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Care
TRACHEOSTOMY CARE
Information This booklet was developed by UPMC/Jefferson Regional Home Health, L.P. in collabo-
for Patients ration with the respiratory care nurses and therapists across the University of Pittsburgh
Medical Center.
Table of contents
Introduction............................................................................................................. page 2
Humidification........................................................................................................ page 6
Suctioning................................................................................................................ page 9
continued
TRACHEOSTOMY CARE
What is a tracheostomy?
When you breathe through the nose and
A tracheostomy is an artificial opening in mouth, the air is filtered, warmed, and
the neck into the windpipe (trachea). This moistened (humidified) before it gets to
opening is called a stoma. It allows air the lungs. When you breathe through
to go in and out of the lungs. It also a tracheostomy tube, air enters directly
allows any mucus to be removed. A small into the windpipe and the usual warming,
tube (the tracheostomy tube) is inserted humidifying, and filtering do not occur.
through this opening. Breathing occurs This booklet will teach you ways to
through this tube. safely care for yourself with a tracheos-
tomy tube.
Sterile technique
In the hospital, sterile or aseptic
(ay-SEP-tik) technique is used. This
means that all equipment used is pack-
aged or cleaned in a way that is free of Wash your hands.
all germs. Sterile gloves are used when
handling anything that will go into the
tracheostomy or anything used to clean
around it. When you are learning in the
hospital, you will use sterile technique.
At least 1 of your gloved hands will
stay sterile.
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Humidifier
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Equipment
• gloves (clean, disposable, and
powderless)
• clean, cotton, lint-free, white wash
cloth or towel Cleaning with
cotton applicator.
• mild soap and water
• hydrogen peroxide
• 4 x 4 gauze dressing without
cotton filler 4. C
rusts may be removed by loos-
ening with peroxide (dilute equal
• cotton tip applicators
parts of peroxide and water) on a
• normal saline or sterile water cotton-tip applicator. Hold cotton-
• container to mix hydrogen peroxide tip applicator securely to keep it
and saline (or sterile water) from going in to the stoma. Rinse
• clean tracheostomy ties well.
5. I f mucus is a problem, you may use
Procedure
4 x 4 gauze without cotton filler
1. W
ash your hands well. Gather the
around the tracheostomy tube.
supplies. Put on gloves.
6. A
djust the tracheostomy ties or
2. D
ampen lint-free, white cotton
apply new ones. Refer to the
wash cloth.
section on tracheostomy ties (page
13) for directions.
7. C
heck your skin daily for redness
or irritation. Tell your health care
provider if you see redness.
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Step 4.
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Equipment
• suction machine and tubing set up
according to manufacturer’s connecting tube
instructions gloves
catheter
Suction machine
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University of Caring for the inner cannula 6. Re-soak and clean as many times as
Pittsburgh needed to get the inner cannula visibly
Medical Center If your tracheostomy tube has an inner
cannula, it is important to remove and clean.
Information
for Patients clean the inner cannula or tube often. 7. Rinse the tube well with cool, running
The nurse can help you establish a water. Check the inner cannula to make
schedule based on your own needs. If sure it is clean.
your tracheostomy has a disposable
8. Gently reinsert the inner cannula and
inner cannula, change it accord-
lock in place.
ing to your health care provider’s
instructions. DO NOT clean and Equipment for new disposable inner
reuse a disposable inner cannula. cannula
• new disposable inner cannula
Equipment for non-disposable
cannula How to change the disposable inner
• a small bowl filled with a mix of cannula
equal parts of hydrogen peroxide 1. Wash your hands.
and water
2. Suction your tracheostomy if needed.
• tracheostomy brush or pipe cleaners
3. Open the package of a new disposable
• gloves (clean, disposable, powderless)
inner cannula.
How to clean the non-disposable 4. Unlock and remove the disposable inner
inner cannula cannula according to the manufacturer’s
1. Wash your hands. directions.
2. Suction your tracheostomy 5. Gently insert a new disposable inner
if needed. cannula and lock in place according to
3. Unlock the inner cannula and the manufacturer’s directions.
remove it. 6. Place used inner cannula into a garbage
4. Place inner cannula into diluted bag and throw away in the trash.
peroxide mixture.
5. Using a brush, gently cleanse and
remove mucus from the inner
cannula.
Place used disposable
cannula in a bag and
throw away.
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2. A
ttach a syringe to the cuff port and • The person with an inflated cuff cannot
speak because no air passes over the
remove air. Immediately cap the
vocal cords.
port. If the port is left open, the
cuff will reinflate. • If the tracheostomy tube cuff is over-
inflated, it can cause serious damage
to the windpipe (trachea). For air- and
water-filled cuffs, inject air and water
into the cuff only until you cannot feel
or hear air moving from the nose and
mouth.
Deflated cuff • Before the cuff is deflated, you may
need to cough or to be suctioned
because mucus may build up on the
top of the cuff while it is inflated.
Fome cuff automatically inflates • Your health care provider may tell you
to deflate your cuff from time to time.
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TRACHEOSTOMY CARE
University of Changing the outer cannula 8. Hold the clean outer cannula with the
Pittsburgh (tracheostomy tube) guide (obturator) inside.
