A tracheostomy is a surgical procedure that creates an opening in the neck to place a tube into the windpipe. This tube, called a tracheostomy tube, helps you breathe when the usual route for breathing is obstructed or impaired.
If you have a tracheostomy, it's important to understand how to care for your tube and stoma (the opening in your neck). Proper tracheostomy care prevents infection, keeps the tube functioning well, and helps you breathe more easily.
In this article, we'll cover the essentials of tracheostomy care. You'll learn what tracheostomy care entails, its purpose, and the steps involved in maintaining your tracheostomy tube.
What is Tracheostomy Care?
Tracheostomy care is the ongoing process of keeping the tracheostomy site and tube clean and functional. It involves several key steps:
Cleaning the skin around the stoma.
Suctioning secretions from the tracheostomy tube.
Replacing the tracheostomy tube's inner cannula.
Changing the tracheostomy dressing and ties.
These steps are typically performed several times a day, depending on the amount of secretions and your specific needs.
Purpose of Tracheostomy Care
The main purposes of tracheostomy care are to:
Prevent infection: Cleaning the stoma and tube reduces the risk of infection, which is a common complication of tracheostomies.
Maintain a patent airway: Suctioning removes secretions that can block the tracheostomy tube and make breathing difficult.
Promote airflow: Ensuring the tracheostomy tube is clean and in the correct position optimizes airflow to and from the lungs.
Facilitate breathing and oxygenation: By keeping the airway clear and promoting airflow, tracheostomy care helps you breathe more easily and get enough oxygen.
Indications for Tracheostomy Care
Tracheostomy care is necessary for various medical conditions that affect breathing. If you have any of the following conditions, you may require a tracheostomy and ongoing tracheostomy care:
Respiratory Failure or Arrest
Respiratory failure occurs when your lungs can't provide enough oxygen to your body or remove enough carbon dioxide. This can happen suddenly (acute respiratory failure) or gradually over time (chronic respiratory failure).
Respiratory arrest is a life-threatening emergency that happens when breathing stops completely. In these situations, a tracheostomy may be necessary to help you breathe.
Severe Neck or Mouth Injuries
Trauma to the neck or mouth, such as from a car accident or sports injury, can damage the airway and make breathing difficult. A tracheostomy may be needed to bypass the injured area and provide a clear route for breathing.
Blocked Airway due to Inhalation of Harmful Material
Inhaling harmful substances like smoke, chemicals, or foreign objects can cause swelling and inflammation in the airway, making it hard to breathe. A tracheostomy can help you breathe until the swelling goes down and the airway is clear again.
Cancer of the Throat or Neck
Cancerous tumors in the throat or neck can press on the airway and make breathing difficult. You may need a tracheostomy to help you breathe while undergoing cancer treatment, such as surgery or radiation therapy.
Paralysis of Swallowing Muscles
Certain neurological conditions, such as amyotrophic lateral sclerosis (ALS) or multiple sclerosis (MS), can weaken the muscles involved in swallowing. This increases the risk of aspirating food or liquid into the lungs, which can cause pneumonia. A tracheostomy can help prevent aspiration and protect the lungs.
Long-term Mechanical Ventilation
If you require long-term mechanical ventilation due to a chronic lung disease or other medical condition, you may need a tracheostomy. A tracheostomy allows for easier connection to a ventilator and can be more comfortable than a breathing tube placed through the mouth or nose.
Equipment Needed for Tracheostomy Care
To properly care for your tracheostomy, you'll need the following supplies:
Sterile Tracheostomy Cleaning Kit
A sterile tracheostomy cleaning kit typically includes sterile containers, sterile nylon brush or pipe cleaners, sterile applicators, and gauze squares. These items are used to clean the tracheostomy tube and the skin around the stoma.
Suction Catheter Kit
A suction catheter kit is used to remove secretions from the tracheostomy tube. The kit includes a suction machine, connecting tubing, and sterile suction catheters in various sizes.
