Living with a Tracheostomy (Trach)

Get to Know Your Trach

Outer Cannula (Trach Tube) - maintains the airway

Inner Cannula (Disposable/Reusable) - keeps the airway free of mucous and debris

Cuff - prevents the trach tube from moving or dislodging. Not all trach tubes have a cuff.

Suctioning

Follow this suctioning procedure only if directed by your doctor. Ask for help from your caregiver if needed.

1. Wash your hands.
2. Put on gloves.
3. Attach the suction catheter to the suction machine.
4. Rinse the catheter by suctioning sterile water.
5. Hyperoxygenate the patient by taking 3 or 4 deep breaths (or if ventilated, provide 3 or 4 ventilated breaths).
6. With your thumb off the thumb hole, gently insert the catheter into the tracheostomy tube until it reaches the end of the tube or until the patient coughs.
7. Cover the thumb hole on the catheter to suction.
8. Slowly remove the catheter while rolling it between your thumb and forefinger. Also pulse the suctioning by covering and uncovering the thumb hole of the catheter. (Start to finish, this process should take no longer than 10 seconds.)
9. If more suctioning is needed, rinse the catheter first and have the patient take another 3 to 4 deep breaths (or if ventilated, provide 3 or 4 ventilated breaths), then repeat the suctioning stage. (Allow enough time between each catheter insertion for normal breathing or ventilator support to reoxygenate the patient’s body.)
10. Look at the mucus you have suctioned.
    1. • Normal: Clear, with no odor.
       • Infection: Yellow or green color with foul-smelling odor.
       • Blood: A few streaks of blood is OK, but if it has more bright red or old dark blood, there could be a problem.
11. If you see signs of infection or bright red blood, call your doctor.

What you will need:

• Collection jar for secretions
• Container for water
• Gloves
• Sterile water or saline
• Suction catheter
• Suction machine

Inner Cannula

1. Wash your hands.
2. Hold the neck flange steady with one hand.
3. With the other hand, gently pull the inner cannula out of the tube, using a downward motion.
4. Throw away the used inner cannula.
5. Gently insert new inner cannula into the tube.
6. Ensure it is securely in place.

Cleaning Your Reusable Inner Cannula

You should clearly understand the cleaning procedure before you proceed. Follow your doctor’s recommendations for the cleaning procedure and schedule. Use the listed procedure only if your doctor instructs you to.

1. Wash your hands.
2. Hold the neck flange steady with one hand.
3. Pull the inner cannula out of the tube, using a downward motion.
4. If you need to use a ventilator during this cleaning procedure, insert a clean spare inner cannula.
5. Place the soiled inner cannula in a small wash basin containing sterile normal saline, distilled water, a solution of water, and a mild detergent or a solution of half hydrogen peroxide and half water. Use a small, nonabrasive brush or pipe cleaner to gently remove mucus.
6. After cleaning, rinse the inner cannula thoroughly with sterile normal saline or distilled water to remove all hydrogen peroxide.
7. Air-dry the inner cannula by gently shaking it.
8. Hold the neck flange steady with one hand.
9. Remove the spare inner cannula, if you used one.
10. Reinsert the clean inner cannula into the tube.
11. Clean the spare inner cannula, air-dry and store in a safe place.

Cleaning Supply Checklist:

• Blunt-nose bandage scissors
• Facial tissues
• Container (for catheter rinse water)
• Cotton swabs
• Gloves (like your doctor uses)
• Hydrogen peroxide
• Syringe (if you have a cuffed tube)
• Pre-cut tracheostomy dressing
• Replacement tracheostomy tubes (one the same size and one smaller)
• Small wash basin
• Sterile 4 x 4 in. gauze pads
• Sterile normal saline or sterile water (to soften mucus so that it may be suctioned)
• Suction catheter
• Suction machine with connecting tubing
• Tracheostomy tube mask (optional)
• Twill tape or other tracheostomy tube holder (to secure the tube in place)
• Water-soluble lubricant (K-Y™ Brand Jelly or similar)

Skin Care

Caution: Watch for red, irritated areas. If excessive redness or pimples occur around the opening, call your doctor, reduce humidity delivered around the opening, and use only sterile water for cleaning.

Do not use over-the-counter, petroleum-based creams like zinc oxide or Vaseline™* products around the opening.

If your doctor prescribes an ointment, apply it according to his or her instructions.

How to clean around the opening

1. Wash your hands.
2. Dip a cotton swab into the hydrogen peroxide and water mixture.
3. Roll the cotton swab between the tracheostomy tube and the skin around the opening. Clean from the stoma outward. This removes wet or dried mucus.
4. Repeat steps 2 and 3 using a fresh cotton swab each time, until the entire area around the opening is clean.
5. Rinse the area using clean cotton swabs dipped in clean water only.
6. Use a dry gauze pad to pat lightly around the opening.
7. Replace the tracheostomy dressing, if required.

Skin care is easy but very important. It should be done at least twice a day: once in the morning and once at night. If you smell an odor around the neck or opening, clean the area every eight hours until the odor is gone.

Skin care checklist:

• Cotton swabs
• Hydrogen peroxide and sterile water (mixed in equal parts)
• Pre-cut tracheostomy dressing, if required
• Sterile gauze pads

Trach Tube Ties

Caution: If you use a cuffed tube, protect the inflation line when cutting the ties.

Change the location of the knot to prevent skin irritation.

It’s important to keep the area around the opening in the neck clean to help prevent infection. So, change ties daily or whenever they become wet or soiled.

1. Wash your hands. (An assistant, if present, must wash hands, too.)
2. Leave the old ties in place. Pull one end of the twill tie through either neck flange hole. Adjust the ends of the tie until one is 3 to 4 inches longer than the other.
3. Bring both ends of the tie around your neck and insert the longer end of the tie through the other neck flange hole.
4. Pull the tie snug. Place one finger between the tie and the neck and tie the two ends together using a square knot. Do not use a bow.
5. Cut the ends of the ties leaving only 1 or 2 inches.
6. Carefully cut and remove soiled ties.

Trach tube tie checklist:

• Blunt-nose scissors.
• Gloves
• Twill tape or tracheostomy tube holder

Supplies

Most insurances cover supplies in monthly intervals.

Supply	Image	Purpose	Care	Notes
Trach Tube		Maintain Airway.	Change 1-3 months
Inner Cannula (Disposable)		Keep Trach Tube clean and free of mucous and debris.	Change twice daily (commonly morning and before bed).	Do NOT attempt to clean or re-use.
Trach Tube Holder/Trach Ties		Secure Trach Tube to the neck to prevent dislodge.	Change weekly.
Heat Moisture Exchanger (HME)		Provide moisture to the Trach when not using a humidifier.	Change daily.	The HME is designed to retain moisture and may look slightly wet. Do NOT attempt to clean or re-use.
Trach Care Kit		Cleaning supplies for around Trach, Stoma and re-usable inner cannula.	Clean daily. Contains gloves, pipe cleaner, Trach Tube Brush, Twill Tape, 4x4 Gauze & Drain Sponges.	Items are sterile and should not be re-used.
Saline/Saline Bullets		General cleaning and flushing.	Use as needed to flush in-line suction catheters, assist in cleaning re-usable inner cannula and general Trach care.
Speaking Valve		Allow user to speak.	Clean in mild soapy water daily or as needed when soiled or dropped. Replace as needed.	Do NOT rinse under strong running water.
Trach Mask		Cover Trach Tube for administration of humidification, oxygen or medications.	Clean daily with mild soapy water. Change monthly.