Tracheostomy Care

What is a tracheostomy?

An opening is made into the trachea, or windpipe, to help you breathe. This opening is called a “stoma”.
A tube called a tracheostomy or trach tube, is put into the opening. The trach tube lets you breathe air directly into your windpipe instead of through your mouth and nose.

Your tracheostomy tube

To care for the trach tube, you must read the instructions provided to help you deal with the tracheal tube.
There are different types of trach tubes and yours may not be exactly as pictured here but it should be similar.

The different parts of a trach tube are:

1. An outer cannula: fits into the trachea and maintains the opening during healing
2. Trach plate: It has holes on either side so that ties can be put in and tied around the neck
3. An inner cannula: looks into the outer cannula and can be taken out and cleaned often. You may have more than one and return it
4. An obturator or guide: is used only when the entire trach tube is changed

How do I care for my trach?

You or someone you live with will need to learn how to:

• Clean the inner cannula of your trach tube
• Care for your stoma
• Clear secretions (mucus) from your lungs

We will help you every step of the way.

Cleaning the inner cannula of your trach tube (at least once daily)

To clean the inner cannula, you will need:

• 2 bowls (or disposable cups; 1 for cleaning, 1 for rinsing)
• Hydrogen peroxide solution
• Cotton-tipped applicator sticks (Q-Tip), or a trach brush
• Sterile Water

Steps:

1. Wash your hands well.
2. In the first bowl, make hydrogen peroxide solution: pour 1/2 cup of sterile water and 1/2 cup of hydrogen peroxide into 1 bowl.
3. In the other bowl, pour only sterile water.
4. Cough or suction if needed. This clears the airway of secretions. Take a few deep breaths.

Now you are ready to clean the inner cannula:

1. Loosen the inner cannula. Hold the outer cannula with one hand. With the other hand, turn the inner cannula to your right to unlock.
2. Remove the inner cannula by steadily pulling it down and toward your chest until it is out.
3. Place the inner cannula in the peroxide solution.
4. Use an applicator stick, or trach brush to gently clean the inner cannula and to remove mucus and dried secretions.
5. Now put the inner cannula in the bowl of plain sterile water and rinse well, shake off extra water, do not dry it. Moisture will make the inner cannula slide back in easily.
6. Put the inner cannula back in. Keep the curved part facing downward.
7. Lock the inner cannula into position.
8. Wash your hands when cleaning is done.

Caring for your stoma

Clean the stoma, or area of skin around the outer cannula, at least once a day. If you wear a trach dressing, change it whenever it gets soiled and when you clean your stoma.

You will need:

• A clean gauze
• Normal saline
• Cotton-tipped applicators
• Trach dressings

Cleaning around your stoma

1. Take off the old dressing, if present.
2. Wash your hands well.
3. Wet your gauze with Normal Saline. Gently clean the outer cannula and skin around it. Cotton-tipped applicators may be used for “hard-to-get” areas under the trach plate then dry with clean cloth.
4. Contact your doctor if you notice any redness, swelling, irritation, bleeding, green discharge or food residues in the stoma.
5. Put on a new dressing with the open ends up, if you like to wear one.

Clearing secretions from trach tube

If you are prone to mucus plugs from trach tube, have a lot of secretions, and have needed lots of suctioning while in hospital, you may need a suction machine at home.
Suctioning should be done only when needed, to make breathing easier.

You will need:

• Suction machine
• Suction catheter (tube) – the right size for your trach
• Normal Saline
• A bowl or disposable cup
• Clean gloves

How to suction

1. Wash your hands well.
2. Open the catheter package and connect the catheter to the suction machine tubing. Turn on the suction machine.
3. Put on gloves.
4. Moisten the catheter by dipping it into a clean container of Normal Saline.
5. Insert the catheter. Make sure your thumb is off the opening on the adaptor. Guide the catheter into the tracheostomy tube about 4 to 6 inches (10 to 15 cm).
6. Now place your thumb over the catheter opening (after inserting the suction tube), then lift it and pull the catheter out in a circular (turning) motion.
7. Rinse the catheter of secretions by suctioning through a small amount of Normal Saline.
8. If needed, repeat these steps until you clear from all secretions. Give your patient time to catch his breath between suction passes.

Dear patient, here are some tips to follow if you encounter any problem:

If you have difficulty breathing:

• You may have secretions in the tracheal tube. Remove the inner tube to check for mucus and clean it if necessary. Replace it.
• If your breathing does not improve, try coughing hard.
• You may have secretions behind the tracheal tube, try coughing. If that does not help, suction the secretions.
• You may have infections. If the secretions start to be more than usual, or change color, contact your doctor.

You cannot breathe through the tracheostomy tube

• Try removing the inner tube and make sure there are no secretions, put it back in place and try coughing hard and breathing deeply. Try suctioning if you have a suction device.
• If removing the inner tube and suctioning does not help, remove the entire tracheostomy tube and cough hard and suction secretions directly through the opening.
• If you do not improve, go to the nearest hospital emergency department and take the extra tracheostomy tube with you.

Removing the tracheostomy tube

• Don't worry, the tracheostomy opening will remain open. Move your head back to keep the opening open more.
• Put the tube back in if you know how to put it back in. Use the same movement you used to put the internal cannula in. Tie the tracheostomy tube in place.
• If you don't know how to put the tube back in, go to the nearest hospital and take an extra tube with you.