This information explains your tracheostomy and how to care for yourself after the surgery.

This booklet:

  • Explains the function of the trachea (windpipe)
  • Describes the tracheostomy
  • Explains how to care for yourself after surgery

Brief Overview of the Trachea and Tracheostomy

A tracheostomy is a surgical opening of the trachea to make breathing easier. The trachea is a part of the respiratory system. It extends from the larynx (voice box) to the lungs. It allows the air you breathe to pass from your nose or mouth, through the larynx and into your lungs. The trachea is about 4 1/2 inches long and lies in the front of the neck. It goes into the upper chest and is in front of your esophagus (swallowing tube).

Head and neck surgery may cause short-term swelling in the airway. You may have a hard time breathing until this swelling goes down. To make your breathing easier, a tracheostomy will be done during surgery. Your doctor will make an opening through your neck into your trachea. He or she will insert a tracheostomy tube below the area of swelling. This will allow air to pass in and out of the lungs, bypassing the area of swelling.

While the tracheostomy tube is in place, you will be unable to speak normally. You will be given a pad and pencil so you can write your needs and communicate. Many patients 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 wound will heal. Removal of the tube is painless.

While in the Hospital

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

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 each day will help you regain your strength more quickly.

Tracheostomy Tube Suctioning

You must take proper care of the tracheostomy. This will keep it free of secretions and allow air in and out of your lungs. Suctioning the tube will keep it clear. Your nurse will show you how and tell you how often to do this.

Equipment

You will need the following:

  • A suction machine with plastic tubing
  • A suction catheter
  • A bowl with water
  • A mirror
  • A jar of Dakin's® solution or another antiseptic (when you are in the hospital)
  • A clean, dry cloth or paper towel (when you are at home)

Suction Procedure

When you are ready to begin the suction procedure, follow the steps below:

  1. Gather the above equipment.
  2. Wash your hands thoroughly with soap and water.
  3. Open the catheter package. Connect it to the plastic tubing of the suction machine.
  4. Place the mirror so you can see the tracheostomy tube opening.
  5. Turn on the suction machine. Pinch the catheter between your thumb and forefinger to block the suction.
  6. Cough deeply to bring up any secretions.
  7. Keep the catheter pinched. Insert it about 3 to 5 inches into your tracheostomy tube.
  8. Un-pinch the catheter to begin suctioning. Do not keep the catheter in your trachea for a long time or you may have shortness of breath.
  9. Take out the catheter using a rotating motion. This will suction the secretions from the entire trachea and tracheostomy tube.
  10. Wipe off the secretions with dry gauze.
  11. Rinse the catheter by suctioning water through it.
  12. Repeat the above steps as necessary.
  13. If you need to repeat the suctioning more than 2 or 3 times, rest for a few minutes before doing it again.

Cleaning the Catheter

You must keep the catheter clean between suctionings. Do this by rinsing the tube with water, and then suctioning more clean water through it. In the hospital, put the catheter in a jar of antiseptic fluid. A nursing assistant will change the catheter each day.

Caring for Yourself at Home

Cleaning the Catheter

The cleaning and care of the catheter will be a little different once you are home. Each time you finish the suctioning procedure at home:

  1. Rinse the catheter with water and then suction more water through it.
  2. Dry the catheter with a piece of gauze.
  3. Disconnect the catheter from the plastic tubing.
  4. Place the catheter on a clean, dry paper towel or cloth.
  • Change the catheter every week. You may have to change it more often if it becomes dirty or clogged.
  • Empty the secretions into the toilet bowl. Do not put them into the sink, as this could clog the drain.

Tracheostomy Tube Cleaning

Clean your tracheostomy tube to keep it free of secretions. This will make it easier for you to breathe. Clean your tube every two to four hours, or more often as needed. To clean it, follow the directions below.

The tracheostomy tube has 2 pieces.

  1. The outer cannula always stays in place. This keeps the tracheostomy site open. Only a nurse or doctor should remove the outer cannula.
  2. The inner cannula slides in and out for cleaning.

Equipment

You will need the following equipment:

  • 4x4 gauze sponges
  • 4x3 Curity® Cover gauze sponges
  • Scissors
  • A package of cotton swabs
  • A mirror
  • A nylon brush

Cleaning Procedure

  1. Gather all of your equipment.
  2. Wash your hands thoroughly with soap and water.
  3. Stand or sit in front of a sink with a mirror.
  4. Untie the tape holding the moist 4x4 gauze bib and remove both the tape and the gauze.
  5. Remove the soiled gauze from around your tracheostomy tube. Do this by gently pulling the gauze from behind the tube.
  6. With the fingers of one hand, hold the outer cannula in place. With the fingers of the other hand, unlock the inner cannula and slide it out. Do not keep the inner cannula out for an extended period of time.
  7. Use the nylon brush to clean the inner cannula. Hold it under warm running water.
  8. Once the cannula is clean, shake out the excess water.
  9. Slide the inner cannula back into the outer cannula right after you clean it. This will prevent blockage of the outer cannula.
  10. Gently clean the skin around the tracheostomy tube. Clean it with water-soaked cotton swabs.
  11. Cut a two-inch slit in one of the 4x3 Curity® Cover gauze sponges as shown. Do not use a 4x4 gauze sponge, as you may inhale any loose cotton fibers into your tube. Put the gauze under the tube. Gently pull it up so that it is behind the outer cannula. This will help to protect the skin of your neck.
  12. Moisten a 4x4 gauze with water. Open the gauze and drape it over the neck tape. Put the gauze in front of the tracheostomy tube opening. Tie the tape in a bow to keep it in place. This moist gauze bib will help warm, filter, and moisturize the air you breathe in. The more fluid the secretions are, the easier it will be to suction them and clean the trachea.

Your doctor or nurse will change the whole tracheostomy tube during office visits. This includes the neck tape and inner and outer cannulas. Do not do this on your own since you may not be able to reinsert it into the trachea.

Removal of the Tracheostomy

Your doctor will remove your tracheostomy tube when you no longer need it. This does not require another surgery. The wound will close on its own. After the tube is removed, put your finger over the tracheostomy site dressing when you speak. This will help the wound heal.

Key Points

  • Suction your tube regularly to keep it clear.
  • If you have a hard time breathing, remove the inner cannula right away. If your breathing improves, the inner cannula was clogged. Clean the inner cannula well and reinsert it. If your breathing does not get easier, go to the nearest emergency room right away.
  • If the entire tracheostomy tube is removed by accident, do not panic. The tract will stay open for hours to days. Go to the nearest emergency room right away to have it put back in.
  • If you have any questions or need more information, please speak with your doctor or nurse.