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Tracheostomy Care

WHAT YOU NEED TO KNOW:

What is tracheostomy care?

Tracheostomy (trach) care is done to keep your trach tube clean. This helps prevent a clogged tube and decreases your risk for infection. Trach care includes suctioning and cleaning parts of the tube and your skin. Your healthcare provider 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?

Ask your healthcare provider the type, size, and length of your tracheostomy tube.

  • An outer cannula is the tube that sits in the trachea. There are different sizes of outer cannulas.
  • Flanges are the curved wings on each side of the trach tube. The flanges can be connected to trach ties to hold the trach tube in place.
  • Trach ties go around your neck and help keep the trach tube in place.
  • A cuff fills with air and helps hold the tube in your airway. You may see a thin tube hanging from the outer cannula. Air can be inserted or removed from the cuff through this tube. Your trach may not have a cuff.
  • An inner cannula is a smaller tube that sits inside the outer cannula. The inner cannula can be removed for cleaning. There are different sizes of inner cannulas. Your trach tube may not have an inner cannula.
  • An obturator is a small device used to insert a new trach tube.
  • A speaking valve is a cap that fits over the opening of your trach tube. There are many different types of speaking valves. Ask your healthcare provider if you can use a speaking valve and which one is right for you.
    Parts of Tracheostomy Tube

What supplies do I need for trach care?

Keep spare supplies with you at all times . This includes the following:

  • One trach tube the same size as your current tube and 1 trach tube that is 1 size smaller
  • Obturator for each trach tube and an empty syringe
  • One set of trach ties or a trach holder
  • Portable suction machine with battery backup and tubing that connects to the suction machine
  • Suction catheters
  • Sterile saline and water-based lubricant
  • Rescue breathing bag and mask
  • Emergency phone numbers

How can I prevent infections?

  • Wash your hands. Always wash your hands before and after you care for your trach.
  • Clean your trach equipment as directed. Use clean or sterile trach care methods to clean your equipment.
  • Clean the area around your trach as directed. The area around your trach is called the stoma.
  • Use a trach cover as directed. Do not use a trach cover unless your healthcare provider says it is okay. A trach cover sits over the opening to your trach tube. It prevents dirt and other foreign bodies from getting into your airway.
  • Keep your mouth clean. Saliva and mucus contain germs that cause infection if they enter your airway. Brush your teeth twice a day. Suction your mouth as needed. Use a mouth wash twice a day or as directed.
  • Take deep breaths and cough 10 times each hour. This will decrease your risk for a lung infection. Take a deep breath and hold it for as long as you can. Let the air out and then cough strongly. Deep breaths help open your airway. You may be given an incentive spirometer to help you take deep breaths. Put the plastic piece in your mouth and take a slow, deep breath, then let the air out and cough. Repeat these steps 10 times every hour.

How do I suction my trach tube?

Your healthcare provider will tell you when you need to suction your trach tube. Always take a deep breath and cough strongly before you suction your trach. This may be all that you need to clear your airway. It may help to look at a mirror while you suction your trach tube. You may need someone else to help suction your trach tube.

  • Wash your hands and put on gloves. This will help prevent infection in your airway.
  • Prepare your suction machine. Each suction machine has a pressure gauge. Your healthcare provider will tell you how much pressure to use when you suction your trach tube. Test the pressure before you suction. Do this by covering the suction valve on the catheter with your thumb.
  • Get into a comfortable position. You can sit up or lay flat to suction your tube. Place a pillow or rolled towel under your neck if you lay flat. This will help open your airway.
  • Suction your trach tube. Insert the catheter until it is just past the end of the tube. Your healthcare provider will show you how far to insert the catheter. The catheter may have measurements marked on it for you to follow. You can mark the catheter so you do not put it in too far. Cover the suction valve as you remove the catheter. It should take you less than 15 seconds to remove the suction catheter.
    Tracheostomy Self Suction
    Suction of a Tracheostomy Tube
  • Suction your trach tube a second time if needed. If you use oxygen, replace the oxygen for 30 seconds before you try to suction your trach again.
  • Suction your stoma. Mucus and blood may leak from the sides of your outer cannula. Gently suction this area with the suction catheter.
  • Throw away your suction catheter or clean as directed. Disposable suction catheters should be thrown away. Reusable catheters can be cleaned and reused. To clean a reusable catheter, suction sterile water and air through the catheter as directed. Wipe the outside with alcohol or hydrogen peroxide as directed. Allow the catheter to air dry.
  • Remove your gloves and wash your hands. This will prevent the spread of germs.

How do I care for my trach tube?

You may need someone to help you clean your trach tube.

  • Clean the inner cannula at least once every day. You can skip this step if you do not have an inner cannula.
    Clean the Inner Cannula
    • Wash your hands and put on gloves.
    • Suction your trach.
    • Remove the inner cannula and soak it in hydrogen peroxide for 10 to 15 minutes. Use a soft brush or pipe cleaner to clean the inside and outside of your inner cannula. Make sure to remove all blood and dried mucus.
    • Rinse the inner cannula with sterile saline and replace it into the outer cannula. It should snap into place.
    • If you cannot clean the cannula well, throw it away and use a new inner cannula.
  • Check the cuff pressure at least once each day. Your healthcare provider will show you how to check your cuff pressure. Ask him how much air should be in your cuff. You may need to add or remove air from your cuff. It is important that your cuff contains the correct amount of air. This will prevent breathing problems or damage to your airway.
  • Keep water and other materials out of your trach tube. Do not swim. Use a shower shield or trach cap while you bathe. This will prevent water from entering your airway. Do not use powders or sprays near your trach tube.

