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Caring for Your Tracheostomy

This information will help you care for your tracheostomy while you are in the hospital and at home.
 

The Trachea

The trachea, or windpipe, is a part of your respiratory system. It is about 4 ½ inches long and lies in the front of your neck (see Figure 1). It extends from your larynx (voice box) to your lungs. The air you breathe passes from your nose or mouth into your larynx, then into your trachea, then into your lungs.
Figure 1: Placement of the tracheostomy tube Figure 1: Placement of the tracheostomy tube
 

Tracheostomy

A tracheostomy is a surgical opening that is made in your trachea to make breathing easier and to protect your airway. It may be performed if a tumor is blocking or narrowing your airway, or as part of a head and neck surgery if swelling from the surgery is expected.
 
You will be given anesthesia (medication to make you sleep) for the surgery. Once you are asleep, your doctor will make an opening into your neck. He or she will insert a tracheostomy tube through the opening and into your trachea. This will allow you to breathe without difficulty.
 
Your nurse will teach you how to care for your tracheostomy while you are in the hospital. If you leave the hospital with the tracheostomy in place, you will continue to care for it at home. You will learn how to:
 
  • Suction the tracheostomy tube
  • Clean the suction catheter
  • Clean the inner cannula
  • Clean the skin around the tracheostomy site
  • Moisturize the air you breathe
While the tracheostomy tube is in place, you will not be able to speak normally. You will be given a pen and paper so you can write down your needs and communicate. Many people can speak by covering the opening in the tube with a finger. Your nurse will teach you how to do this.
 
When you no longer need the tracheostomy tube, it will be removed and the opening will close on its own. You must keep a dressing on the site until the opening is completely closed. This usually takes about 1 to 2 weeks.
 

After Your Surgery

Your recovery and daily activities

Stay active after your surgery. This will help:
 
  • Maintain your circulation.
  • Maintain your muscle strength.
  • Expand your lungs.
  • Prevent complications, such as pneumonia and blood clots.
Get out of bed, bathe, and dress yourself. You should walk in the hallways with assistance, if needed. Your nurse will help you sit in a chair, bathe, and dress during the first day or so after surgery. As you feel stronger, you will be able to do more on your own. Doing activities will help you regain your strength more quickly.
 

Suctioning the Tracheostomy Tube

Suctioning the tracheostomy tube will keep your airway free of secretions and allow you to breathe without difficulty. Your nurse will teach you how and tell you how often to do this.
 
Equipment
  • A suction machine with plastic tubing
  • A suction catheter
  • A bowl with water
  • A mirror
  • Dry gauze
Instructions
  1. Gather your equipment.
  2. Wash your hands thoroughly with soap and water or use an alcohol-based hand sanitizer.
  3. Open the package with the suction catheter. Connect it to the plastic tubing of the suction machine.
  4. Position the mirror so you can see the opening of the tracheostomy tube.
  5. Turn on the suction machine. (If you are in the hospital, you must open the clamp on the suction tubing instead.)
  6. Pinch the suction catheter between your thumb and forefinger to block the suction.
  7. Cough deeply to bring up any secretions.
  8. Keep the suction catheter pinched. Insert it about 3 to 5 inches into your tracheostomy tube.
  9. Un-pinch the suction catheter to begin suctioning. Do not keep the suction catheter in your trachea for longer than 10 seconds, or you may have shortness of breath.
  10. Using a rotating motion, take out the suction catheter. Rotating the catheter allows secretions on all sides of your trachea and tube to be suctioned.
  11. Wipe off the secretions from the suction catheter with dry gauze.
  12. Rinse the secretions from the suction catheter by suctioning the water through it.
  13. Repeat the steps above as necessary.
  14. If you need to repeat the suctioning more than 2 or 3 times, rest for a few minutes before doing it again.

Cleaning the Suction Catheter

Each time you finish suctioning your tracheostomy tube, you must clean the suction catheter.
 
Equipment
  • A jar of Dakin’s® solution or another antiseptic (if you are in the hospital)
  • A clean, dry cloth or paper towel (if you are at home)
  • A bowl with water
Instructions
 
While you are in the hospital
  1. Gather your equipment.
  2. Rinse the suction catheter with water and then suction more water through it.
  3. Close the clamp.
  4. Put the suction catheter into a jar of Dakin’s® solution or another antiseptic fluid.
While you are in the hospital, a patient care technician will change the suction catheter each day.
 
When you are at home
  1. Gather your equipment.
  2. Rinse the suction catheter with water and then suction more water through it.
  3. Dry the suction catheter with the dry cloth or paper towel.
  4. Disconnect the suction catheter from the plastic tubing on the suction machine.
  5. Place the suction catheter on the dry cloth or paper towel.
While you are at home, change the suction catheter once a week, or more often if it becomes dirty or clogged.
 
