Your Tracheostomy: Care Instructions

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.

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. Follow the directions for cleaning the machine.
• 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 fibers.
• 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

Suctioning is needed if you can't clear mucus and secretions from your trach tube by coughing. Always have suction supplies ready, including a fully charged suction machine. Suction the trach as often as your doctor recommends or as needed. 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 color 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.