News - Tracheostomy Care

Published: Saturday 26 May, 2007

Source: American Head & Neck Surgery

A tracheostomy is a surgical opening in the trachea (windpipe) to make breathing easier. The opening is called a stoma. A tracheotomy tube is inserted in it to keep it open. Eventually, you may be able to talk by taking a deep breath and placing a finger over the stoma.

Prior to leaving the hospital, the patient (and family if available) should demonstrate a proficiency and knowledge about the care of the tracheostomy tube and site. In addition, written home care instructions are advisable (a sample is provided as an appendix). At times, due to weakness, neuropsychiatric or physical problems (arthritis), the patient may not be able or competent to handle this situation. Other arrangements will need to be made to make this safe for the patient.

  1. An explanation as to the type of tube and the various pieces and their function (outer cannula, inner cannula, obturator) will make the transition from hospital care to home care smooth and less anxiety producing. 
  2. Some tracheostomy tubes have an inner part (or cannula) that is removed and cleaned. This should be done with a "clean hands" technique. That is, wash the hands thoroughly before and after the care is given. Sterile technique is seldom necessary. 
  3. The patient should demonstrate his/her ability to remove and cleanse the inner cannula. 
  4. Some tracheotomy tubes do not have an inner cannula, and these cannot be cleaned as those that do. An explanation as to cleansing and what to do in case of obstruction is needed. 
  5. The patient and family should be instructed in the following: 
    1. How to clean the tracheotomy site. 
    2. Patients who have a tracheotomy tube with a disposable inner cannula, should be told how often it should be changed.
    3. How to use a suction machine if necessary. (Arrangements should be made to have a machine at the home.) 
    4. What things they should watch for and report to the physician:
      Bleeding - oozing versus bright red and pulsatile
      Signs of infection - swelling, redness, warmth, pus, increasing pain Subcutaneous emphysema
      Obstruction of the tube and difficulty breathing. 
  6. Keeping the airway humidified, particularly in the summer and winter when they cool or heat the air in their homes. 
  7. Manipulating the tie that holds the tube in place. If there is a flap reconstruction, the tie may compromise the blood flow to the flap if tied too tightly. 
  8. Observe for aspiration, and what to do if it happens during meals or otherwise. 
  9. Observe for coughing blood, or increased coughing with swallowing, especially after laryngectomy.

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