How do I care for my skin around my trach tube?

Clean your skin at least once each day. You may need to clean it more often if you cough up a lot of thick mucus. You may need someone to help you clean your skin.

  • Wash your hands and put on gloves. This will prevent infection.
  • Suction the area around your stoma. This will help remove mucus.
  • Clean your skin around the stoma. Use the following steps to clean your skin around your trach tube:
    • You may be told to use soap and water or hydrogen peroxide mixed with water. Mix hydrogen peroxide with an equal amount of sterile water. Pour this mixture onto clean gauze. The gauze should be damp but not soaked.
    • Gently wipe around your stoma. Use a new gauze every time you wipe a new area of your skin. This will prevent infection.
    • Dip clean cotton tips in the hydrogen peroxide and water mixture. Use the cotton tips to wipe dried mucus or clean from under the flanges.
    • Pour sterile water onto clean gauze. Use sterile water to wash off the hydrogen peroxide. Start closest to your stoma and move outward. Use a new gauze every time you wipe a new area of your skin.
    • Use a dry, clean, gauze to gently pat dry the area around your stoma.
    • Apply antibacterial ointment only if directed by your healthcare provider.
  • Clean the tube flanges. Dampen clean gauze with the hydrogen peroxide and water mixture. Gently scrub the flanges to remove mucus or crust.
  • Change wet or dirty trach ties. Hold or have someone else hold your trach tube while you change the ties. Cut or peel the ties from the flanges. Wrap a new tie around your neck. Attach the ends of the tie to the flanges. Make sure you can fit 2 fingers between your neck and the tie. Ties that are too tight can make it difficult to breath. Ties that are too lose can cause the tube to move out of place.
  • Place a gauze between your skin and the flanges. This will keep your skin clean and dry. You may not need gauze if you have no secretions. Do not cut the gauze. Fold the gauze instead so you do not breathe in the cut fibers.
  • Check your skin every day for signs of infection. Look for redness or swelling of the skin around your tube. Also look for pus, bleeding, or a rash.

How do I change my trach tube?

Change your trach tube if it moves out of place, feels uncomfortable, or the cuff leaks or breaks. You may need someone to help you change the trach tube.

  • Prepare the new trach tube. Insert the obturator into the new tube. Test the cuff if your trach has one. Inflate the cuff with air to make sure it works, and then let the air out. Place a small amount of water-based lubricant on the lower end of the tube.
  • Sit or lie down. Place a pillow or rolled up towel behind your neck if you lay down. This will help open your airway.
  • Deflate the cuff on your current trach tube if you have one. You can damage your airway or stoma if you do not deflate your cuff before you remove the tube. Your healthcare provider will show you how to deflate the cuff. Attach a syringe to the end of the cuff. Slowly pull back on the syringe to remove air.
  • Remove your trach tube as you breath out. Gently pull your trach tube up and out.
  • Insert the new trach tube at a 90° angle. Point the tube in and then down. Remove the obturator immediately after the trach tube is in place. Insert a new or clean inner cannula if your trach uses one.
  • Inflate the cuff as directed if your trach has one. Your healthcare provider will show you how much air to use. A cuff with too much air can leak, break, or harm your airway.
  • Secure your trach tube with trach ties. Make sure that your trach ties are not too tight. You should be able to fit 2 fingers between the ties and your neck.

What can I do to keep my secretions thin?

Keep your secretions thin to help prevent your trach from becoming clogged. Thin secretions will make it easier for you to cough up fluid that could cause infection.

  • Drink plenty of liquids. Ask how much liquid to drink each day and which liquids are best for you.
  • Use a warm humidifier in your room. Follow directions for cleaning the humidifier.
  • Use devices that add moisture to your airway. Use a heat moisture exchanger (HME), a trach collar, or fabric stoma covers as directed. 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 should I do if I have trouble breathing?

  • Take deep breaths and cough. A strong cough may help move mucus, water, or irritants out of your airway.
  • Suction your trach tube as directed. This will help remove things that are blocking your airway.
  • Remove your inner cannula. Look for fluids or mucus inside the inner cannula. Remove and clean the inner cannula if it has mucus in it. You can also replace the inner cannula with a new one.
  • Gently move the trach tube. Your tube opening may be against your airway. Gently reposition the tube to make sure it sits in the center of your airway.
  • Replace your trach tube. Insert a new trach tube. Try a smaller size if a regular sized tube will not go in properly.
  • Have someone else call 911 if you still have trouble breathing. A trained person can use a bag-mask over your stoma to help you breathe until help arrives.

Call 911 or have someone else call for any of the following:

  • You have trouble breathing even after you suction, clean, or change your trach tube.
  • You cough up bright red blood.
  • You cannot insert a new trach tube.
  • You stop breathing.
  • Your lips turn blue.

When should I seek immediate care?

  • You see food or liquids coming from your trach.
  • Your breathing is faster than usual.
  • You are bleeding from your trach or stoma.

When should I contact my healthcare provider?

  • You have a fever.
  • You have increased or thicker secretions than usual.
  • Your secretions are yellow or green.
  • Your skin around your trach tube, is red, swollen, or draining pus.
  • You have pain when you swallow.

Care Agreement

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. 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.

© 2016 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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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