Tracheostomy Care Instructions & Tips

Key Takeaways

A tracheostomy, also called a stoma, is an opening created in your upper airway, specifically the trachea (windpipe), to make it easier to breathe. A tube is inserted into the opening to act as an artificial airway.
Your medical team will show you how to clean the tracheostomy tube. You might also have a home health care nurse visit you for breathing tube care.
You should replace the suction catheter with a new one every week, or more frequently if it appears blocked or dirty.

You may need a tracheostomy if something is blocking your airway and causing breathing problems. A tracheostomy, also called a stoma, is an opening created in your upper airway, specifically the trachea (windpipe). This surgical opening makes it easier for you to breathe. The surgical procedure to create a tracheostomy opening is usually done using general anesthesia.

After the surgeon creates an opening in your trachea during a tracheostomy procedure, they will insert a tube in it through which air passes and which prevents the tracheostomy hole from closing. This tracheostomy tube acts as an artificial airway and is used to remove secretions from your airway.

If needed, the tracheostomy tube can be connected to an oxygen supply or breathing machine for mechanical ventilation.

Please continue reading for some tips and instructions on caring for a tracheostomy tube.

What does a tracheostomy tube look like?

A tracheostomy tube or tracheotomy tube is essentially a hollow plastic tube. You must keep the tube in place around the clock to prevent the tracheostomy opening in your windpipe from closing. Tracheostomy tubes have three main parts:

An outer plastic tube or cannula that remains in place all the time. It should only be removed by your health care team. It is a cuffed tube that provides an airtight seal.
An inner tube or cannula that fits into the outer cannula. This also remains in all the time, except for a few minutes when you change it out. You need to replace the inner tube with a new tube twice daily to prevent tracheal secretions from clogging your airway. If you have trouble breathing, try removing the inner tube, as it could be clogged with thick secretions.
A velcro strap (tracheostomy tie) that is connected to the outer tube and loops around your neck to keep the tracheostomy secure.
You may have additional devices, such as speaking valves, to make communication easier.

Which action will the nurse include when doing tracheostomy care?

If you’re going home with a tracheostomy tube, then before you leave the hospital, your medical team will guide you on how to clean it and answer questions you may have. You might also have a home health care nurse visit you for breathing tube care. If your child requires a tracheostomy, you will need help with care (older children may be able to do it themselves).

Tracheostomy care includes the following steps:

Suctioning the tracheostomy tube to clear secretions from the airway to make breathing easier.
Cleaning the suctioning catheter to lower the risk of infections.
Changing the inner tube to prevent secretions from clogging it.
Cleaning the tracheostomy site (the skin around the tracheostomy) to prevent infection and irritation of the skin.
Moisturizing the air to thin and loosen secretions and make them easier to remove.

What should be at the bedside of a patient with a tracheostomy?

When healthcare providers care for a tracheostomy tube in a hospital setting, they have a range of safety equipment in place at the patient’s bedside for an emergency situation. This includes the obturator that was used during the initial tracheostomy procedure. This is a curved rod that is used to insert and position the tracheostomy tube in the airway. The obturator can be used in case someone needs emergency reinsertion of the tracheostomy tube. Additionally, there are spare tracheostomy tubes in the correct size (the appropriate size and smaller sizes), a syringe for cuff inflation, lubricant, and velcro ties to secure the tracheostomy tube. A bag valve mask is also kept at the patient’s bedside.

If you are going home with a tracheostomy, you’ll need the following supplies. Your medical team will help you collect these before your discharge from the hospital. To care for the tracheostomy tube at home, you’ll need the following.

To suction the tracheostomy tube:

A suctioning machine and suction catheters
A wall-mounted or surface-standing mirror
A large cup or bowl of water
A clean and dry paper towel or cloth
Dry gauze pads

To change the inner cannula and clean the tracheostomy site:

Cotton swabs
A mirror
A new inner cannula

To moisturize the inhaled air:

A 4x4 inch gauze
A string to go around your neck

How to care for a tracheostomy?

Always wash your hands with mild soap and hot water or use a hand sanitizer (alcohol-based) before handling your tracheostomy. Gather the supplies you’ll need (see above).

Suctioning the tracheostomy tube:

Connect the catheter with the suction tubing on the machine.
Position yourself in front of a mirror so the tracheostomy tube opening is visible.
Switch on the machine (or unclamp the tubing if you are hospitalized).
Close the suction catheter by pinching it with your index finger and thumb.
Cough strongly to remove secretions.
With the suction catheter still closed, push it into the tracheostomy tube by about 8-13 cm (3-5 inches).
Release the suction catheter and turn on the suctioning for 10 seconds. Using it for longer periods of time can lead to difficulty breathing.
Slowly extract the suction catheter from your tracheostomy tube using a rotating motion (this helps to clear the secretions from the side of your tracheostomy tube and trachea).
Use a dry gauze to clean the suction catheter from outside.
Run warm water through the suction catheter to rinse the inside.
Repeat the suctioning if there are more secretions to clear out. Rest after 2-3 suctionings.
After you finish, ensure the supplies are clean before storing them. Remove the suction catheter from the suction machine’s plastic tubing. Leave it to dry on a clean paper towel.
Empty the suction water in the toilet bowl (avoid using the sink as the secretions can block the drain).

Changing the inner cannula:

Secure the outer cannula with one hand and gently squeeze the pinch tab on the inner cannula with your other hand to unlock it.
Slide the inner cannula out and discard it.
Insert a new inner cannula by pressing on the pinch tab and sliding it into the outer cannula. Make sure you only have the inner tube out for a short time.
Release the tab after the inner cannula is securely locked onto the rim of the connector.
Use moist cotton swabs to gently clean the tracheostomy site.

Moisturizing the air:

You can use a heat and moisture exchanger (HME) or humidifier to keep the inhaled air moist. This helps to thin secretions so that they are easier to cough up. If you need to moisturize more, you can drape a moist gauze over the tracheostomy tube and secure it in place with a string tied behind your neck. This will filter, warm up, and moisten inhaled air.

How often do you need to clean a tracheostomy?

You should replace the suction catheter with a new one every week, more frequently, if it appears blocked or dirty. Use a new suction catheter each time you are hospitalized. The canister of the suction machine should be cleaned as needed using soap and water.

You should inspect the inner tube of your tracheostomy at least thrice a day and replace the inner cannula twice a day, morning and evening, more often if you have a buildup of secretions. However, avoid changing the inner cannula more often than needed, or you could run out. Tell your healthcare team if you frequently need to replace the inner cannula more than two times in a day.

Your healthcare provider will change the whole tracheostomy (outer cannula, inner cannula, and tracheostomy ties) during an office visit if you have the tracheostomy in place for a longer period. Never try to remove the outer cannula or do a whole tube change at home. You might be unable to reinsert it and end up needing emergency care. Also, don’t change the trach ties unless your health care team says so.

Is trach suctioning clean or sterile?

Trach suctioning can be done both with clean and sterile (aseptic) techniques. If you are using an aseptic technique, you will need sterile gloves, a sterile suction catheter, and sterile water. The clean technique does not require sterile supplies.

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