Caring for a tracheostomy - an incision in the windpipe made to relieve an obstruction to breathing - can seem complex, perhaps even scary. The truth is that maintenance procedures are not complicated; but they are critical to keeping the tracheostomy opening and skin around it clean and free of infection. Individuals living with a tracheostomy are likely dealing with a number of medical problems that put them at risk for complications. Proper maintenance of the tube prevents further airway obstructions.
Tracheostomy 101
It is essential that anyone caring for a tracheostomy understand its function. A tracheostomy creates a hole in the neck and windpipe to open up an airway. This procedure is necessary when the natural airway becomes unavailable due to trauma or illness. Once the surgeon makes the hole, a tube keeps it open. Self-care of the tubing helps clear obstructions and reduces the risk of infection and skin irritation. It is important to get care instructions from a medical professional prior to leaving the hospital or rehab facility.
Supplies for Tracheostomy Care
- Extra “trach" ties; ribbons that hold the tube in place
- Sterile water or saline
- Medium to large gauze dressing
- Sterile cotton swabs or cotton balls
- 3% hydrogen peroxide
- Two disposable cups
- One or two extra “trach" tubes
- Portable suction machine and tubing
- Catheters with suction valve
Emergency Supplies to Keep on Hand
- One or two extra “trach" tubes
- Portable suction machine and tubing
- Catheters with suction valve
Daily Care Procedures for a Tracheostomy
Daily care of the tracheostomy tube does two things:
- Keeps the tube clean and free of mucus
- Protects the skin around the tracheostomy from irritation
Cleaning should take just a few minutes to complete.
- Start by washing your hands well.
- Pour one part hydrogen peroxide and one part sterile water in a cup and plain sterile water into another.
- Soak cotton swabs or balls in the hydrogen peroxide solution and clean the skin around the stoma, or opening in the neck. Position the cotton near the tube, and pull away as you clean to avoid pushing debris and fluid into the tracheostomy opening.
- Wipe down the flange of the tube with damp cotton.
- Rinse the skin with a swab dampened with sterile water, then dry it with clean cotton.
- Cut a gauze square up the middle halfway to create a slot for the tube. Slide it between the tracheostomy tube and the opening to protect the skin underneath.
- Hold the tube in place with two fingers and cut the ties. Replace them with clean ribbon ties.
- Wash your hands after completing the procedure.
During the cleaning, check the skin under the tube for signs of infections. These include:
- Red areas
- Swelling
- Skin that is hot to the touch
- Red streaks
- Foul odor
Contact the physician if there is any sign of infection.
Keeping the Tube Free from Obstruction
Clearing the tube of mucus is a challenge at times. Caregivers and patients must carry at least one spare tube in case there is a plug. It may be necessary to switch the tubes quickly to open the airway. Not all “trach" designs are the same, so the care staff will provide specific instructions on changing the tube. Once the new tube is in place, wash the old one and check it for cracks or tears. If it is in good shape, it can be the replacement tube for the next change.
One or two drops of saline accompanied by a hard cough can loosen a plug and make breathing easier. Do not let the fluid sit; cough it out immediately.
Tracheostomy maintenance is a combination of daily cleaning and taking steps to keep the tube clear. For example, with normal breathing, the nose helps humidify air prior to it entering the airway. After a tracheostomy, air no longer goes that route, so humidifying with moist gauze around the tube or a room humidifier becomes necessary.
The last step helps keep debris from entering the opening. When going outside, use a tracheostomy cover, or a cloth over the tube, to prevent pollutants from contaminating the airway.