Tracheostomy Care at Home

The normal pathway to receive air into the lungs and expel carbon dioxide is into the mouth or nose, down the throat, and into the lungs. Suppose a blockage occurs anywhere along that path preventing air from reaching the lung. An emergency surgical incision may be performed through the neck and into the trachea creating an airway opening. An artificial airway inserted through the opening (i.e., stoma) keeps the incision area open, allowing oxygen flow. While having direct access to the lungs allows oxygen and carbon dioxide exchange, it also carries risk. Anything could enter the lungs with an unprotected opening, leading to infection, airway blockage, or lung contamination. Careful tracheostomy care is essential to prevent damage or potential injury.

Want More Information?

Before you left the hospital, you probably had the opportunity to learn how to clean your family member’s trach, change the cannula, ties, and do a few other things. However, learning in the hospital with someone watching over you and being on your own can feel very different. John Hopkins provides excellent patient teaching available on YouTube for their patients with trachs. I’ve linked to their training materials so you can review what you learned while in the hospital if you feel you need a refresher.

“Tracheostomy Service,” at https://www.hopkinsmedicine.org/tracheostomy/living/

The information they provide is very comprehensive and easy to follow.

Helpful Tips 

In addition to the above, I want to share the following helpful tidbits with you.

• Thick secretions may clog a tracheostomy tube. Using a room humidifier prevents that from happening by increasing the moisture content in the air. So anything you can do to add moisture, including increasing your fluid intake, is a plus.

• If you have skin irritation from secretions seeping around your stoma, be careful about what you use to treat the irritation. Remember that anything you put there could be inhaled directly into the lung. Only use products designed for use around tracheostomies. If you use dressings, only use ones that don’t have loose fibers that might break off and might get inhaled into the lung, such as gauze with frayed edges.
• Always clean away from and not toward the stoma to reduce the likelihood of introducing germs into the lungs.

• When changing your trach ties, have an extra set cut in advance, and within reach, in case you drop one when you’re in the middle of replacing them.

• If you are suctioning and see blood in the sputum, you may be inserting the catheter too deep. Try not to enter it as far. If that doesn’t make the appearance of blood spots stop, contact your doctor. Sometimes bleeding can signal something more serious such as skin erosion from a tube pressing against the trachea’s wall. If you see a lot of blood that doesn’t stop, it could signal an emergency. Call 9-1-1- and go to the emergency room because the trach cannula could be cutting a hole into one of the blood vessels.  

Taking Care of Skin Around your Stoma

Mucus may seep around the cannula throughout the day, causing the stoma to become red and sore if allowed to stay there too long. It’s essential to keep that area clean and dry. Therefore, you try to clean the area several times a day.

Preparation:

Gather mild antibacterial soap (Dial hand soap is a good option), your trach care kit, washbasin with warm water, 2-3 clean washcloths, new trach ties, and scissors. Cut your new ties in advance if you plan to change them.

Cleaning the Skin:

1. Wash your hands thoroughly with warm soap and water.
2. Use a clean washcloth each time. Dip a corner of the cloth into warm water, squeeze out the excess water, apply a mild soap. Rub the soap into the fabric.
3. Remove soiled ties holding onto the trach tube to keep it secure.
4. Begin stoma care promptly.
5. Use one washcloth corner to wipe, starting from the stoma cleaning outward toward the rest of the neck. Repeat the process with a new edge of a new section of the washcloth. Continue until all parts are clean.
6. Apply clean ties.
7. To absorb future secretions, you may apply a dry dressing between the trach opening and the trach tube. Make sure it does not cover the opening of the trach.

Reference: 

https://preferredhomecare.com/medical-supplies/patient-education-resources-2/

Resource: YouTube:

How to Care for Your Child’s Skin and Do a Trach Tie Change Produced by CincinnatiChildrens

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(adult) Tracheostomy Care Tutorial  Produced by jsccsimulationlab

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Emergency Trach Situations

Tracheotomy Care:

 How to Manage Accidental Decannulation Produced by UWWISH

• If the cannula seems to have come out of the trachea, is the person having any trouble breathing? If so, determine if you need to call 9-1-1 and assist with breathing.
• Get your spare trach tube, lubricant, and self or flow-inflating resuscitator if they are okay.
• Ventilate as necessary to keep them comfortable as you gather supplies and proceed.
• Please help them to lie flat, remove their pillow from under their head.
• Insert the replacement tube and check to see if they are breathing properly.

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Emergency Airway Care:

 Plugged Tracheostomy Tube Produced by Childrens Hospital Colorodo

• Try suctioning first.
• If suction doesn’t work, try an emergency trach change using a smaller trach if you have one as a substitute.
• Use an Ambu bag to give breaths until relief from the obstruction occurs.

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From Hospital to Home: How to Suction a Tracheostomy Produced by ArkansasChildrens

This video demonstrates how to perform the suctioning technique through a tracheostomy tube. . This video is for informational purposes only and does not replace hands on training.

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Cleaning the Trach Tube and Disinfecting Non-Sterile Supplies

Supplies needed to Clean the Trach Tube

• Mild soap (recommend Dial antibacterial soap – Dawn or Joy are too harsh. Avoid anything with perfumes or dyes); another option is white distilled vinegar.
• Pipe cleaner or soft bottle brush
• Paper towels
• Pen and tape
• Plastic bags

Steps

• Wash your hands.
• Clean the dirty trach tube and obturator (the part that goes inside the cannula) with the pipe cleaner or soft brush, making sure to remove all remaining mucus from the inside of the cannula.
• Inspect the tube for cracks or sharp edges. If you find any, throw them away.
• Rinse the tube and obturator in water. Soak in mild soap and water solution for 2-3 hours in a clean container.

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From Hospital to Home: How to Clean and Care for a Tracheostomy Produced by ArkansasChildrens

This video demonstrates the daily care required for a tracheostomy. This daily care includes cleaning the trach site, changing the trach ties, & changing the trach sponge. This video is for informational purposes only and does not replace hands on training.

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Note: If you have a silicone Bivona or cuffed Shiley trach tube, add this step:  Boil water and remove from direct heat. Place the trach tube and obturator in hot water and leave it there until the water is cool enough to pull the tube out using your bare hands.

• Rinse the soapy solution off and place the trach on a clean, dry paper towel to air dry. Place a clean paper towel over the wet tube and obturator to protect them from dust and let dry overnight.
• Once the tube is dry, handle it by the wings only. Inspect it again for damage
• Store in a clean container or zip lock bag. Label and date; it is clean.

Disinfecting Non-Sterile Supplies

• Mix ½ oz. (1 tablespoon) of mild antibacterial soap with 2 quarts of warm water in a basin. First, wash and rinse your supplies in the sink, then soak items in the warm soapy solution for 10 minutes. Rinse thoroughly (allow water to run over them for 2 minutes) with tap water and then air dry. Once dried, you can put them in a zip lock bag and mark them as clean.

Reference:  https://preferredhomecare.com/medical-supplies/patient-education-resources-2/