How to care for your tracheostomy

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While a person is in the hospital, healthcare professionals will care for the tracheostomy.

If a person has a temporary or permanent tracheostomy, they will need to know how to care for it after they leave the hospital. A healthcare professional will provide training on how to do this.

Healthcare professionals will instruct a person on how to:

• Clean: This involves cleaning the tracheostomy site; the opening in the trachea, which is called the stoma; the trachea tubes; and the cannula, which is an inner tube within the larger tube that some tracheostomies require.
• Suction: A person will learn how to suction the tracheostomy to remove mucus and prevent mucus plugs from forming.
• Change tubes: A person may need to replace their tubes with new ones every 1–3 months.
• Use equipment: Healthcare professionals will teach a person how to use relevant equipment, such as a portable suction machine, disposable suction catheters, and a bag-valve mask, which some people may need.
• Bathe or shower: Healthcare professionals will provide supplies to waterproof the tracheostomy opening and the tube and instruct a person on how to prevent water from entering.

Healthcare professionals will also instruct a person on living with a tracheostomy, such as how to eat, how to engage in physical activity, and what to do in an emergency.

A person will need to do the following every day to ensure that the tracheostomy site and tube are clean. How a person keeps the tracheostomy tube clean can depend on the type of tube they have.

Assessing and cleaning the stoma site

Individuals should ensure that the stoma site is always clean and dry. A person should inspect the tracheostomy site regularly for signs of irritation and infection, such as:

• pain
• inflammation
• hardening and thickening of the skin
• abscesses or fluid beneath the skin
• secretion of fluids

A person should clean the skin around the tracheostomy 2–3 times per day with cotton swabs or gauze pads and saline or sterile water.

They should gently wipe away any dried secretions and excess moisture in the area.

Cleaning the speaking valves

A speaking valve is a one-way valve that fits onto a tracheostomy to allow air to enter through the tube and exit through the nose and mouth. The valve can help a person speak and make noise more easily.

A person can clean a speaking valve by following these steps:

1. Swish the valve in lukewarm water with a few drops of mild soap and fragrance-free dishwashing liquid.
2. Rinse the valve under running lukewarm water.
3. Place the valve on its side to air dry.
4. Store the valve in its storage container once it is dry.

Using a humidifier is important because it can help keep the secretions loose so the tracheostomy tube does not become clogged.

A person can use a humidifier to moisten the air or hang a clean, moistened piece of gauze in front of the tracheostomy opening.

The number of times a person will need to suction the tracheostomy in a day can differ between individuals.

A person may need to suction a recent tracheostomy more often. Also, people may experience more secretions and mucus on some days than on others, which could lead to more frequent suction.

To suction the tracheostomy tube, a person will need to:

1. Wash their hands well with soap and water.
2. Connect the suction catheter to the tubing on the suction machine.
3. Turn on the suction machine.
4. Hold the suction catheter closed between the fingers to block suction and cough to bring up secretions.
5. Look in a mirror to see the opening of the tracheostomy tube.
6. Continue to pinch the suction catheter closed and feed it 3–5 inches into the tracheostomy tube.
7. Unpinch the suction catheter from between the fingers to allow it to begin suctioning.
8. Avoid keeping the suction catheter in the trachea for longer than 10 seconds.
9. Gently rotate the suction catheter and slowly pull it out of the tracheostomy.
10. Wipe the outside of the suction catheter with gauze and suction sterile water through it to rinse it.

A person may need to change the tracheostomy tube every 1–3 months. A healthcare professional will instruct a person on how to change the tube, depending on its type.

A person may need to change their inner cannula two times per day, or more often if secretions build up inside it. Typically, a person should change their cannula once in the morning and once at night.

To change the cannula, a person should:

1. Wash their hands well with soap and water.
2. Sit or stand in front of a mirror.
3. Hold the outer tube in place and gently squeeze the pinch tab with the other hand to unlock the inner cannula and slide it out.
4. Gently squeeze the pinch tab, slide the new inner cannula into the outer tube, and release the pinch tab when the connector securely locks onto the connector rim.

If a person is not using disposable cannulas, they should clean the used cannula once they have replaced it.

A person should clean a reusable cannula according to the manufacturer’s directions, which may instruct a person to clean with saline solution alone or with a mixture of sterile water and diluted hydrogen peroxide.

Tracheostomy ties go around a person’s neck and secure the tracheostomy tubes in place.

A person should change the ties as needed if they become visibly dirty, if they become loose, or if they use Velcro that is no longer effective. There are different types of tracheostomy ties, and a person may need help replacing them.

A person should put the new tie through both sides of the neck plate and fasten it at the back of the neck, either with a knot or with Velcro, and then remove the old ties. There should be enough room for a person to put a finger beneath the ties.

Individuals should ensure that the new ties secure the tracheostomy tube in place before they remove the old ties.

A person should discuss aspects of living with a tracheostomy with their healthcare team. Issues may include:

• Bathing or showering: A person should avoid getting water in the tracheostomy, as it could travel to the lungs. A person can shower with their back to the water and cover the tube with gauze or another material that keeps water out and allows air in.
• Rest and sleeping: It may take time for a person to adjust to sleeping with a tracheostomy. Although using a humidifier may cause noise, which may disrupt sleep, the moisture will improve air quality.
• Swallowing: A person may find it difficult to swallow at first. However, people are typically able to eat normally over time. It may be helpful to start with small sips of water and then move on to eating soft foods.
• Intimacy: A person should ensure that the tracheostomy tube is secure and protected during intimacy and may want to clear secretions before they are intimate with someone. If someone experiences self-consciousness or anxiety about intimacy after a tracheostomy, they may find it helpful to communicate their feelings with their partner, trusted friends, or a mental health professional.
• Travel: A person should ensure that they have all the supplies they may need, including emergency supplies, before traveling. These may include:
  • sterile saline
  • alcohol-based hand sanitizer
  • gloves
  • tracheostomy ties
  • extra inner cannulas
  • gauze pads
  • portable suction machine and suction catheter
  • portable humidifier
  • medications
  • oxygen, if necessary
  • syringe
  • water-soluble lubricant
  • obturator, which a person uses to insert the outer cannula

If a person has suctioned the tracheostomy and still cannot breathe, they or someone else should call 911.

If the tube comes out

If the tracheostomy tube comes out, a person should not panic, as they can breathe through the stoma. To replace the tube, a person should:

1. Put their head back.
2. Undo the ties.
3. Place the obturator inside the tube.
4. Apply a small amount of lubricant to the tracheostomy tube and insert it into the stoma.
5. Remove the obturator and replace the inner cannula.
6. Attach new ties.

A person may wish to contact a doctor once they have replaced the tube. If a person is unable to replace the tube or has difficulty breathing, they should call 911.

When to call a doctor

If a person has symptoms of infection, they should contact a doctor. These include:

• redness around the stoma
• fever
• chills
• excessive or bad-smelling mucus

Healthcare professionals will instruct a person on how to care for a tracheostomy before they leave the hospital.

Healthcare professionals will also teach a person how to use all the necessary equipment, such as a suctioning machine; how to handle lifestyle changes such as bathing and eating; and how to handle emergencies.