Tracheostomy Care

A tracheostomy is an opening made in your neck and into your trachea (windpipe) to make it easier for you to breathe. It may be temporary or permanent. These instructions will help you take care of your tracheostomy tube (“trach”), your stoma (the opening in your neck), and the skin around the stoma.  Follow these steps and any other directions you have received.

Cleaning your trach tube and stoma

  • Clean the opening of the trach tube and the skin around it at least once a day. Some doctors will advise cleanings twice daily or more.

  • Choose a clean, well-lighted space near a sink and mirror, and collect the following supplies:

    • Gauze pads or other non-fraying material advised by your doctor

    • Cotton swabs

    • Trach tube brush

    • Bowl filled with normal saline solution. Your doctor may advise a mixture of equal parts normal saline and hydrogen peroxide, so it is important to identify his or her preference.

    • Wash your hands with soap and warm water. Put on clean, disposable, powderless gloves.

  • Remove the inner cannula (the tube that slides into your trach opening).

    • Hold the neck plate with one hand. With the other hand, unlock the inner cannula. Gently remove the inner cannula.

  • Clean the inner cannula.

    • Soak the reusable inner cannula in the bowl of normal saline or hydrogen peroxide and normal saline mixture as directed by your doctor. This is a common mixture, although many doctors now advise using normal saline only. Others may advise using the mixture of hydrogen peroxide and normal saline only if needed to remove secretions on the inner cannula. Ask your doctor which approach he or she prefers.

    • Disposable inner cannulas do not need to be cleaned as they are meant for one time use. If you have a metal inner cannula, don't use hydrogen peroxide as it can cause pitting, rather use only normal saline.

    • Clean the inner cannula with a trach tube brush. Don't use a toothbrush. Rinse with normal saline solution to remove hydrogen peroxide and debris.

    • Put the wet inner cannula back into the outer cannula. Lock the inner cannula in place.

  • Clean your neck plate and skin.

    • Remove the gauze pad from behind the neck plate. Assess the area for evidence of skin breakdown or infection. Clean the neck plate and the skin under it. Use clean gauze pads or other non-fraying material dabbed in normal saline solution. A thorough cleaning technique you may consider involves cleaning the stoma in a step-wise fashion, one quarter at a time. Start at the 12 o'clock position wiping to the 3 o'clock position, then with a new gauze pad for each section, clean from 12 o'clock to 9 o'clock followed by the 3 o'clock to 6 o'clock position and lastly from the 9 o'clock to 6 o'clock position. Gently pat the skin dry. This pattern can be followed on the surrounding skin and tube flange.

    • Put a clean, pre-cut gauze pad under the neck plate. This pad protects your skin. Don't cut a gauze pad because the frayed edged increases the risk for infection.

Clearing a mucous plug

It is normal to have some mucus in your airway, but mucus can build up and thicken. If this happens, your trach tube can become plugged. Follow these steps and any other guidelines you have been given to clear your trach tube.

Find a clean, well-lighted space near a sink and mirror, and collect the following supplies:

  • Suction machine

  • Clean suction catheter (tube). Your doctor will instruct you on which type of catheter and suction process is appropriate for your trach tube.

  • Small bowl of normal saline solution.

  • Wash your hands with soap and warm water. Put on clean, disposable, powderless gloves.

Turn on the suction machine to the pressure setting you were given.

  • Attach the suction catheter to the suction machine.

  • Ensure the suction is working by dipping the catheter tip into the normal saline solution in the bowl.

  • Take a few deep breaths to fill your lungs with oxygen.

  • Gently insert the catheter into your trach tube. While you are inserting the catheter, don't suction. Stop inserting the catheter when you start to cough.

  • Apply suction. At the same time, slowly pull the catheter out of your trach tube. Rotate the catheter as you pull it all the way out.

  • Take 5 to 10 seconds to remove the catheter completely. If you need to suction again, relax and breathe for 30 seconds to a few minutes, then start over.

  • Before suctioning again, rinse the catheter with normal saline.

  • When you are finished, turn off the suction machine. Discard the used catheter, water and gloves.

When to call your healthcare provider

Return promptly or contact your doctor if any of the following occur:

  • Shortness of breath, trouble breathing or wheezing that does not respond to breathing treatments

  • Severe, prolonged coughing spells

  • Red, painful, or bleeding stoma

  • Swelling of the skin around the stoma

  • Fever of 100.4ºF (38ºC) or higher, or as directed by your healthcare provider

  • Coughing up yellow, smelly, bloody or thick mucus

  • Blocked tracheostomy tube that you cannot clear with suctioning

  • Tracheostomy tube falls out and cannot be replaced

Call 911

Call 911 or get immediate medidcal care if you are having significant trouble breathing, either from a blocked tracheostomy tube or an underlying disease.

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