Home Health Care Service Providers

Tracheostomy: what is it?

An opening that is made through the neck into the windpipe is called tracheostomy. The purpose of this procedure is to open the patient’s airway and aid his or her breathing.

This procedure may be done in an emergency. Before the procedure, anesthesia may be used to help relieve the pain that the patient may feel. A tracheostomy can either be temporary or permanent depending on the patient’s health condition.

When to consider tracheostomy?

A tracheostomy may be done when the patient has any of the following conditions:

• There is an obstruction in the mouth or throat
• Difficulty in breathing that is caused by edema, pulmonary conditions, or injury
• During airway reconstruction following surgery
• To provide airway protection from food or secretions caused by swallowing problems
• Providing airway protection after the patient’s head or neck surgery
• Has a need for long-term ventilator support

What is a tracheostomy tube?

The small tube that is inserted into the opening of the stoma is called the trach tube.

There are many kinds of trach tubes that are available and they are made of different kinds of materials such as semi-flexible plastic, rigid plastic or metal. These tubes can either be disposable or reusable. A cuffed tube may be used if it is needed. It is necessary for patients who have difficulties in swallowing or receiving mechanical ventilation. The choice of the tube will depend on the patient’s health condition and other factors.

All of the trach tubes have pieces called the outer cannula (the main shaft) and the neck plate. The neck plate will rest on the patient’s neck over their stoma. A trach tube is inserted in each hole of the neck-plate using a tie to ensure that it is in place.

Is there anything I should know after coming home with a tracheostomy?

• Use writing to communicate with others until you are given instructions on communication techniques by your healthcare provider.
• Unless your healthcare provider has instructed you to do so, do not remove the main shaft.
• To protect your airway from the outside elements, you’ll need to use a trach cover. Be sure to ask your healthcare provider for information about trach covers and where you can buy them.

When should I contact my healthcare provider?

You should contact your healthcare provider or attending physician when:

• Your heart rate is irregular.
• You feel an increased amount of pain and discomfort. (Note: It is normal to feel a certain amount of pain and discomfort for about a week after the procedure.)
• Your breathing becomes difficult and cannot be relieved by your usual method of clearing the secretions.
• The secretions become thick, crusting occurs, or mucus plugs are present. Your doctor may recommend that you raise your intake of fluids or use cool mist humidification.
• You have any problems or concerns that you’d like them to know about.

Are there ways to care for my tracheostomy tube?

Our nurses will teach you the proper way of caring for your trach tube. Routine trach care should be done after you are discharged from the hospital.

1. The supplies you should gather include:
   • Trach tube ties
   • A clean pair of scissors
   • A clean towel
   • A clean cotton tipped-swab
   • A clean skin or basin
   • A pair of sterile gloves
   • Saline or tap water
   • Hydrogen peroxide
   • A clean washcloth
   • Clean 4 x 4 fine mesh gauze pads
2. Wash your hands thoroughly with water and soap.
3. Find a comfortable place in front of the mirror to stand or sit in.
4. Put on the clean pair of gloves.
5. Perform a suction on your trach tube. (We will provide you with more information about this).
6. Remove the inner cannula if your tube has one. (Proceed to step 12 if your tube does not have one.)
7. Take the inner cannula and hold it over the basin. Pour the hydrogen peroxide over and into the piece. Be sure to use as much hydrogen peroxide as you need to make sure that the inner cannula is thoroughly cleaned.
8. Use a brush or pipe cleaners to clean the inner cannula.
9. Rinse the inner cannula with the normal saline or tap water.
10. Use the Clean 4 x 4 fine mesh gauze pads to completely dry the inside and outside of the inner cannula.
11. Reinsert the inner cannula to its proper place.
12. Remove and throw away the solid gauze from your neck.
13. Check the skin around the stoma if there are any signs of redness or irritation. If there are any problems, be sure to call your doctor immediately.
14. Use the half hydrogen peroxide and half water to soak the cotton swabs. Clean the outer cannula and the skin around the stoma using the cotton swabs.
15. Wet the washcloth with normal saline or tap water and use it to wipe away the hydrogen peroxide on the skin.
16. Dry the outer cannula and the skin around the stoma with a clean, dry towel.
17. Change the trach tube ties. (Our nurses will teach you how to do this.)
18. Take a fine mesh gauze and place it under the neck plate and trach ties.
19. Take off the gloves and throw them away.
20. Wash your hands thoroughly with warm water and soap.
21. Wash the basin you’ve used with a small brush and water. After it dries, put it away in a safe place.
22. Place the used washcloth and towel in the laundry.
23. Wash your hands with warm water and soap once again.