.com)
  • If the suction catheter won't pass, treat it as a warning that the tube is blocked or out of position. Act on it. (rch.org.au, ohsu.edu)
  • Keep a spare trach in the current size, plus one a size smaller, with the patient at all times. (rch.org.au, ohsu.edu)
  • Chart SpO2 as part of routine respiratory monitoring for a trach and vent patient. (childrenscolorado.org, rch.org.au)

What this rests on

No published decision turned up for this question. We looked, and the searches are in the record. So this article stands on published guidance and on how the question is asked on the floor, not on a court opinion. That is a weaker footing than the rest of the guide, and you should know it before you rely on it. The decisions behind the other articles are all in one place.

From nurses online

Quoted as written. Opinion, not a source.

  • This is for established trachs, not fresh post-op which go to our ICU - would be important to get training for what to do if the stoma isn’t healed/established if you’d have these patients. ... Theyll cover it in orientation. First, yell for help and either call RT or delegate to someone to. Get out

    r/nursing on Reddit: Emergency decannulation reddit

  • With private duty, you are most likely working with pediatrics. You are the link between them living with their family or living in an institution. You play a role that is vastly different, in that you are caring for a stable patient vs. acute, but still require nursing interventions. This may inclu

    r/nursing on Reddit: I don’t understand how home health is low stress? reddit

  • I would speak with your supervisor about getting checked off. It is very common in home care, and essential - there’s not an RT on another hall that can come if it comes out at home! ... When I was doing in home care of ventilator-dependent patients, changing their trach was part of my scope of prac

    r/nursing on Reddit: Are nurses allowed to change the outer cannula of a trach pt? reddit

  • No matter if we have been nurses for 1 year or 40 years there will be a time when you need help or to bounce an idea off someone/double check something. That will be near impossible if you are alone in someone's home. If they are as desperate as you say I wouldn't believe them if they say

    r/nursing on Reddit: Is it a terrible idea to take a pediatric home care job as a new grad reddit

Other guides

Advice, not law.