Saline and Hydrogen Peroxide
Sterile saline (salt water) is used to moisten the gauze or applicators when cleaning the skin around the stoma. Hydrogen peroxide may be used in a half-strength solution to remove crusty secretions.
Medical Gloves and Towels
Clean, disposable medical gloves should be worn during tracheostomy care to prevent the spread of infection. You'll also need clean towels to create a clean field and to dry the skin around the stoma after cleaning.
Tracheostomy Dressing and Ties
A tracheostomy dressing, also called a trach sponge or trach collar, is a soft, absorbent pad that fits around the tracheostomy tube and absorbs secretions. Tracheostomy ties are used to keep the tracheostomy tube securely in place. They can be made of twill tape, Velcro, or other soft, flexible materials.
Sterilized Scissors
Sterilized scissors may be needed to cut tracheostomy ties or dressings to the appropriate size.
Gather all necessary supplies before beginning tracheostomy care. Having everything readily available will make the process more efficient and help ensure you maintain a clean, sterile technique.
How to Perform Tracheostomy Care
Proper tracheostomy care involves several steps to maintain a clean, functional tracheostomy tube and prevent complications.
Here's a step-by-step guide on how to perform tracheostomy care:
Gather Necessary Supplies and Equipment
Before starting, gather all the supplies and equipment you'll need, including sterile gloves, a suction catheter kit, a tracheostomy cleaning kit, hydrogen peroxide, saline, clean towels, and a new tracheostomy dressing and ties.
Explain the Procedure to the Patient
If the patient is conscious, explain each step of the tracheostomy care procedure to help them feel more at ease and prepared. Encourage them to communicate any discomfort or concerns throughout the process.
Position the Patient Appropriately
Position the patient in a semi-Fowler's position, with their head slightly elevated and neck extended. This position allows for easier access to the tracheostomy tube and helps prevent aspiration of secretions.
Perform Tracheostomy Suctioning
Put on sterile gloves and connect the suction catheter to the suction machine tubing. Turn on the suction machine and adjust the suction pressure as per the manufacturer's instructions or your facility's protocol.
Gently insert the suction catheter into the tracheostomy tube without applying suction. Once the catheter is in place, apply suction by occluding the thumb port on the catheter and slowly withdraw the catheter while maintaining suction.
Repeat suctioning as needed to clear secretions, allowing brief rest periods between passes to prevent hypoxia.
Clean the Inner Cannula and Stoma Site
Carefully remove the inner cannula from the tracheostomy tube. Then, clean the inner cannula with a mixture of equal parts hydrogen peroxide and saline using a sterile brush or pipe cleaners.
Rinse the inner cannula thoroughly with saline and set it aside on a clean towel and clean the skin around the stoma using cotton swabs or gauze moistened with saline. Use a circular motion, starting at the stoma and working outward.
Assess the stoma site for any signs of infection, such as redness, swelling, or unusual drainage.
Replace the Inner Cannula and Apply Fresh Dressing
Gently reinsert the cleaned and dried inner cannula into the tracheostomy tube, ensuring it locks securely in place. Apply a new tracheostomy dressing under the flange of the tracheostomy tube. The dressing should fit snugly without constricting the tube.
If necessary, replace the tracheostomy ties, adjusting them so that you can comfortably fit one finger between the ties and the patient's neck.
Document the Procedure and Patient's Response
After completing tracheostomy care, document the procedure in the patient's medical record. Include details such as the patient's tolerance of the procedure, the amount and characteristics of secretions suctioned, the condition of the stoma site, and any changes made to the tracheostomy tube or dressing.
Regularly performing tracheostomy care helps maintain a patent airway, reduces the risk of infection, and promotes the patient's comfort and well-being. If you notice any signs of complications or have concerns about the patient's respiratory status, promptly inform the healthcare team for further evaluation and intervention.
