Caring for Your Tracheostomy

This information will help you care for your tracheostomy (TRAY-kee-OS-toh-mee).

About your trachea

Your trachea (windpipe) is part of your respiratory system. It’s about 4½ inches (11 centimeters) long and is at the front of your neck (see Figure 1). It runs from your larynx (voice box) to your lungs.

When you breathe, air travels from your nose or mouth into your larynx, through your trachea, and into your lungs. This path is called your airway.

About your tracheostomy

A tracheostomy is a surgical opening in your trachea. It makes breathing easier and protects your airway from being blocked. You may need a tracheostomy if:

• A tumor is blocking or narrowing your airway.
• Secretions (mucus) are blocking or narrowing your airway.
• You have swelling that blocks or narrows your airway. This swelling may be caused by surgery, radiation therapy, a serious infection, or abscess (a pocket of pus caused by an infection). 
• There is a problem with your vocal cords. 
• You need an emergency airway for any reason. 

Your tracheostomy may be temporary or permanent. Your doctor will talk with you about how long you’ll need it.

About your tracheostomy tube

A tracheostomy tube is a hollow tube that’s put in your tracheostomy to keep it from closing. Once you have a tracheostomy, you’ll need to wear a tracheostomy tube all the time.

A tracheostomy tube has 3 parts (see Figure 2):

• An outer cannula that always stays in place. This keeps your tracheostomy from closing. Do not remove the outer cannula. Only your doctor or nurse should remove it.
• An inner cannula that can slide in and out. You’ll change the inner cannula twice a day. This keeps secretions from building up inside and blocking your airway. Do not leave the inner cannula out for more than a few minutes. Keep it in place except when you’re changing it.
• A tracheostomy tie that goes around your neck and connects to the outer cannula. This keeps your tracheostomy tube in place.

Communicating with a tracheostomy

While you have a tracheostomy, you won’t be able to speak like usual. Many people can speak by covering the opening in their tracheostomy tube with a finger. Your nurse will teach you how to do this. They’ll also give you a pen and paper to help you communicate.

It’s also important to use a humidifier while you have a tracheostomy, especially at night. This will help keep your secretions loose so they don’t clog your tracheostomy tube.

Caring for your tracheostomy

While you’re in the hospital, your nurse will teach you how to care for your tracheostomy. You’ll learn how to:

• Suction your tracheostomy tube. This clears the secretions from your airway so it’s easier to breathe.
• Clean the suction catheter. This helps prevent infection.
• Replace the inner cannula. This helps keep secretions from blocking it.
• Clean your skin around your tracheostomy. This helps keep it from getting irritated.
• Moisturize the air you breathe. This helps loosen your secretions so they’re easier to suction. 
• Respond to a tracheostomy emergency. You’ll learn what to do if there’s a problem with your tracheostomy. 

If you’re discharged from the hospital with your tracheostomy, you’ll care for it at home. You’ll get the supplies you need before you’re discharged from the hospital. You may also have a nurse visit you at home to help. Your healthcare team will plan these things with you.

You can use the following instructions to help you remember how to care for your tracheostomy.

How to suction your tracheostomy tube

Your nurse will tell you how often to do this.

• A suction machine with plastic tubing
• A suction catheter
• A mirror
• A bowl or large cup filled with water
• 2 to 4 dry gauze pads
• A clean, dry cloth or paper towel 

You can use a mirror that hangs on a wall or stands on a surface.

• If you’re using soap and water, wet your hands and apply soap. Rub your hands together well for at least 20 seconds, then rinse. Dry them with a paper towel and use the same paper towel to turn off the faucet. 
• If you are using an alcohol-based sanitizer, be sure to cover all parts of your hands with it, then rub them together until they are dry. 

Repeat these steps if you feel you have more secretions that need to be cleared out. If you need to repeat the suctioning more than 2 or 3 times, rest for a few minutes before starting again.

Once you’re done:

While you’re at home, change the suction catheter once a week or more often if it’s dirty or clogged. If you’re in the hospital, use a new one each time.

Clean the suction machine’s canister with soap and water as needed.

How to change the inner cannula and clean your skin around your tracheostomy

Remove and inspect your inner cannula regularly, at least 3 times a day. Change it 2 times per day: once in the morning and once at night. If you see secretions building up inside, change it sooner.

Try not to change your inner cannula more than 2 times per day. If you do, you might run out. If you regularly need to change your inner cannula more often than 2 times per day, call your healthcare team to tell them.

• A new inner cannula
• 4 to 6 cotton swabs (or as many as needed)
• A mirror

• If you’re using soap and water, wet your hands and apply soap. Rub your hands together well for at least 20 seconds, then rinse. Dry them with a paper towel and use the same paper towel to turn off the faucet. 
• If you are using an alcohol-based sanitizer, be sure to cover all parts of your hands with it, then rub them together until they are dry. 

If you’ll have your tracheostomy for a longer time, your healthcare provider will change your whole tracheostomy tube (inner cannula, outer cannula, and tracheostomy ties) during your office visits. Do not remove your tracheostomy tube’s outer cannula on your own. You may not be able to put it back into your trachea. Do not change your tracheostomy ties until your doctor tells you it’s safe to do so.

How to moisturize the air you breathe

Use a humidifier to moisten the air you breathe. Moisturizing the air your breathe will help loosen secretions so they’re easier to suction. If you want or need more moisture, you can place a moist piece of gauze in front of your tracheostomy tube. This will help filter, moisturize, and warm the air you breathe in.

• 1 (4-inch x 4-inch) piece of gauze
• A string long enough to go around your neck
• Scissors

Removing your tracheostomy tube

Your doctor will remove your tracheostomy tube when you no longer need it. You won’t feel any pain when it’s taken out. You won’t need to have surgery, and the opening will close on its own. You won’t need stitches.

Before your tracheostomy tube is removed, you’ll put a cap over your inner cannula. The cap will block your tracheostomy so you breathe normally. You’ll leave the cap in place for at least 24 hours. If you’re able to breathe normally with it in place, your doctor will remove your tracheostomy tube and put a dressing (bandage) over your tracheostomy site.

• Keep a dressing over your tracheostomy until it’s completely closed. Your healthcare provider will tell you when this happens. It usually takes about 1 to 2 weeks.
• Change the dressing twice a day or more often if it gets dirty. Clean your skin underneath with moistened pieces of gauze every time you change it.
• Put your finger over the dressing when you cough or speak. This will help your tracheostomy close.

Important points

• Remove the inner cannula right away if you have trouble breathing. If it gets easier to breathe, the inner cannula was probably clogged. Inspect the inner cannula and replace it with a new one if needed. Call 911 or go to the nearest emergency room right away if your breathing doesn’t get better.
• If your whole tracheostomy tube is removed by accident, don’t panic. Your tracheostomy will stay open for hours to days. Call 911 or go to the nearest emergency room right away to have it put back in.
• If you vomit (throw up), lightly cover the opening of your tracheostomy tube to keep vomit or food from getting inside.
  • If you think vomit or food got into your tracheostomy tube, suction right away.