Tracheostomy Care

Tracheostomy  is an opening that surgeons create through the front of the neck and into the windpipe (trachea). A tracheostomy tube is placed into the hole to provide an air passage to help you breathe when the usual route for breathing is somehow blocked or reduced. The term for the surgical procedure to create this opening is tracheotomy.

You can however live a normal life, and life with tracheostomy is manageable and not as bad a it seems.

Situations that may call for a tracheostomy include:

  • Medical conditions that make it necessary to use a breathing machine (ventilator) for an extended period, usually more than one or two weeks
  • Medical conditions that block or narrow your airway, such as vocal cord paralysis or throat cancer
  • Paralysis, neurological problems or other conditions that make it difficult to cough up secretions from your throat and require direct suctioning of the windpipe (trachea) to clear your airway
  • Preparation for major head or neck surgery to assist breathing during recovery
  • Severe trauma to the head or neck that obstructs breathing
  • Other emergency situations when breathing is obstructed and emergency personnel can’t put a breathing tube through your mouth and into your trachea
Tracheostomies are generally safe, but they do have risks. Some complications are particularly likely during or shortly after surgery. The risk of such problems greatly increases when the tracheotomy is performed as an emergency procedure. Some things to be careful about are:
  • Bleeding
  • Damage to the trachea, thyroid gland or nerves in the neck
  • Misplacement or displacement of the tracheostomy tube
  • Air trapped in tissue under the skin of the neck (subcutaneous emphysema), which can cause breathing problems and damage to the trachea or food pipe (esophagus)
  • Buildup of air between the chest wall and lungs (pneumothorax), which causes pain, breathing problems or lung collapse
  • A collection of blood (hematoma), which may form in the neck and compress the trachea, causing breathing problems

How you prepare

How you prepare for a tracheostomy depends on the type of procedure you’ll undergo. If you’ll be receiving general anesthesia, your doctor may ask that you avoid eating and drinking for several hours before your procedure. You may also be asked to stop certain medications.
Plan for your hospital stay
After the tracheostomy procedure, you’ll likely stay in the hospital for several days as your body heals. If possible, plan ahead for your hospital stay by bringing:
  • Comfortable clothing, such as pajamas, a robe and slippers
  • Personal care items, such as your toothbrush and shaving supplies
  • Entertainment to help you pass the time, such as books, magazines or games
  • A communication method, such as a pencil and a pad of paper, a smartphone, or a computer, as you’ll be unable to talk at first

After the procedure

You’ll likely spend several days in the hospital as your body heals. During that time, you’ll learn skills necessary for maintaining and coping with your tracheostomy:
  • Caring for your tracheostomy tube. A nurse will teach you how to clean and change your tracheostomy tube to help prevent infection and reduce the risk of complications. You’ll continue to do this as long as you have a tracheostomy.
Inspect stoma daily: Tracheostomy care is done every 8 to 12 hours and PRN
Check for irritation/inflammation.
Avoid dressings trapping moisture.
Check secretions: white & clear; greenish-yellow
Odor often indicates infection.
Assess need for suctioning q2h.
 Stoma Care: The stoma should be inspected daily for signs of irritation and inflammation. The site must be maintained clean and dry through careful attention to replacing soiled ties and removing secretions that collect around or under the tracheostomy tube plate. Dressings that trap moisture should be avoided (i.e., gauze pads). At home, mild soap and water applied with a Q-tip is usually sufficient to clean the stoma site. Adherent secretions may be removed with a Q-tip and half-strength hydrogen peroxide and sterile water.
The patient should be evaluated for nutritional well-being and wound healing. The relationship among good nutrition, meticulous skin care, and prevention of wound infection should be stressed. The patient with a tracheostomy is at risk of nutritional deficiency, because of altered taste and smell sensations. To counter these problems, the patient is encouraged to maintain good oral hygiene and eat high-calorie snacks, if not medically contraindicated. Maintenance of body weight is one objective measure of nutritional adequacy.
  • Speaking. Generally, a tracheostomy prevents speaking because exhaled air goes out the tracheostomy opening rather than up through your voice box. But there are devices and techniques for redirecting airflow enough to produce speech. Depending on the type of tube, width of your trachea and condition of your voice box, you may be able to speak with the tube in place. If necessary, a speech therapist or a nurse trained in tracheostomy care can suggest options for communicating and help you learn to use your voice again.
  • Eating. While you’re healing, swallowing will be difficult. You’ll receive nutrients through an intravenous (IV) line inserted into a vein in your body, a feeding tube that passes through your mouth or nose, or a tube inserted directly into your stomach. When you’re ready to eat again, you may need to work with a speech therapist, who can help you regain the muscle strength and coordination needed for swallowing.
  • Coping with dry air. The air you breathe will be much drier because it no longer passes through your moist nose and throat before reaching your lungs. This can cause irritation, coughing and excess mucus coming out of the tracheostomy. Putting small amounts of saline directly into the tracheostomy tube, as directed, may help loosen secretions. Or a saline nebulizer treatment may help. A device called a heat and moisture exchanger captures moisture from the air you exhale and humidifies the air you inhale. A humidifier or vaporizer adds moisture to the air in a room.
  • Managing other effects. Your health care team will show you ways to care for other common effects related to having a tracheostomy. For example, you may learn to use a suction machine to help you clear secretions from your throat or airway.