Tracheostomy tube care

A tracheostomy is an artificial opening or hole into the neck that the patient breathes into directly. A plastic tube called a tracheostomy tube is placed in it to keep it open.

A ribbon is tied around the neck to keep the tube in place. Alternatively, it may also be secured using stitches.

Before you leave the hospital, health care providers will teach you how to do the following:

Clean, replace, and suction the tube
Keep the air breathed in moist
Clean the hole with water and mild soap.
Change the dressing around the hole

Humidity

The nose and mouth warm and humidify the air we breathe. When the patient breathes through a tracheostomy tube directly, we must replace this humidification. Without added moisture the secretions in the throat may become thick and hard to cough out, making it difficult to breathe.

To maintain moisture and help clear secretions:

1. Ensure that the patient drinks plenty of fluids to keep the secretions thin, about 10 glasses of water/other fluids a day.

2. Use a moistened tracheostomy bib to cover the tube at all times.

How to suction the tracheostomy tube

Your doctor/nurse will teach you how to suction the tube before discharge. The tube must be suction every 2-3 hours, amd more frequently if advised.

Equipment required -

A suction machine (ask your doctor/nurse where to purchase it before discharge)
A suction catheter
A bowl or large cup filled with water
2 to 4 dry gauze pads
A clean, dry cloth

Instructions

Clean your hands well with soap and water.
Connect the suction catheter to the suction machine’s plastic tubing.
Turn on the suction machine.
Pinch the suction catheter between your thumb and pointer finger to block the suction.
Ask the patient to cough deeply to bring up any secretions.
Keep the suction catheter pinched. Put it about 3 to 5 inches (8 to 13 centimeters) into the tracheostomy tube.
Un-pinch the suction catheter to start suctioning. Don’t keep the suction catheter in the tube for longer than 10 seconds. Keeping it in too long can cause shortness of breath.
Using a rotating motion, slowly pull the suction catheter out of your tracheostomy. Rotating the catheter helps it suck up secretions on all sides of your trachea and tracheostomy tube.
Do not insert the catheter more than 3 times during a suction period.
Ask the patient to breathe deeply after the catheter is removed.
Wipe the secretions from the outside of the suction catheter with dry gauze.
Rinse the secretions from the inside of the suction catheter by suctioning the water through it.
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:

Make sure the suction catheter and plastic tube are clean. Rinse and wipe the outside and suction water through the inside to clean them, if needed.
Disconnect the suction catheter from the plastic tubing on the suction machine.
Place the suction catheter on the dry cloth or paper towel.
If you’re at home, empty the secretions from the inside of the suction machine into the toilet. Don’t empty them into the sink. They can clog the drain. In the hospital, a staff member will do this for you.
While you’re at home, change the suction catheter once a week or more often if it’s dirty or clogged. Clean the suction machine’s canister with soap and water as needed.

When to seek help

Vomiting

If the patient vomits, make sure to cover the tracheostomy tube with a towel or clean cloth. This will prevent vomit from being inhaled into the airway. Suction right away if you think any vomit may have entered the tube.

Thick secretions

If the throat secretions become very thick and difficult to cough up or suction - increase the frequency of chest physiotherapy, steam inhalation and ask the patient to drink more liquids,

Difficulty breathing

A plugged or partially plugged trach will make it difficult to breathe. This is usually caused by a build-up of secretions. If this happens -

1. Ask the patient to cough really hard.

2. Try suctioning.

3. If you have normal saline available, squirt some into your trach with a syringe. Cough and try to loosen up the plug.

5. Suction again if needed. If you continue to have difficulty breathing, report to the hospital immediately.

When to call your doctor

Fever with chills , Fever of 101° F or higher
Reddened or swollen skin around your stoma
Bleeding or drainage from the hole
Cough or shortness of breath, even after you suction your tube
More mucus than usual and changes in color; especially from clear to yellow, green or brown
Mucus has a bad smell