How do you care for a new tracheostomy?

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Caring for a Tracheostomy

Tracheostomy tubes need to be kept clear and clean. Taking good care of your tracheostomy will help prevent infection, plugs or blockages, and breathing problems.

When your tracheostomy is new and you're still getting used to it, your health care team will handle caring for it. If you’re going home with a tracheostomy, your health care team will be sure you know how to take care of your tracheostomy, that you have the supplies you need, and that your caregiver knows what to do too. You will probably have help from home health care nurses to get you settled at home.

Keeping the tube in place

Securing your tracheostomy tube will help prevent the tube from accidentally coming out (dislodging or displacement). A tracheostomy opening will close up if the tube comes out and this can be dangerous. There is a higher chance of this happening in the first week or two while the tissue in the opening is still healing. If the tube does come out, you won’t be able to breathe well, and might not be able to breathe at all if the stoma closes off completely.

Your health care team will be sure your tracheostomy is secured using a dressing and tape. Sometimes patients have stitches when their tracheostomy is very new. If your tracheostomy is in place for a long time or is permanent, the dressing and tape might not be needed after a certain amount of time has passed and when certain complications are not expected.

Regular suctioning of a tracheostomy is often needed to keep the tube and opening free from extra mucus and drainage (secretions) that come from the lungs and tissue around the stoma. Sometimes these secretions can be cleared by coughing, but sometimes they can cause the tube to become plugged. This is more likely to happen when a tracheostomy is new or if you have other problems that are causing lots of secretions. Your health care team will listen to your lungs and chest area, and will monitor your oxygen level and amount of secretions.

If your tracheostomy needs to be suctioned, a clear tube called a suction catheter is put into the tube and hooked up to a machine that sucks out the extra secretions. This can be uncomfortable, but is needed to keep your airway clear.

If your tracheostomy has an inner cannula (a liner), it needs to be cleaned. Some inner cannulas are disposable, and others are reused after being cleaned. The cannula can be replaced with a new cannula if damaged or if a blockage cannot be cleared.

If secretions are very thick, or too thick to suction easily, you may have a humidifier in your room or at your bedside. A humidifier will help warm, moisten, and filter secretions so they are easier to clear and remove. Your health care team may also use small amounts of a solution when they are cleaning and suctioning to help loosen secretions.

How often suctioning is done depends on many factors. Newer tracheostomies may be suctioned frequently. The number of times a tracheostomy is suctioned per day will decrease over time, as long as the secretions are able to be cleared by coughing and no other problems happen. But sometimes the amount of secretions can change, so suctioning needs will vary.

Cleaning the tracheostomy

If your tracheostomy has an inner cannula, the cannula is removed regularly to be cleaned. This is to be sure it doesn’t become plugged. You may also have an extra inner cannula to keep at your bedside in case the one being used can’t be cleared or comes out.

Bathing

When taking a bath or shower, you should avoid getting water into the tracheostomy. Water that gets in can go into your lungs. It’s a good idea to cover the tube with something that still allows air to get in but doesn’t let water in, such as a piece of gauze. You can also shower with your back to the water.

What to wear when you have a tracheostomy

You do not need special clothes for everyday wear. But you’ll want to avoid clothing that’s too snug or that blocks the tube so your airway stays clear.

Caring for the skin around your stoma

Your health care team will clean the area around your stoma regularly. They will use different supplies depending on the type of tracheostomy and any problems you may be having.

If you’re going home or caring for your tracheostomy yourself, it’s important to let your health care team know of any reddened or swollen areas that you notice around your tracheostomy tube. This can be a sign of infection or other problems.

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Overview

A tracheostomy is a surgical opening through the neck into the windpipe (trachea). The opening is also called a stoma. A tracheostomy helps you breathe if you have a lung or nerve problem, an infection, or trouble handling secretions.

Taking good care of a tracheostomy is very important. It can prevent infections and help keep you breathing easily.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line (811 in most provinces and territories) if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

How can you care for yourself at home?

General tips

Your doctor or nurse will give you instructions about how to take care of your tracheostomy, or trach (say "trayk"). This will include how to suction your trach, how to clean the opening in your neck (stoma), and how to clean and replace the trach's inner tube (inner cannula). Be sure to follow all of these instructions closely.

