Daily Tracheostomy Care Routine
Keeping the tracheostomy tube clean and the airway moist is the heart of home care. Clean the skin around the stoma twice a day with sterile saline and dry it gently, and change the dressing whenever it becomes damp or soiled. Use a suction machine as the care team showed you to remove mucus from the tube, especially first thing in the morning and after meals, and increase fluids or use a humidifier to keep secretions thin. Always wash your hands before handling the tube and keep a spare tube plus the emergency kit within reach.
Call the doctor right away for warning signs such as difficulty breathing, blue lips, rapid heart rate, thick green or foul-smelling mucus, redness spreading around the stoma, fever, or bleeding. Sudden trouble breathing may mean the tube is blocked or dislodged; in that case follow your emergency plan, which usually involves suctioning, removing the inner cannula, or replacing the tube. Keep a written emergency checklist taped near the bed so every family member knows the steps.
Description
Understanding tracheostomy care home caregivers is important for seniors and their caregivers.
General anesthesia
is used, unless the situation is critical. If that happens, a numbing medicine is placed into the area to help you feel less pain during the procedure. Other medicines are also given to relax and calm you (if there is time).
The neck is cleaned and draped. Surgical cuts are made to reveal the tough cartilage rings that form the outer wall of the trachea. The surgeon creates an opening into the trachea and inserts a tracheostomy tube.
Why the Procedure is Performed?
A tracheostomy may be done if you have:
- A large object blocking the airway
- An inability to breathe on your own
- An inherited abnormality of the larynx or trachea
- Inhaled (breathed in) harmful material such as smoke, steam, or other toxic gases that swell and block the airway
- Cancer of the neck, which can restrict breathing by pressing on the airway
-
Paralysis
of the muscles that cause swallowing
- Severe neck or mouth injuries
- Surgery around the voice box (larynx) that prevents normal breathing and swallowing
What Are the Possible Risks and Side Effects?
The risks for any anesthesia are:
- Problems breathing
-
Reactions to medicines, including
heart attack
and
stroke
, or allergic reaction (
rash
,
swelling
,
breathing difficulty
)
The risks for any surgery are:
- Bleeding
- Infection
- Nerve injury, including paralysis
- Scarring
Other risks include:
- Abnormal connection between the trachea and major blood vessels
- Damage to the thyroid gland
-
Erosion
of the trachea (rare)
-
Puncture of the lung and
lung collapse
- Injury to the esophagus
- Scar tissue in the trachea that causes pain or trouble breathing
What Is After the Procedure?
A person may have a sense of panic and feel unable to breathe and speak when first waking up after the tracheostomy and placement of the tracheostomy tube. This feeling will lessen over time. Medicines may be given to help reduce the person’s stress.
If the tracheostomy is temporary (for example, if the condition leading to its placement can be improved or cured), the tube will eventually be removed. Healing usually occurs quickly, leaving a small scar. Sometimes, a surgical procedure may be needed to close the site (stoma).
Occasionally a stricture, or narrowing of the trachea may develop, which may restrict breathing.
If the tracheostomy tube is permanent, the hole remains open.
What Is Outlook (Prognosis)?
Most people need 1 to 3 days to adapt to breathing through a tracheostomy tube. It will take some time to learn how to communicate with others. At first, it may be impossible for the person to talk or make sounds.
After training and practice, most people can learn to talk with a tracheostomy tube, many times by using special speaking valves. People or family members learn how to take care of the tracheostomy during the hospital stay. Home-care service may also be available.
You should be able to go back to your normal lifestyle. When you are outside, you can wear a loose covering (a scarf or other protection) over the tracheostomy stoma (hole). Use safety precautions when you are exposed to water, aerosols, powder, or food particles.
-
Tracheostomy – series
Cameron J. Chest wall, mediastinum, and trachea. In: Cameron J, ed.
Current Surgical Therapy
. 14th ed. Philadelphia, PA: Elsevier; 2023:chap 15.
Greenwood JC, Winters ME. Tracheostomy care. In: Roberts JR, Custalow CB, Thomsen TW, eds.
Roberts and Hedges’ Clinical Procedures in Emergency Medicine and Acute Care
. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 7.
Updated by: Frank D. Brodkey, MD, FCCM, Associate Professor, Section of Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
