Tracheostomy Care

A tracheostomy is a procedure that involves making an incision in the neck followed by an incision or puncture in the trachea (windpipe) through which a tracheostomy tube is placed. This helps to facilitate breathing in certain circumstances such as a blockage of the upper airway.

In most cases a tracheostomy is meant to be temporary, but in cases of chronic or degenerative illness a tracheostomy may need to remain in place for a longer period of time. Tracheostomies require maintenance care to remain patent and functioning and to avoid an infection in the stoma (the opening through which the tube is placed).

Some tracheostomy care can be done by you (the patient) or by your family members. Other cares must be performed by a doctor or another trained medical professional. Prior to leaving the hospital with a tracheostomy you should be thoroughly instructed on what tracheostomy care will need to be done and how to do it.

The instructions given to you by your nurse or doctor may differ slightly from the information found in this article. You should always follow the instructions of your health care provider since they are likely tailored to your individual and unique circumstances.

Each tracheostomy tube has a neck plate that rests flat against your skin. There are two openings on each side of the neck plate through which the tube can be secured using ties or velcro straps. It is very important that the tube is secured to avoid accidentally dislodging the tube.

A two-person approach is recommended when changing out the ties and resecuring the tube. You will want to make sure that the straps or ties not only hold the tube in place firmly but are comfortable (not too tight or too loose), clean and dry. While one of the two care providers are changing the straps, cleaning the site, or moving the patient, the second person's sole responsibility should be to make sure the tracheostomy does not become dislodged from the patient's neck.

The skin around the stoma usually needs to be routinely cleaned using a cotton swab and normal saline solution. How often this is done will be determined by your health care professional but it is usually done every 12 to 24 hours and usually at the time of dressing changes.

Less commonly recommended today, a solution of an equal mixture of hydrogen peroxide and normal saline solution is sometimes suggested to clean around the stoma, but typically only if the site is infected. Care should be taken not to accidentally dislodge the tube as the skin is being cleaned. Sometimes a barrier cream is applied to the skin after cleaning to help to protect it.

The dressing around the tracheostomy needs to be changed periodically and any time it becomes wet or soiled. You should notify your doctor if the dressing smells foul or if you notice any drainage that looks like pus or infection.

Your tracheostomy tube may need to be suctioned occasionally to keep it clear and prevent mucus plugs. This is not done on a set schedule but according to need. Different types of trach tubes may need to be suctioned slightly differently but regardless the technique is similar. Indications that the tube needs to be suctioned may include:

• You have tried to clear the tube yourself by coughing but have been unsuccessful
• You are having to work harder to breathe or breathing faster
• You have abnormal breathing sounds such as wheezing
• Mucus is coming out of the tube opening

Prior to having your trach tube suctioned you should increase your oxygenation by taking a few deep breaths. A plastic catheter is inserted into the trach opening and a couple of centimeters past the end of the tube (it should not be inserted deeper than this). The catheter is then slowly pulled out as mucus is suctioned into the tube. No more than two to three passes of the suction catheter should be done at a time to avoid oxygenation problems.

Suctioning may be easier and may be required less often when you are well hydrated so make sure that you drink plenty of fluids. You may also use a humidifier to keep secretions thin and easier to clear. The use of saline inserted directly into the trach tube is sometimes done but is discouraged as a way to thin mucus.

The tracheostomy tube may occasionally need to be changed out. This should only be done by a trained professional with emergency equipment on hand.

These are signs that you need medical help:

• You have increased pain at the site of the infection
• You have a fever
• The skin around the tube becomes red, tender or inflamed
• You have pus or foul-smelling drainage coming from the stoma
• You find it more difficult to breathe or have an increased heart rate
• Call 911 or go to the emergency room if the tube becomes dislodged