Medical Center
Information DO NOT remove the outer cannula 9. If your old tracheostomy tube is cuffed
for Patients unless your doctor tells you to do and inflated, deflate it before removal.
so. If you will be changing the outer
10. T
ake a deep breath and remove the
cannula, your health care provider will
tracheostomy tube. Be sure to remove
help you with the following procedure.
the tube following the curve of the
A tracheostomy tube should never
throat.
be changed if the stoma is less than 1
week old. 11. Immediately insert the clean cannula
and guide (obturator), again following
Equipment
the curve of the throat. Never force
• clean set of tracheostomy tubes re-entry.
and obturator (some patients will
12. Hold the tube in place with 1 hand
also get a smaller size tracheostomy
tube set) and quickly remove the guide (obtura-
tor) with the other hand.
• tracheostomy ties
13. Attach the tracheostomy ties as indi-
• water-soluble lubricant
cated. Check for tension by slipping 1
• gloves to 2 fingers between the ties and neck.
• syringe (if using a cuffed tube)
Be sure to plan ahead. When you are
learning about changing the tracheos-
tomy tube, ask your health care provider
Procedure to change outer cannula
what you should do if you can’t get the
1. Wash your hands thoroughly.
tube back in. At this time, the smaller size
2. Remove the inner cannula from the tracheostomy tube may be temporarily
clean set. inserted to keep the airway open. Be sure
3. If tube is cuffed, check the cuff for a to tell your doctor if you do this. Some
leak according to the manufacturer’s more suggestions are included in the
directions. “Emergency tips” section on page 23.
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TRACHEOSTOMY CARE
Long-term use
Some people choose to have a fenestrated
tracheostomy tube on a long-term basis.
Your doctor and health care team can help
you decide if this is right for you. In the
Note: Airflow occurs through daytime, the fenestrated tracheostomy
mouth and nose. (Diagram courtesy tube may be capped for normal mouth and
of Mallinckrodt/Shiley) nose breathing and speaking. For sleeping
and suctioning, the inner cannula can be
inserted. Then breathing and suctioning
Types of fenestrated tracheostomy can occur through the tracheostomy tube.
tubes
Fenestrated tracheostomy tubes also may
• cuffed or cuffless
help swallowing.
• Disposable inner cannula or
reusable inner cannula
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exhalation valve
oxygen
port
bag
tracheostomy
connector
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TRACHEOSTOMY
• If the person is breathing on his or 3. If you are giving the prescribed amount
her own, try to match the delivered of oxygen, set the oxygen flow to_____.
breaths with the person’s own 4. Deliver breaths as described above.
efforts. As soon as the person starts
to inhale, squeeze the bag.
When you are finished using the resus-
• Give a breath every 4 to 5 seconds,
allowing the bag to refill after each citation bag with oxygen, be sure to
breath. If the person is short of reconnect the oxygen source as directed
breath, then deliver breaths at a or turn off the oxygen.
faster rate, still allowing for the bag
to refill, about 12 to 16 breaths per
minute.
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TRACHEOSTOMY CARE
Follow-up
• Continue to see your doctor at regular
intervals. He or she can answer your
questions and coordinate your care.
• Talk with your doctor about how
often the tracheostomy tube should
be changed. Some patients, depending
upon the situation, may need to have
this scheduled as a procedure in the
hospital’s ambulatory or outpatient area.
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TRACHEOSTOMY CARE
University of Tips for everyday living • Be careful that nothing enters your new
Pittsburgh airway. This includes cotton swabs, tis-
Medical Center You can do most things with a trache-
sues, shaving cream, hairs, powders,
Information ostomy. One thing you will not be able
and aerosols. When you are outside,
for Patients to do is swim. You also will not be able make sure insects, leaves, and other
to do anything where there is a lot of things don’t enter the tracheostomy
dust. tube.
Follow these precautions for everyday • Give special attention to your nose
activities: and mouth. These areas are no longer
• Carry some form of identification in moist, and it is harder for you to detect
case of any emergency. We recom- mouth odor. Good mouth care stimu-
mend that you have a Medical Alert lates taste buds.
Bracelet that states “Neck Breather.” • Pay attention to the type and amount of
• Use a humidifier to moisten the air mucus through your stoma. Report any
you breathe. Keep the humidifier changes to your doctor.
clean by following the manufactur- • Tell your doctor before you take any
er’s instructions. medicines. Some drugs may dry out
• Stay healthy by eating a balanced secretions.
diet and drinking enough fluids. You • Men need to be careful when shaving.
should drink 8 cups per day unless It is easy to cut yourself because nerve
your doctor tells you otherwise. Get endings cut during surgery can decrease
plenty of rest and stay away from sensation.
people who have a cold or the flu. • Tracheostomy tapes, usually called
• Protect your stoma from very hot twill tape, can be bought on a roll in a
or freezing temperatures, and from sewing store or anywhere thread and
heavy pollution. Use a dressing, buttons are sold. Velcro ties also are
crocheted bib, clothing, or other available from your medical supplier.
shield to cover your stoma. Make Some people use shoelaces as another
sure you can breathe through the option.
stoma covering. You can buy stoma • To loosen secretions and help remove
coverings at medical supply mucus plugs, your doctor may recom-
companies. mend using drops of saline, sometimes
• In the shower, aim the showerhead called saline bullets.
low or wear a special shower shield • Do not go into areas where there is a
to keep water from entering your lot of dust, fumes, and smoke.
lungs. It may be easier to take a bath
in the tub. You can buy protective
shower guards at medical supply
companies.
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University of
Pittsburgh
Medical Center
Information
for Patients
For help in finding a doctor or health service that suits your needs, call the UPMC Referral Service
at 412-647-UPMC (8762) or 1-800-533-UPMC (8762). Select option 1.
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Form # 8478-82191-0807 your health care needs. Ask your own doctor or health care provider any specific medical questions that you have.