Empty the secretions from the inside of the suction machine into the toilet. Do not empty them into the sink or the drain could become clogged.
 
Clean the canister of the suction machine as needed with soap and water.
 

Cleaning the Inner Cannula and the Skin Around the Tracheostomy Site

Figure 2: Inner and outer cannulas Figure 2: Inner and outer cannulas Your tracheostomy tube has 2 pieces (see Figure 2):
 
  • The outer cannula, which always stays in place. This keeps the tracheostomy site open. Do not remove the outer cannula. Only your doctor or nurse should remove it.
  • The inner cannula, which slides in and out for cleaning. Do not leave the inner cannula out for more than a few minutes. It should always remain in place when not being cleaned.
Clean the inner cannula every 2 to 4 hours, or more often as needed, to keep it free of secretions. This will make it easier for you to breathe.
 
Do not start changing the tracheostomy tube ties that hold the tracheostomy tube in place until your doctor tells you it is safe to do so.
 
Equipment
  • Figure 3: Unlocking the inner cannula Figure 3: Unlocking the inner cannula Cotton swabs
  • A mirror
  • A nylon brush
Instructions
  1. Gather your equipment.
  2. Wash your hands thoroughly with soap and water or use an alcohol-based hand sanitizer.
  3. Stand or sit in front of a sink with a mirror.
  4. With the fingers of one hand, hold the outer cannula in place. With the fingers of your other hand, unlock the inner cannula and slide it out (see Figure 3). Do not keep the inner cannula out for more than a few minutes.
  5. Hold the inner cannula under warm running water. Clean it with the nylon brush (see Figure 4). Once the cannula is clean, shake out the excess water.

Figure 4: Cleaning the inner cannula Figure 4: Cleaning the inner cannula

  1. Slide the inner cannula back into the outer cannula right after you clean it. This will prevent the outer cannula from becoming blocked with secretions.
  2. Gently clean the skin around your tracheostomy tube with moistened cotton swabs.
If you will have a tracheostomy for an extended period of time, your doctor or nurse will change the entire tracheostomy tube during office visits. This includes the inner and outer cannulas and the tracheostomy tube ties that keep your tracheostomy tube in place. Do not do this on your own since you may not be able to reinsert it into your trachea.
 

Moisturizing the Air You Breathe

Placing a moist piece of gauze in front of your tracheostomy tube will help filter, moisturize, and warm the air you breathe in. This will keep your secretions fluid and will make it easier to suction them and clean your trachea.
 
Equipment
  • One 4 x 4 piece of gauze
  • Neck string
  • Scissors
Instructions
  1. Gather your equipment.
  2. Wash your hands thoroughly with soap and water or use an alcohol-based hand sanitizer.
  3. Stand or sit in front of a sink with a mirror.
  4. Moisten the 4 x 4 piece of gauze with water. Cut a piece of neck string that is long enough to fit comfortably around your neck.
  5. Open the gauze and drape it over the neck string. Put the gauze in front of the tracheostomy tube opening (see Figure 5). Tie the neck string in a bow at the back of your neck to keep it in place.

Figure 5: Moistened gauze placed over the tracheostomy tube opening Figure 5: Moistened gauze placed over the tracheostomy tube opening

Removal of the Tracheostomy Tube

Your doctor will remove your tracheostomy tube when you no longer need it. You will not need to have surgery to do this. The opening will close on its own and you will not need stitches.
 
Before the tube is removed, a closed inner cannula will be inserted in your tracheostomy tube. If you are able to breathe normally with the closed inner cannula in place, your tube will be removed. You will not experience any pain when the tube is taken out.
 
After the tube is removed, your doctor will put a dressing over the tracheostomy site. When you cough or speak, put your finger over the tracheostomy site dressing. This will help the site to close.
 
Change the dressing over the tracheostomy site twice a day, or more often if it gets soiled. Each time you change the dressing, clean the skin at the site with moistened pieces of 4 x 4 gauze. Once the tracheostomy site is closed, you will not need to wear a dressing.
 

Important Points

  • Protect your airway at all times. Do not submerge yourself in water. You cannot go swimming while your tracheostomy tube is in place, or after the tube is removed until the site is completely closed. When showering, avoid having water spray or splash directly into the tracheostomy.
  • Use a humidifier, especially at night. It will help to keep your secretions loose and prevent clogging.
  • If you have trouble breathing, remove the inner cannula right away. If your breathing improves, the inner cannula was most likely clogged. Clean the inner cannula well and reinsert it. If your breathing does not get better, call 911 or go to the nearest emergency room immediately.
  • If the entire tracheostomy tube is removed by accident, do not panic. The tract will stay open for hours to days. Call 911 or go to the nearest emergency room immediately to have it put back in.