What Is a Tracheostomy?
A tracheostomy is a small surgical opening in a part of your throat called the trachea or windpipe. A tube (often called a trach) is placed into this hole to make it easier for you to breathe. It will keep your airway open so you can receive oxygen, humidity and/or breathing treatments.
Mucous can be removed by suctioning through this tube. For some people, a breathing machine called a ventilator is necessary. The ventilator can also be attached to the trach.
Most trach tubes are made of plastic and consist of several parts. They are available in different sizes. The two types of trachs discussed in this lesson are "cuffed" and "cuff-less."
There are two types of inner cannulas that can be placed into either of these types of trach tubes. The inner cannula is especially important when suctioning. It helps guide the suction catheter into the airway. Cannulas can be disposable or re-usable.
Cleaning the Trach
The trach tube and the skin around the tube need special care. The trach area should be cleaned once everyday or more often, if needed. The trach ties should be changed weekly or more often, if needed. Your doctor will change the entire trach tube when necessary.
Step 1: Gather the supplies.
The necessary supplies include:
- Two small plastic containers or bowls + 1 container with lid for storage
- Clean inner cannula
- Cotton tipped applicators (like Q-Tips)
- Hydrogen peroxide
- One small baby nipple brush or pipe cleaners with smooth tips
- Small white towel
- Clean container with lid or clean white envelope or cloth bag (plastic bags should only be used if equipment is totally dry)
- Gauze pad and drain sponge
- Velcro trach tie
- Two clean gloves
- Sterile water or sterile normal saline
Step 2: Wash your hands.
Step 3: Put on a clean pair of gloves.
Step 4: Make cleaning solution.
Pour hydrogen peroxide and sterile water or normal saline into one of the clean containers. This makes a 1/2 strength solution. Pour sterile water or normal saline into the second container.
Step 5: Change inner cannula.
Place two fingers of one hand on the neck plate of the trach. With the other hand, unlock the inner cannula by turning it counter clockwise or by unsnapping the side clips of a disposable type. Now gently pull it out.
Step 6: Insert clean inner cannula.
- Insert clean inner cannula. To do this, place two fingers from one hand on the neck plate while gently inserting the cannula into the trach tube. Next, turn the inner cannula clockwise to lock in place.
- The two blue dots should be lined up with each other when correctly locked.
- Lock a disposable inner cannula by squeezing the side clips open and snapping it into place.
Step 7: Clean trach area.
- Soak the cotton tipped applicators in the hydrogen peroxide mixture for 10 seconds. Using the soaked cotton tipped applicators, clean around the trach tube using a sweeping motion in one direction.
- Use one applicator per sweep and then discard. Do not put anything dirty into this solution as it will be used for more cleaning later.
- Keep one or more of the applicators to clean the top of the neck plate.
- Now soak a gauze pad in the cleaning solution and clean around the larger parts of the neck. Or, you may use soap and water on a small white towel to clean the area. Rinse well and dry the skin.
- Inspect the skin of the entire neck and throat area. Look for redness or sores.
- Report skin problems to your doctor.
Step 8: Change drain sponge.
Change this daily but more often as it becomes wet. To avoid skin problems, do not leave a wet drain sponge in place for a long period of time.
Step 9: Change trach ties.
- Change the ties at least once a week. If they are wet, change them more often to prevent skin problems. Soiled ties can be washed in soap and water and then air-dried.
- When changing a trach tie, never let go of the trach tube. Remove one side of the tie at a time. Keep one hand on the neck plate while the other unfastens the tie. Remove one side of the tie, thread the new one through this side and fasten. Unfasten the other side, remove, thread the rest of the new one and fasten securely.
- When both sides are secure, place two fingers between the neck and the tie to make sure it is not too tight. It needs to be snug but not tight.
Step 10: Clean dirty inner cannula.
- Place used inner cannula into the 1/2 strength solution of hydrogen peroxide. Let it soak for a few minutes. Clean the inside and outside of the inner cannula with the small brush or pipe cleaners.
- If the mucous inside is tough or sticking to the tube, run some hot water through it.
- Next rinse the inner cannula by putting it into the saline or water container and gently swirl the tube for about 10 seconds. Shake off excess water/saline. Place it on a clean white towel and allow it to air dry.
Step 11: Store clean inner cannula.
- When the cannula is dry, store it in an envelope, container or paper/cloth bag.
- Plastic bags are OK only if the equipment is totally dry before placing into the bag.
Step 12: Throw out used supplies.
Pour cleaning solutions into the toilet.
Step 13: Clean containers
Clean containers or bowls with warm, soapy water and then rinse in warm water. Allow them to air dry.
Step 14: Remove gloves and wash hands.
Important Points
- Your doctor will change the entire trach tube when necessary.
- Trach care can make the patient cough; if this happens, cover the trach with a tissue and wait until coughing stops.
- Always check the skin around the trach area at least once a day. Report any problems to the doctor.
- Call the doctor immediately if you are having problems with the trach. Call 911 (emergency services) if the person is having trouble breathing.
- Always keep a spare trach at home.
- If the trach tube comes out, do not panic. Gently try to place it back in the hole. If you cannot (if you meet resistance or the hole starts to close), cover the hole with a gauze pad and tape the pad to the neck. Give extra breaths using the Ambu Bag via a face mask. Call 911 (or local emergency services) for help immediately. Refer to emergency trach section.