How to Care for a Tracheostomy

About this topic

A tracheostomy or trach is an opening made by a cut in your neck. The opening is called a stoma. A small tube is placed through the stoma. It goes into your windpipe or trachea. This is called a trach tube. It helps keep your airway open and removes secretions from your lungs. ‚
A trach is done for many reasons. Some people need it to help them breathe more easily. Others have health problems caused by an injury, scarring, or surgeries. Some trachs are needed only for a short time. Others are needed for a long time. A trach may be connected to a breathing machine or covered with a small cap. ‚

General

It is important to learn to care for your trach. You will need many supplies to help you. Keep all supplies together in one place and set them up before use. Practice caring for your trach before going home. Be sure you are comfortable caring for your trach. Be sure to ask your doctor or nurse any questions that you may have. ‚
Learn the parts of your trach tube. ‚

Inner cannula ¢ ˆ ’ Fits inside the outer cannula. Locks into the outer cannula to keep it from being coughed out. It should be removed and cleaned more often.
Outer cannula ¢ ˆ ’ Holds the stoma open while healing. Sometimes, there is just one cannula.
Trach plate ¢ ˆ ’ Has holes on the sides. This is where ties are placed and then tied around the neck. This may also be called the flange.
Trach ties ¢ ˆ ’ These secure the trach to help keep it from falling out.
Obturator ¢ ˆ ’ Act as a guide to help place the trach tube in the trachea.
Cuff ¢ ˆ ’ This may be made of foam or a balloon. It helps block air from leaking back out of the windpipe.

How to Clean the Cannula ‚

Wash your hands carefully.
Remove the inner cannula from your trach tube.
Place in a basin with hydrogen peroxide solution. Let it soak for a few minutes.
Clean the cannula with cotton-tipped swabs.
Scrub off all secretions and rinse with sterile water or normal saline.
Shake the cannula to get all the water off. Dry with a sterile gauze pad.
Put the cannula back in the trach tube and carefully lock it in place.
Replace the outer cannula if it comes out. Replace it if you think mucus is plugged at the end of the outer cannula. Talk to your doctor about whether you should or should not change the outer tube yourself.
Wash your hands carefully.

How to Change the Tracheostomy Ties ‚

You may need someone to help you hold the trach tube so it will not move out of place.
Remove the old ties.
Put one end of each tie into the opening of the neck plate.
Secure both ends together to the side of your neck. Make sure that only one finger can slip under it.
If changing the outer cannula, put fresh, clean ties on the new cannula before putting it in place.

How to Change the Tracheostomy ‚

Talk to your doctor about how often you need to change your tracheostomy. Always have at least one more trach on hand. Many doctors suggest having a trach one size smaller available as well.
You may need someone to help you change your trach.
Wash your hands carefully.
Gather all your supplies and make sure the cuff or balloon works on the new trach.
Put new ties on the new trach.
Remove the old ties. Gently take out the old trach and replace with the new one.
Take out the obturator. Secure the new trach with the clean ties.
Wash your hands carefully.

How to Clean Your Stoma ‚

Wash your hands carefully.
Gently remove your old dressing and throw it away. Wash your hands again.
Gently wipe the outer cannula and your skin around the trach tube. Use a gauge sponge or cotton-tipped swab with 1/2 strength hydrogen peroxide.
If you have dried mucus in your stoma, remove it with a cotton-tipped swab soaked in 1/2 strength hydrogen peroxide. Take extra care not to get any water or secretions into your stoma.
Rinse the stoma with moist gauze. Pat your skin dry with a clean cloth.
Watch for any signs of redness, swelling, irritation, bleeding, and any discharge.
Put on cream, ointment, or gels as directed by your doctor. Be sure to use an applicator stick.
Cover your stoma with a clean dressing. Change your dressing when it is soiled or at least once a day.
Wash your hands carefully.
Clean your stoma at least once a day or as often as needed.

How to Suction the Trach Tube ‚
It is important to keep the trach tube free of thick mucus. Always have a cloth or tissue ready when you cough. This will help catch the mucus coming out from your tube. You may need to use a suction machine to help clear your trach tube. ‚

Wash your hands carefully.
Attach the suction tube to the suction machine.
Turn the suction machine on.
Take a deep breath. Gently put the suction tube into your trach tube. Do not apply the suction while putting in the tube. If you feel uneasy, remove the suction tube slightly.
Cover the suction control with your thumb to apply suction. Gently rotate the tube while removing it as you apply suction.
Take a deep breath after you suction.
Soak the suction tube in water and rinse carefully.
Wash your hands carefully.
Talk to your doctor if you are not able to clear your secretions.

How to Keep Your Breathing Moist ‚

Keep relative humidity in your home. Keep a humidifier in your living area. Sleep in a cool room at night.
Drink lots of fluids to keep mucus thin. Drink at least 6 to 8 glasses of water a day.

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What lifestyle changes are needed?

While your trach tube is in place, you may not be able to speak for a while. You may have breathing and vocal changes. You may need to communicate with other people by: ‚

Writing on a piece of paper
Gestures or lip reading
Communication board, such as a dry erase board or a picture board
Electronic devices like artificial sound source
Use of a talking trach tube. An outside air source is used to force air into your vocal cords. Your doctor and a speech therapist can teach you how to do this.

Will there be any other care needed?

Do not get water in your trach tube. Use a movable shower head to control water flow. Cover the tube with plastic or clothing to keep water away from your trach tube. Avoid swimming pools. Water can easily flow into your trach tube. You cannot hold your breath under water, and if the trach tube is submerged, you can easily drown.
Keep small elements from getting into your trach tube. Take extra care around food bits, dust, powders, and sprays. Cover your tracheostomy with light clothing or scarves. This is helpful when going outdoors to keep you from getting infections.
If your trach tube falls out, tilt your back to keep the stoma wider.
Practice proper mouth care and hand washing.
Get a flu shot each year and pneumonia shot as often as your doctor advises.
Avoid crowded places and people. Try to avoid people who are sick.
It is important to always do trach care in a clean environment.

When do I need to call the doctor?

Go to the ER right away if: ‚

Your trach tube falls out and you cannot replace it.

Call the doctor for: ‚

Signs of wound infection. These include swelling, redness, warmth around the wound; too much pain when touched; yellowish, greenish, or bloody discharge; foul smell coming from the cut site; cut site opens up.
Trouble breathing that is not relieved by clearing out the secretions

Helpful tips

Do not smoke and avoid secondhand smoke.
Avoid triggers that can make your breathing worse such as very cold air.

Teach Back: Helping You Understand

The Teach Back Method helps you understand the information we are giving you. The idea is simple. After talking with the staff, tell them in your own words what you were just told. This helps to make sure the staff has covered each thing clearly. It also helps to explain things that may have been a bit confusing. Before going home, make sure you are able to do these: ‚

I can tell you about my procedure.
I can tell you how I will care for my trach and how to clean the cannula.
I can tell you how to suction and change my trach.
I can tell you what I will do if I have trouble breathing or cannot replace my trach tube.

Where can I learn more?

Tracheostomy.com ‚
http://www.tracheostomy.com/care/care.htm ‚

Consumer Information Use and Disclaimer

This information is not specific medical advice and does not replace information you receive from your health care provider. This is only a brief summary of general information. It does NOT include all information about conditions, illnesses, injuries, tests, procedures, treatments, therapies, discharge instructions or life-style choices that may apply to you. You must talk with your health care provider for complete information about your health and treatment options. This information should not be used to decide whether or not to accept your health care providers advice, instructions or recommendations. Only your health care provider has the knowledge and training to provide advice that is right for you. ‚

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