Taking Care of Tracheostomy at Home
When a trach has been performed and it is anticipated that the patient will go home with a trach, the patient as well as family may have some anxiety over the care required.
Though much of the information provided here should be reviewed again and again while in the hospital, this webpage serves as a reference for those interested. Also, when the patient is discharged home, home health care visits by a nurse is common.
Information about why and how a trach is performed can be found here.
The following edited information and illustrations are based on a webpage put out by University of Iowa here.
The trach tube is composed of three parts: trach tube (B), obturator (C), and inner cannula (A). These component are typically made from either plastic or metal. Plastic trachs may contain a balloon cuff or not. The type of trach depends on your medical needs which your doctor should be able to explain to you. Such factors to be considered include need for ventilation, radiation treatment, radiological surveillance, future surgeries, etc.
The obturator (C) is used ONLY when the trach is changed to a new one. It should always be handy in the event of an accidental decannulation when the trach tube dislodges and "falls" out.
The trach tube (B) is what is inserted into the neck. The obturator is used to help insert the trach tube into the neck when being changed.
The inner cannula (A) is inserted into the trach tube and is locked into place. This cannula should only be removed for cleaning. Why is this component even necessary? It allows for keeping the trach tube clean without need to replace the entire trach tube. One would only need to swap out the inner cannula.
Pop singer, George Michael, underwent a trach after he fell ill with severe pneumonia during his 2011 European Tour. Read more.
Humidity is extremely important for the first few months after a trach is placed. Normally, the nose and mouth humidifies any inhaled air before it reaches the lungs. However, with a trach, air bypasses these organs and is directly deposited into the trachea and into the lungs. Dry air is very irritating. How much humidity should be present? Ideally, there should be a very light condensation on the room window where the patient will be residing (the humidity percentage varies depending on the temperature).
Saline solution is a salt solution that can be made by boiling water for 5 minutes, then adding 1 1/2 level teaspoons of noniodized salt per quart of water. Cool to room temperature prior to use. Because germs may grow in the solution, discard unused saline solution after 24 hours. Alternatively, you can purchase single-use disposable 5ml sterile saline bullets on Amazon.
Instilling Saltwater Into Trach
- Pour a small amount of saline solution into a clean cup.
- Draw up 2 to 3 cc into the syringe.
- While taking a deep breath, instill saline solution through the tracheostomy tube.
- Cough while covering your tube with a gauze sponge or soft paper towel.
- Repeat until your airway is clear. If unable to clear your airway with saline solution, use suction.
- When secretions become thick and dry, saline solution may need to be instilled as often as every hour.
Saltwater instillation into the trach tube should be performed regularly for the first 1-2 months to help loosen dried up or help release thick, sticky secretions in order to help the patient cough it out. The frequency varies depending on the amount of secretions present. However, it is typically performed more frequently the first few weeks (every 4-6 hours). As the secretions decrease, saltwater usage can correspondingly decrease. If the cough is weak and the patient is still having difficulty coughing the secretions out, a thin suction tube can be threaded into the trach tube and secretions vacuumed out.
Suctioning the Trach
The purpose of suction is to remove secretions that you cannot cough out. Suction will clear your airway and help you breathe better. The correct size suction catheter should be used. The catheter should be half the size of the tracheostomy tube.
- Connect suction catheter to tubing from suction machine.
- Moisten the catheter tip with saline solution.
- Gently insert the suction catheter through the tracheostomy tube while inhaling. Do not cover the suction control vent while you insert the catheter. Pass the catheter as far as you can without force, then withdraw slightly before starting suction
- To apply suction, cover the vent with your thumb. Do not apply suction for more than 10 seconds. Release thumb from vent if you feel the catheter grab during suction. Gently rotate the catheter as it is withdrawn
- Suction water to clean the catheter. Do not insert the catheter more than 3 times during a suction period. If more suction is needed, allow yourself a 5- or 10-minute rest.
- Breathe deeply after the catheter is removed. In most cases, the use of saltwater solution and a humidifier keeps secretions thin enough to cough or suction out.
- If you have thick secretions, mucous plugs, or a feeling that your airway is not clear, the following may help:
- Fill the bathtub with hot water and sit in the steam-filled bathroom for 20 minutes.
- Place a moist all-gauze square over your tracheostomy tube. Keep gauze damp. The gauze may be held in place by folding it over twill tape or bias tape tied around your neck.
- Stand in the shower with water directed away from your tracheostomy tube.
- Fill a spray bottle with saline solution and spray into your tracheostomy tube several times a day.
Cleaning the Inner Cannula
To ensure that the inner cannula does not become plugged due to secretion accumulation and crusting, it must be cleaned and should be performed 1-2x per day. If thick secretions are present, it may need to be changed more frequently.