5 Tips for Effective Tracheostomy Care
Proper tracheostomy care is essential for maintaining a healthy stoma and preventing complications.
Here are five tips to help you provide effective tracheostomy care:
Maintain Strict Infection Control Measures
Infection is a serious risk for patients with tracheostomies. To minimize this risk, always perform hand hygiene before and after tracheostomy care. Use sterile technique when suctioning, cleaning the stoma, and changing the tracheostomy dressing.
Wear clean gloves and use sterile supplies to prevent the introduction of bacteria into the airway.
Assess the Patient's Respiratory Status Before and After Care
Before beginning tracheostomy care, assess the patient's respiratory status. Check their breathing rate, oxygen saturation, and listen for any abnormal breath sounds. Monitor for signs of respiratory distress, such as increased work of breathing, cyanosis, or agitation.
After completing care, reassess the patient's respiratory status to ensure the tracheostomy tube is patent and the patient is breathing comfortably.
Ensure Proper Positioning During Care
Proper positioning is key to facilitating effective tracheostomy care and preventing complications. Elevate the head of the bed to at least 30 degrees, unless contraindicated, to reduce the risk of aspiration.
Support the patient's neck with a small roll or towel to maintain a neutral position and prevent excessive pressure on the tracheostomy tube.
Provide Adequate Humidification
Patients with tracheostomies are at risk for thick, dry secretions that can obstruct the airway. To prevent this, provide adequate humidification to the airway. Use a humidifier or heat and moisture exchanger (HME) to add moisture to the inspired air.
You can also place moistened gauze over the tracheostomy tube to help humidify the airway and trap any secretions.
Involve and Educate the Patient and Family
Involving the patient and their family in tracheostomy care promotes better outcomes and patient satisfaction. Teach the patient and their caregivers how to properly clean the stoma, suction the tracheostomy tube, and change the dressing. Provide written instructions and hands-on demonstrations to reinforce learning.
Educate them on the signs and symptoms of complications, such as infection or tube dislodgement, and when to seek medical attention.
When to Seek Professional Help with Tracheostomy Care
While you can perform many aspects of tracheostomy care at home, certain situations require professional medical assistance.
Seek help from a healthcare provider if you notice any of the following:
Difficulty breathing or signs of respiratory distress such as increased work of breathing, rapid or shallow breaths, or bluish discoloration of the lips or fingernails. These symptoms may indicate a blocked or dislodged tracheostomy tube or an underlying medical condition that requires immediate attention.
Excessive bleeding from the tracheostomy site. While small amounts of blood-tinged secretions are normal, heavy or persistent bleeding should be evaluated promptly.
Signs of infection around the stoma, such as redness, swelling, tenderness, or foul-smelling discharge. Infections can spread quickly and lead to serious complications if left untreated.
Inability to reinsert the tracheostomy tube after cleaning or accidental dislodgement. Never force the tube back in, as this can cause trauma to the stoma or airway. Cover the stoma with gauze and seek medical help right away.
Frequent suctioning requirements or thick, copious secretions that are difficult to clear. These may be signs of an underlying respiratory infection or other medical issues that need professional evaluation and treatment.
For complex tracheostomy care needs, consider skilled nursing services or private duty nursing care. These healthcare professionals have specialized training in managing tracheostomies and can provide comprehensive care tailored to your individual needs.
If you're caring for a loved one with a tracheostomy after a hospital stay, refer to at-home senior care tips for the critical 72-hour post-discharge period. This resource offers valuable guidance on ensuring a smooth transition from hospital to home and preventing complications during this vulnerable time.
Remember, when in doubt, always err on the side of caution and seek professional medical advice. Your healthcare team is there to support you and ensure the best possible outcomes for you or your loved one with a tracheostomy.
Care Indeed offers skilled nursing services tailored to your tracheostomy care needs, ensuring a safe and comfortable experience. Contact Care Indeed today to learn how they can support your tracheostomy care effectively.