Some Airway Problems That May Require a
- Infections (e.g. epiglottitis)
- Subglottic stenosis or web
- Vocal cord paralysis
- Neck, larynx or mouth injuries
- Airway burns
- Need for prolonged respiratory support with ventilator
- Chest wall injury
- Neuromuscular diseases with weakened breathing muscles
Movement of the trach tube and secretions can irritate the skin around
the stoma. Daily care of the site is needed to prevent infection and
skin breakdown. Care should be done at least once a day and more often
if needed. Those with new trachs or on ventilators may need trach care
more often. Tracheostomy dressings are used if there is drainage from
the tracheostomy site or irritation from the tube rubbing on the skin.
Have the patient in a comfortable position on his back with a small
blanket or towel roll under the shoulders to extend the neck. After
washing your hands, open Q-tips, trach gauze and regular gauze. Cut
the trach ties to appropriate length (if these are to be changed).
Pour 1/2 strength hydrogen peroxide into one cup and sterile water into
another. Clean the skin around the trach tube with Q-tips soaked in
1/2 strength hydrogen peroxide. Using a rolling motion, work from the
center outward using 4 swabs, one for each quarter around the stoma
and under the flange of the tube. Do not allow any liquid to get into
trach tube or stoma.
Next, clean the area with Q-tip soaked in sterile water and pat dry
with gauze pad. Change the trach ties if needed and check the skin under
Tuck pre-cut trach gauze around and under the trach tube flush to the
skin. Do not cut the gauze or use gauze containing cotton because small
particles may be inhaled. Use precut tracheostomy gauze or use two gauze
pads, one placed under each wing of the tube. Be sure the trach dressing
does not fold over and cover the tube opening. Change the dressing when
moist, to prevent skin irritation.
Monitor skin for signs of infection. If the stoma area becomes red,
swollen, or has a foul odor, call Doctor Caruana. Check before applying
any salves or ointments near the trach. If an antibiotic or antifungal
ointment is ordered by the doctor, apply the ointment lightly with a
cotton swab in the direction away from the trach stoma and wash your
hands thoroughly after trach care.
Care of Inner Cannulas
Some patients have trach tubes with an inner cannula. While some inner
cannulas are disposable and should be discarded daily, reusable cannulas
the cannula should be cleaned 1 to 3 times a day (or more often if needed).
Do not leave the inner cannula out for more than 15 minutes.
After washing your hands pour 1/2 strength hydrogen peroxide into a
bowl or cup and normal saline or sterile water into another. Remove
the inner cannula and place it into the 1/2 strength hydrogen peroxide.
Soak it for a few seconds and use a brush to clean secretions from the
inside and outside of the cannula. Place the cannula into normal saline
or sterile water solution and rinse. Dry the excess water with a clean
Suction through the outer cannula if needed, then replace inner cannula.
Make sure the cannula is "locked" in place in the trach tube
and then wash your hands once again.
If you have any questions at any time about care of the tracheostomy,
please call the doctor.