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Tracheostomy Care

Managing Tracheostomy Care at Home

     A tracheostomy is a surgical incision made through the neck into the trachea to create an airway that allows someone to breathe.  An artificial airway inserted through a stoma creates an opening that keeps it from closing. Having direct access to the lungs carries some significant risks, as you can imagine. Therefore, the responsibility for managing a tracheostomy site is substantial. 

 

     Hopefully, if you were sent home with a new trach, you had the opportunity to work with someone 1:1 before you left the hospital to learn how to clean, change, and manage the care of the cannula and stoma site. However, I know that sometimes there is a difference between what should be and what is. I have found a few hospital sites that do a pretty good job of providing information for their patients online.  One of them is John Hopkins.  I recommend checking out their website,

“Tracheostomy Service,” at https://www.hopkinsmedicine.org/tracheostomy/living/

 

     The information they provide is very comprehensive and easy to follow.  

 

     I also really like this booklet,

“Guide to Pediatric Tracheostomy Care at Home,” produced by

Children’s Hospital of Greenville Health System.  Here’s the link http://www.ghschildrens.org/wp-content/uploads/2017/12/17-0330-Guide-for-Pediatric-Tracheostomy-Care-Digital.pdf.

 

     The information in the booklet could apply to adults as well as children.

 

     I also want to share the following general tidbits of wisdom with you.

  • Thick secretions may clog a tracheostomy tube. Using a room humidifier prevents that from happening by increasing the moisture content in the air. Anything you can do to add humidity or increase your hydration (fluid intake) is a plus. Even something like having a glass of crushed ice handy as a refreshing beverage can help. 
  • If you have secretions seeping around your stoma, causing skin irritation, be cautious about what you place on the skin in that area. You don’t want to inhale anything directly into the lung. Don’t put lotions or other conditioners on the skin; however, you can put skin coverings there that absorb moisture and change them frequently provided they don’t have small fibers that might break off and get into the lungs. Don’t use gauze dressings with frayed ends.
  • Always clean away from and not toward the stoma to reduce the likelihood of introducing germs into the lungs.
  • When changing your trach ties, have an extra set cut in advance, and within reach, in case you drop one when you’re in the middle of replacing them.
  • If you are suctioning and you see blood in the sputum, you may be going inserting the catheter too deep. Try not to enter it as far.  If that doesn’t make the appearance of blood spots stop, contact your doctor. Sometimes bleeding can signal of something more serious such as skin erosion from a tube pressing against the wall of the trachea. If you see a lot of blood, go to the emergency room because the trach cannula could be cutting a hole into one of the blood vessels.  That’s an emergency.

 

Reference:

https://www.hopkinsmedicine.org/tracheostomy/living/
http://www.ghschildrens.org/wp-content/uploads/2017/12/17-0330-Guide-for-Pediatric-Tracheostomy-Care-Digital.pdf.

Taking Care of Skin Around your Stoma

Tracheostomy

     Mucus may seep around the cannula throughout the day, causing the stoma to become red and sore if allowed to stay there too long.  It’s essential to keep that area clean and dry. Therefore, you should do skincare several times a day.

 

Preparation:

Gather mild antibacterial soap (Dial hand soap is a good option), your trach care kit, washbasin with warm water, 2-3 clean washcloths, new trach ties, and scissors.  Cut your new ties in advance if you plan to change them.

 

Cleaning the Skin:
  1. Wash your hands thoroughly with warm soap and water.
  2. Use a clean washcloth each time. Dip a corner of the cloth into warm water, squeeze out the excess water, apply a mild soap. Rub the soap into fabric.
  3. Remove soiled ties holding onto the trach tube to keep it secure.
  4. Begin stoma care promptly.
  5. Use one washcloth corner to wipe, starting from stoma cleaning outward toward the rest of the neck. Repeat process with a new edge of a new section of the washcloth. Continue until all parts are clean.
  6. Apply clean ties.
  7. You may apply a dry dressing between the trach opening and the trach tube to absorb future secretions. Make sure it does not cover the opening of the trach.

 

Reference: http://preferredhomecare.com/wp-content/uploads/2014/04/A-guide-for-tracheostomy-care-at-home-PHC-Master_20140522.pdf 

A Caregiver’s Guide for Tracheostomy Care at Home. Preferred HomeCare /LifeSolutions. Phoenix, AZ. 

Resource: YouTube:

How to Care for Your Child’s Skin and Do a Trach Tie Change 
(adult) Tracheostomy Care Tutorial 

emergency Trach situations

Tracheotomy Care: How to Manage Accidental Decannulation

 

     If the cannula seems to have come out of trachea, check to see if the person has any difficulty breathing. Obtain your spare trach tube, lubricant, and self-inflating or flow-inflating resuscitator. Ventilate the patient as needed.  Flatten the patient in bed. Insert the replacement tube and reassess the patient. 

 

Emergency Airway Care: Plugged Tracheostomy Tube

     

      Suction patient deeper if necessary.  You may need to do an emergency tracheostomy change if suctioning does not remove the obstruction. Use the next smallest size trach during the emergency substitution. Use an Ambu bag to give support breaths. 

Cleaning the Trach Tube and Disinfecting Non-Sterile Supplies

Cleaning the Trach Tube

 

Supplies needed
  • Mild soap (recommend Dial anti-bacterial soap – Dawn or Joy are too harsh. Avoid anything with perfumes or dyes) another option is white distilled vinegar
  • Pipe cleaner or soft bottle brush
  • Paper towels
  • Pen and tape
  • Plastic bags
 
Steps    
  • Wash your hands.
  • Clean the dirty trach tube and obturator (the part that goes inside the cannula) with the pipe cleaner or soft brush, making sure to remove all remaining mucus from the inside of the cannula.
  • Inspect the tube for cracks or sharp edges. If you find any, throw it away.
  • Rinse the tube and obturator in water. Soak in mild soap and water solution for 2-3 hours in a clean container.
  • Note: If you have a silicone Bivona or cuffed Shiley trach tube, add this step:  Boil water and remove from direct heat. Place trach tube and obturator in hot water and leave it there until the water is cool enough for you to pull the tube out using your bare hands.  
  • Rinse the soapy solution off and place trach on a clean, dry paper towel to air dry. Place a clean paper towel over the wet tube and obturator to protect from dust and let dry overnight.
  • Once the tube is dry, handle it by the wings only. Inspect it again for damage
  • Store in a clean container or zip lock bag. Label and date; it as clean.
 
Disinfecting Non-Sterile Supplies
  • Mix ½ oz. (1 tablespoon) of mild anti-bacterial soap with 2 quarts of warm water in a basin. First, wash and rinse your supplies in the sink, then soak items in the warm soapy solution for 10 minutes. Rinse thoroughly (allow water to run over them for 2 minutes) with tap water and then allow to air dry. Once dried, you can put them in a zip lock bag and mark as clean.

 

Reference:  A Caregiver’s Guide for Tracheostomy Care at Home. Preferred HomeCare /LifeSolutions. Phoenix, AZ.  http://preferredhomecare.com/wp-content/uploads/2014/04/A-guide-for-tracheostomy-care-at-home-PHC-Master_20140522.pdf

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