What is tracheostomy care?
Tracheostomy (trach) care is done to ensure your trach tube and the area around it stays clean. This helps prevent a clogged tube and decreases the risk of infection. Trach care includes suctioning and cleaning your skin and parts of the tube. Your caregiver will show you how to care for your trach tube, and what to do in an emergency.
What are the parts of a trach tube?
- Flanges: These are the curved wings on each side of the trach tube. The flanges help keep the trach tube in place.
- Trach ties: The ties go around your neck and hold the flanges in place. The ties may be made of fabric tape. A trach holder made from hook and loop fasteners may also be used.
- Inner cannula: This is a smaller tube that sits inside the trach tube. The inner cannula can be removed for cleaning.
- Obturator: This is a small device used to insert a new trach tube.
- Cuff: Some plastic trach tubes have a cuff that fills with air and helps hold the tube in place. A thin tube and reservoir may hang from the trach tube so you can inflate and deflate the cuff.
What supplies do I need for trach care?
Keep spare supplies with you at all times while you have a trach tube. You may at any time need to suction or change your tube if it gets clogged or needs to be replaced quickly.
- One trach tube the same size as your current tube and another trach tube that is 1 size smaller
- Obturator for each trach tube
- One set of trach ties or a trach holder
- Portable suction machine with battery backup and tubing that connects to the suction machine
- Catheters with a suction valve
- Sterile saline
- Rescue breathing bag and mask
- Emergency phone numbers
How can I prevent infections?
- Wash your hands: Always wash your hands before and after any trach tube care.
- Clean your trach equipment: Use clean or sterile trach care methods and clean your equipment as your caregiver directs.
- Keep your neck clean and dry: Change the gauze and trach ties when they are wet or dirty.
- Keep your mouth clean: Saliva and mucus contain germs that cause infection if they enter your airway. Brush your teeth twice a day and suction your mouth as needed to help prevent infections.
How do I suction my trach tube?
You may be told to suction your trach tube at least twice a day. Your caregiver will tell you when or if you need to suction more often.
- Prepare your suction machine: Each suction machine has a pressure gauge. Your caregiver will tell you what amount of pressure to use when you suction your trach tube. You can test the pressure before you suction by covering the suction valve on the catheter with your thumb.
- Use saline only as directed: Your caregiver may tell you to insert a few drops of sterile saline into your trach tube to make your secretions thin. Do not use saline unless directed by your caregiver.
- Suction your trach tube: The catheter should be inserted until it is just past the end of the tube. Your caregiver will tell you how far to insert the catheter. The catheter may have measurements marked on it for you to follow. You can also measure and mark the catheter so you do not put it in too far. Take a deep breath and try to cough up the secretions before you suction your trach tube. Only cover the suction valve as you remove the catheter. Gently twist the catheter as you pull it out. It should take less than 15 seconds.
How do I care for my trach tube?
Clean the area around your tube and the inner cannula at least once each day.
- Check for signs of infection: Wash your hands before you remove your trach dressing. Look for redness or swelling of the skin around your tube. Clean the area and replace the trach dressing as directed. Do not cut the gauze. Fold the gauze instead so you do not breathe in the cut fibers.
- Clean the inner cannula: Suction your trach tube before you remove the inner cannula. Clean the inner cannula with a cleaning solution as directed by your caregiver. Rinse the inner cannula before you replace it in your trach tube.
- Change wet or dirty trach ties: A finger should fit snugly between your neck and the trach ties. Ties that are too tight can cause skin breakdown. The trach tube can move out of place when the ties are too loose. You may need someone to help you hold the trach tube in place or attach the new ties.
How do I change my trach tube?
Change your trach tube as often as your caregiver directs. You may also need to change the trach tube if it moves out of place, feels uncomfortable, or the cuff leaks. You may need someone to help you change the trach tube.
- Prepare the new trach tube: Insert the obturator into the new tube. Inflate the cuff with air to make sure it works, and then let the air out. Place a small amount of lubricant on the lower end of the tube as directed by your caregiver. Wipe off excess lubricant.
- Deflate the cuff on your current trach tube before you remove it: You can damage your airway or skin if you forget to do this. Pull your trach tube out gently.
- Insert the new trach tube: Remove the obturator after the trach tube is in place. Insert a new or clean inner cannula. Use trach ties or a trach holder as directed to secure the tube.
- Inflate the cuff as directed: Your caregiver will show you how much air to use. A cuff with too much air can leak, break, or harm your airway.
How do I keep my secretions thin?
- Keep water and other materials out of your trach tube: Do not swim. Use a shower shield or trach cap while you bathe to keep water from entering your airway. Avoid breathing in dust. Do not use powders or sprays near your trach tube.
- Drink plenty of liquids: Ask your caregiver which liquids are best for you and how much liquid you should drink each day.
- Humidify the room: Use a room humidifier or vaporizer while you sleep.
- Humidify your airway: You may be directed to use a heat moisture exchanger (HME), a trach collar, or fabric stoma covers. An HME attaches to your trach tube and prevents moisture loss. A trach collar connects to a machine that supplies humidified air to your trach. Fabric stoma covers are moistened and worn over your trach tube.
What steps do I follow if I am having trouble breathing?
- Try to clear the trach tube: Cough to help move mucus, water, or irritants out of your airway. Suction the tube if coughing does not clear your airway.
- Gently move the trach tube: Your tube opening may be against your airway. Gently reposition the tube to make sure it sits in your airway properly.
- Remove your inner cannula: Look for secretions inside the inner cannula. Clean the inner cannula if it has mucus in it.
- Replace your trach tube: Insert a new trach tube. Try a smaller size if a regular sized tube will not go in properly.
- Call 911: Have someone call 911 if you still cannot breathe easily.
When should I contact my caregiver?
Contact your caregiver if:
- You have a fever.
- You have increased or thicker secretions than usual.
- Your secretions are yellow or green.
- You see thick, red tissue growing around your trach tube, or the skin is red, swollen, or draining pus.
- Your trach cuff is leaking or broken.
- It hurts to swallow.
When should I seek immediate care?
Seek care immediately or call 911 if:
- You cannot breathe well even after you clean or change your trach tube.
- You find blood around or coming from your trach tube.
- You cannot insert a new trach tube.
You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.
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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.
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