• Have your emergency supplies ready and available wherever you are.
• Be sure to connect to oxygen before and after suctioning and cleaning, as needed.
• Always wash your hands before and after caring for your tracheostomy.
• Keep the air in your home moist with a room humidifier.
• Eat while sitting up. If any food gets into the tube, suction it out right away.
• Wear clothing that is loose around your neck, and avoid clothing with loose fibres.
• In a bath or shower, avoid getting water into the tracheostomy. Cover the stoma so that no water gets in but you can still breathe. You can also shower with your back to the water.
• Do not swim.
• Replace the tube holder (trach tube tie) if it gets wet or damaged. If it is not damaged, it can be washed and dried and used again.

Suctioning

Always have suction supplies ready, including a fully charged suction machine. Suction the trach 3 to 4 times a day, or more if needed. For example, two of the times could be before you go to bed and when you wake up in the morning. You will need suction catheters, a suction machine, and a mirror. Here are the steps to take:

1. Wash your hands with soap and water for at least 30 seconds.
2. Connect to oxygen for 30 to 60 seconds before suctioning.
3. Connect a catheter to the suction machine tubing. Insert the catheter into the trach. Push the tube in gently to the premeasured length.
4. Slowly pull the catheter out of the trach, rolling it back and forth between your fingers, with your thumb over the control valve (this turns the suction on). Do not keep the suction on for more than 10 seconds at a time.
5. Wait about 30 seconds and repeat inserting and pulling out the tube until all the mucus has been removed.
6. Throw away the used catheter. Or ask your doctor how to clean it properly to use it again. Connect to oxygen after suctioning. Wash your hands again.

Stoma care

The opening in your neck is called a stoma. To care for your stoma, clean and dry it 2 times a day, and as needed. Do not let crust form on the skin at the stoma. You will need saline fluid or sterile water, 8 or 10 cotton-tipped swabs, gauze pads, a small cup, a mirror, presplit gauze, and ointment for the skin. Follow these steps:

1. Wash your hands with soap and water for at least 30 seconds.
2. Fill the cup with the saline fluid or sterile water. Dampen a gauze pad or cotton-tipped swab and squeeze out any excess liquid from the gauze.
3. Clean and remove dried mucus around the stoma with the damp gauze pad or cotton-tipped swabs. To prevent spreading an infection, wipe the gauze or swab only once and then throw it away. Repeat with new, sterile material until the skin is clean. Be sure to look for any changes to the area, such as changes in colour or swelling.
4. Dry your skin with a clean gauze pad. If your doctor tells you to use skin ointment for your stoma, apply the ointment with the remaining cotton-tipped swabs. If needed, use a new, presplit gauze to protect the skin.
5. Wash your hands again.

Cleaning the inner cannula

A cannula is the tube that fits into the stoma. Clean and replace the inner cannula 2 times each day, and as needed. For a reusable inner cannula, you will need 2 small bowls, a small cannula pipe brush, sterile water or saline fluid, and a mirror. To clean the inner cannula:

1. Wash your hands with soap and water for at least 30 seconds.
2. Pour a small amount of sterile water or saline fluid into both bowls.
3. Unlock the inner cannula from the trach and remove it by gently turning it counterclockwise then pulling it out and down. Put the reusable inner cannula into the first bowl. (If the inner cannula is disposable, throw it away and replace it with a new inner cannula.) Clean the inside and outside of the reusable inner cannula with the brush.
4. Rinse the cannula in the second bowl. Shake the cannula out and slide it gently back into the outer cannula. Make sure the cannula is locked in place and you cannot pull it out.
5. Wash your hands again.

When should you call for help?

Call 911 anytime you think you may need emergency care. For example, call if:

• You have severe trouble breathing, and coughing or suctioning does not help.
• Your trach falls out and you cannot get it back in.

Call your doctor or nurse advice line now or seek immediate medical care if:

• You have trouble breathing after suctioning.
• You have signs of infection, such as:
  • Increased pain, swelling, warmth, or redness in the stoma.
  • Red streaks leading from the stoma.
  • Pus draining from the stoma.
  • A fever.
• Your secretions change.

Watch closely for changes in your health, and be sure to contact your doctor or nurse advice line if you have any problems. Make sure you have your emergency supplies, including the obturator, available when help arrives or when you arrive at the doctor's office.

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