Patient education: How to care for a tracheostomy (The Basics)

What is a tracheostomy? — A tracheostomy (or "trach") is an opening made by a cut through your neck into your windpipe. "Trachea" is the medical term for the windpipe.

The opening is called a stoma. A small tube ("tracheostomy tube" or "trach tube") is placed through the stoma into your trachea (figure 1).

A trach can help keep your airway open, allow you to breathe easily, and make it easier to remove secretions or mucus from your lungs.

What should I know about the trach tube? — It is important to understand the parts of a trach tube and how to care for them. Taking good care of the trach will help keep the tube free from mucus buildup, protect your skin, and prevent infection.

Trach tubes come in different sizes and materials. Most are disposable. Some trach tubes have a cuff to block air from leaking back out of the windpipe.

Trachs consist of the following parts (figure 2):

●Cannula – A trach has 1 or 2 "cannulas," or tubes:

•Outer cannula − This is the main body of the trach tube. It holds the stoma open while healing. It might have a cuff. A trach with a cuff will have a "pilot balloon" that is used to inflate the cuff. The cuff helps to make sure that the air goes into the lungs and doesn't escape through the mouth and nose. The balloon lets you know if the cuff is inflated or not.

•Inner cannula – This is a tube that fits inside the outer cannula. It might lock into the outer cannula to keep you from coughing it out. The inner cannula can be removed and cleaned to keep it free of mucus. Not all trachs have an inner cannula.

●Trach plate – This is a part of the outer cannula with holes on the sides. This is where ties are placed to help keep your trach in place. The trach plate rests over the opening in your neck. You might hear it called the neck plate, flange, or face plate. The size of the trach is sometimes listed on the plate.

●Trach ties − These go through the holes in the trach plate and around the neck. They secure the trach to help keep it from falling out.

●Obturator – This is a firm plastic guide that is used to place the trach tube into the trachea. It goes inside the outer cannula of the trach when you are inserting the trach and makes the trach easier to insert. Once the trach is inserted, the obturator is removed. If the trach has an inner cannula, you insert it after you take out the obturator.

How do I care for myself at home? — Ask the doctor or nurse what you should do when you go home. Make sure that you understand exactly what you need to do to care for yourself. Ask questions if there is anything you do not understand.

Before you go home, your doctor or nurse will tell you about the kind of trach tube you have and how to care for it. Always care for the trach in a clean space. You might need a family member or friend to help you care for the trach. Some people have a home health nurse come to their home to help with this.

You will learn how to:

●Clean the skin around the trach

●Clean the inner cannula, if there is one

●Change the trach tube

●Change the trach ties

●Suction the trach to clear it out

Your doctor or nurse will also make sure that you have the supplies you need. Having a trach increases your risk of infection. This is why it's so important to take care of it.

How do I clean the skin around the trach? — Clean the skin around the trach at least once each day and when it is soiled. If you have a lot of secretions, you will need to care for the trach more often.

●Gather the supplies and place them on a clean workspace. You might need cotton swabs, gauze, or a clean washcloth. You will also need saline or sterile water, a clean dressing, and any ointment, gel, or cream that your doctor ordered.

●Wash your hands.

●Remove the old dressing, if there is one, and throw it away. Wash your hands again.

●Wet some gauze, a cotton swab, or a clean washcloth with saline or sterile water. Gently wipe the outer cannula and the skin around the trach tube. Clean the trach plate, too.

●If there is dried mucus in the stoma, remove it with a cotton swab soaked in saline or sterile water. Do not get any water or secretions into the stoma.

●Check the skin for any signs of redness, swelling, irritation, bleeding, or discharge.

●Use clean cotton swabs to put on any cream, ointment, or gel as instructed by your doctor.

●Cover the skin around the trach with a clean dressing if ordered.

●Wash your hands.

How do I clean the inner cannula? — If the inner cannula is reusable, clean it 2 to 3 times a day and whenever you have problems breathing. This helps prevent mucus buildup, which could make it harder to breathe.

●Gather the supplies, and place them on a clean workspace. You might need cotton swabs, a small brush, or pipe cleaner, saline or sterile water, a small bowl, and a new inner cannula (if they are disposable).

●Wash your hands.

●Remove the inner cannula from the trach tube. Place it in a bowl with the saline or sterile solution.

●Clean the cannula with the swabs, brush, or pipe cleaners. Scrub off all mucus, and rinse with saline or sterile water.

