Tracheostomy Care: What to Know

Tracheostomy is needed to help people who have severe breathing troubles to get relief through external methods. 

What is a Tracheostomy?

Tracheostomy is the process of creating a small surgical opening in a part of your throat called trachea or the windpipe in common terminology. A specially designed tube, generally known as a trach, is placed into this opening to enable a person to breathe easily. 

It helps to keep the airway open to help with oxygen supply, breathing treatments, and to regularly help with the cleaning of mucous accumulated. For some people who have extreme breathing troubles, a ventilator is attached to this tube to make breathing easier. 

Why Would a Tracheostomy Be Needed?

Tracheostomy is a severe procedure that can only be performed by experienced nurses and doctors. A tracheostomy is performed if one of the following conditions are present:

1. Obstruction faced in the mouth or throat that prevents airflow.

2. The breathing difficulty caused in cases of edema (swelling), severe injuries or pulmonary (lung) based conditions.
3. Recovery time needed for airway reconstruction following a tracheal or laryngeal surgery.
4. Airway protection needed due to secretions in the trachea or food-related trouble because of swallowing problems.
5. Airway protection to be provided after head and neck surgery to ease the patient's breathing effort.
6. The long-term or permanent need for a ventilator (breathing machine) support in case of unrecoverable issues.

Parts of a Trach Tube

Trach tubes are available in various sizes and types. The most popular are cuffed and cuff-less types, which are paired with two types of inner cannulas. Inner cannulas are crucial for suctioning as they help guide the suction catheter into the airway. 

A trach tube generally consists of the following:

1. An outer cannula: It refers to the tube that sits inside the trachea through the opening made from surgical methods.

2. Flanges: These are the curved wings placed on either side of the trach tube. It is connected to the trach ties to hold the trach tube in place and prevent any mishaps.

3. Trach ties: They are constructed in a way that enables them to encircle the neck and help stabilize the trach tube.

4. Cuff: It fills up with air drawn in to help with breathing. It also helps fix the tube in the airway. 

5. Inner cannula: It refers to the smaller tube present in the outer cannula. The inner cannula is constructed in a way that makes it easier for it to be regularly removed and cleaned. However, every trach tube doesn't need to have an inner cannula.

6. Obturator: It is a small device that helps in inserting a new trach tube.

7. Speaking valve: It is a cap-like structure that covers the opening of the trach tube. The healthcare provider should be consulted for the appropriate speaking valve.

Cleaning the Trach Tube

The implantation of a trach tube in the surgically made hole in the trachea is a very delicate process. The skin around the trach tube and the tube itself need extensive care. 

Therefore, regular cleaning of the trach area should be done, either daily or even more frequently, in certain cases. The trach ties should be changed at the first signs of damage or discomfort. 

Tracheostomy Care Supplies

• Small plastic containers or bowls
•  A lid covered container for storage
•  Neck plate
• Clean inner cannula 
• Small white towel or washcloth
• Cotton tipped applicators (like Q-Tips)
• Clean container with a lid or cloth bag (plastic bags should only be used if the equipment is totally dry)
• Hydrogen peroxide
• Gauze pad and drain sponge
• Pipe cleaners with smooth tips
• Velcro trach tie 
• Two clean gloves
•  Sterile water or sterile normal saline

1. Wash your hands thoroughly with medicinal agents
2. Cover your hands in clean medical gloves
3. Prepare a cleaning solution
4. Replace the inner cannula

• Lay two fingers of one hand upon the neck plate of the trach.
• Then unlock the internal cannula by unsnapping the side fasteners of an expendable kind or by rotating it counterclockwise.
• Now gently draw it out.

5. Insertion of the clean inner cannula 

• To do this, lay two fingers from one hand on the neck plate while delicately embedding the cannula into the trach tube.
• Next, turn the internal cannula clockwise to secure.
• The two blue spots ought to be aligned with one another when accurately bolted.
•  Lock a dispensable inward cannula by pressing the side clasps open and adjusting it properly.

6. Cleaning of Trach Area
 Trach Tube is to be cleaned delicately with cotton-tipped applicators dipped in hydrogen peroxide
 Used applicators should not be reintroduced to the solution
 Gauze soaked in soap solution is to be used to clean larger parts of the neck
7. Changing Drain sponge

• Change it as often as it becomes wet
• A wet sponge is not to be used for long periods to avoid skin problems

8. Changing trach ties

• Trach ties are to be replaced regularly
• Wet or soiled ties are to be changed even more frequently
• Trach tube is to be supported while changing ties
• Ties need to be tied snugly rather than tightly

9. Cleaning soiled inner cannula

• 1/2 strength hydrogen peroxide solution is used to store the cannula
• The small brush is used to clean it
• Hot water is to be used to prevent mucus from remaining
• Rinsing should be done with saline water
• Should be air-dried by placing it on a clean towel.

10. Storage of inner cannula

• An envelope is used to store the clean cannula.
• Plastic bags can be used only when the equipment is completely dry.

Additional Tips

• Used supplies should be thrown out and not be reused

• Containers should be rinsed in hot water and air-dried

• Hands should be thoroughly cleaned in medicinal solution after removing gloves

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