Depending on the manufacturer of the trach, the inner cannula can typically be unlocked either by turning the inner cannula (usually metal or plastic) or by pinching the side flanges (plastic) thereby disengaging the inner cannula from the trach tube.
If made of plastic, use a small brush or pipe cleaners to clean the inner cannula under cool running water. Look through the inner cannula to make sure it is clean. Shake the inner cannula to remove excess moisture. Reinsert the inner cannula and lock in place. If the inner cannula looks dirty in spite of cleaning or the plastic is starting to crack, throw it out and use a new one.
Alternatively if a spare (metal) inner cannula is present, simply place the removed inner cannula in the dishwasher and allow it to fully dry out before reuse.
If the doctor allows the trach tube to be corked, do so as directed.
Secure the cork string to the trach tie which secures the trach around the neck.
When corked, the patient can talk. Also breathing will occur through the nose/mouth just like any other person.
The cork should be removed for shortness of breath or to cough out secretions that cannot be handled through the nose or mouth.
Continue to clean the inner cannula. Remove cork when cleaning.
For the first few weeks after trach placement, apply bacitracin to the skin around the trach site as well as the trach tube itself. Carefully release the velcro holding the trach tube in place and withdraw about 1-2 cm away from the skin. Clean away any moisture accumulatioin and crusting that may be present. Using a finger, apply bacitracin ointment around the skin AND on the trach tube itself. Fully insert the trach tube back up against the skin and apply velcro trach ties. The trach tube should be snug up against the skin (necktie tight or belt cinched tight).
A 4 x 4 split dressing can be applied around the trach to help keep the area dry.
Once minimal moisture seen with trach care, bacitracin and dressing application may be stopped.
Overall, skin around the tube should be kept clean and dry.
A damp washcloth may be used to gently clean around the neck opening. Gauze may be placed under the ties next to the skin to prevent excessive moisture from accumulating on the skin as well as skin chafing. Hold the tube while changing the gauze. The gauze should be changed if it becomes wet, dirty, or frayed.
Changing the Trach Ties
Different ties can be used, such as twill tape, bias tape, or Velcro tube holders. Change the tie when wet, dirty, or frayed. Plan to do this when you have someone to help you. The clean tie should be in place before soiled tie is removed. Remember, when properly placed, the trach tube should be around the neck with the same snugness as with neckties or belts around the waist!
a. Insert tie through opening in the sides of the trach tube plate and bring it around to the other side of the neck.
b. Insert this same end through the other side in the neck plate and pull it through. Secure the tie in a triple knot at the side of the neck.
c. Make sure the new tie is not too tight or too loose. You should be able to slip 1 finger under the tie.
d. Remove the old tie.
e. If the tie stretches with wear, retie it.
If using a Velcro tube holder:
a. Thread narrow Velcro tabs through opening in the sides of the trach tube plate.
b. Adhere tabs to soft material on the band.
c. Adjust and secure to fit your neck.
d. Cut off excess band.
Changing/Replacing the Trach Tube (The Whole Thing)
If you have been instructed to change your trach tube, this is done about once a week or two.
1. Prepare the clean tube by inserting neck trach ties into the opening of the trach tube plate. Place the obturator inside the trach tube.
2. Detach the trach ties holding the current trach tube in place.
3. Take a deep breath and remove the trach tube while exhaling.
4. While holding the obturator in place, insert the clean trach tube.
5. Quickly remove the obturator, take a breath, and secure the tie or Velcro tube holder.
6. Insert the inner cannula.
After the trach tube is changed, clean the dirty one and store until the next trach tube change.
Clean plastic tubes with mild soap and water or equal parts of hydrogen peroxide and water. Rinse well, air dry, and store in a clean, covered container. Clean metal tubes with mild soap and water or place in dishwasher. Rinse well, air dry, and store in a clean, covered container. Hydrogen peroxide may also be used to clean stainless steel tubes if rinsed well.
When bathing or taking a shower, keep water out of tube. Do not swim. Avoid powders, aerosol sprays, dust, smoke, and lint from facial tissues which is quite irritating if inhaled through the trach. Try to avoid using over-the-counter antihistamines which can dry secretions in the airway.
The information and illustrations are based on a webpage put out by University of Iowa here.
Keep in mind that many of the trach care products can be purchased on Amazon.
Related Blog Articles
- U.S. Rep. Gabrielle Gifford Gets a Tracheostomy After 7 Days of Intubation
- Creative Ways to Wear a Scarf for Patients with a Trach or Ugly Neck Scar
- Singer George Michael With Tracheostomy
- Doctors Don't Always Take Their Advice (ENT Perspective)
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