●Gently shake the cannula to dry it.

●Put the cannula back in the trach tube, and carefully lock it in place.

●Wash your hands.

How do I change the trach tube? — Some people are taught to change the trach tube themselves. Other times, the doctor or nurse will change the trach tube. Talk to your doctor about how often your trach tube needs to be changed and who is the best person to do it.

If you or a caregiver are taught to change the trach, always have at least 1 more trach tube ready. Many doctors suggest having a trach 1 size smaller available as well. It can be helpful to have another person help you change the trach.

●Gather the supplies. Make sure that the cuff or balloon works on the new trach before placing it. Put new trach ties on the new trach.

●Wash your hands.

●Remove the old ties. Deflate the cuff by removing air from the balloon. Gently take out the old trach, and replace with the new one.

●Tilt your head back slightly or place a towel roll behind your shoulders to make it easier to insert the new trach.

●Take out the obturator, and inflate the cuff. Secure the new trach with the clean ties.

●Wash your hands.

Always replace the trach if it comes out. Replace the trach if you think that mucus is plugged at the end of the outer cannula. If you cannot replace the trach, call for emergency help right away (in the US and Canada, call 9-1-1).

How do I change the trach ties? — Change the trach ties at least once a week and if they are soiled. It can be helpful to have another person help you change the trach ties.

●Wash your hands.

●Remove the old ties. Some people change 1 side of the trach tie at a time. Hold the trach tube steady and in place.

●Put 1 end of the trach tie into the opening of the neck plate. Repeat with the other tie.

●Secure both ends together to the side of your neck. It should be tight enough that you can only place 1 finger between the tie and your neck.

●Wash your hands.

If you are changing the trach or outer cannula, put fresh, clean ties on the new one before putting it in place.

How do I suction the trach tube? — It is important to keep the trach tube free of thick mucus. Always have a cloth or tissue ready when you cough. This will help catch the mucus coming out from the trach tube. If you have trouble breathing or hear noise when you breathe, you or a caregiver might need to use a suction machine to help clear the trach tube.

It is important to know how far to insert the suction catheter. This is the length of the trach plus any adaptor.

●Gather the supplies. You will need a suction machine, suction tubing, a suction catheter, and a small bowl of saline or distilled water.

●Wash your hands, and put on gloves.

●Turn the suction machine on. Attach the suction catheter to the suction tubing.

●Cover the suction control with your thumb, and suck up a small amount of liquid from the bowl. This makes sure that the catheter is clear and that the suction is working.

●Take a deep breath. Gently put the suction tube all of the way into your trach tube or until you meet resistance. Do not apply the suction while putting the catheter in the trach. If you meet resistance, pull the suction catheter back a little.

●Cover the suction control with your thumb to apply suction. Gently rotate the catheter as you remove it. Do not apply suction for more than 10 seconds.

●Take a deep breath after you suction. If needed, repeat the process.

●Clean the catheter by covering the suction control with your thumb and sucking up a small amount of liquid from the bowl.

●Take off the gloves, and wash your hands.

If you are having trouble or cannot insert the suction catheter, try to clean or change the inner cannula.

What else should I know?

●Do not get water in your trach tube. If possible, use a movable shower head to control water flow. Shield your trach tube without blocking airflow to keep water away from it. Avoid swimming pools. Water can easily flow into your trach tube. With a trach, you cannot hold your breath under water, and if the trach tube is submerged, you can easily drown.

●Keep things from getting into your trach tube. Take extra care around food bits, dust, powders, and sprays. Cover your trach with light clothing or scarves. This helps prevent you from getting an infection when you go outside or are around others.

●Practice proper mouth care and hand washing.

●Get a flu shot each year and a pneumonia shot as often as your doctor advises.

●Avoid crowded places and people. Try to avoid people who are sick.

●Do not smoke, and avoid secondhand smoke.

●Avoid triggers that can make your breathing worse such as very cold air.

When should I call the doctor? — Call for emergency help right away (in the US and Canada, call 9-1-1) if:

●Your trach tube falls out and you cannot replace it.

Call the doctor for advice if:

●The skin around your trach is red, swollen, irritated, bleeding, or has discharge.

●You have more mucus than usual, or the mucus is a different color.

●You have trouble breathing that is not relieved by clearing out the secretions.

More on this topic

Patient education: Tracheostomy (The Basics)
Patient education: Emergency care for infants and children with a tracheostomy (The Basics)