Discharge Instructions: Caring for Your Tracheostomy Tube and Stoma

Safety note

When cleaning your tube and stoma, it's important to have the right supplies in case of an emergency. Make sure you have:

• Extra trach tubes.

• A manual ventilator bag.

• An obturator that is your size.

• A suctioning device with catheters.

Cleaning your trach tube and stoma

Clean your tube and the skin around it at least 1 time a day. Clean them more often if told to by your doctor. Follow these steps and any other guidelines you have been given.

Step 1. Collect your supplies

Choose a clean, well-lighted space near a sink and mirror. Spread a clean towel on a surface for your supplies, and place on it:

• Gauze pads or other non-fraying material advised by your doctor.

• Cotton swabs.

• A trach tube brush.

• A bowl filled with the type of solution advised by your doctor. They may advise you to use saline solution. Or they may advise you to use a mixture of equal parts saline and hydrogen peroxide. A saline and hydrogen peroxide mixture is often used to clean tracheostomy equipment.

Step 2. Remove the inner cannula

1. First, wash your hands with soap and clean, running water. Put on clean, disposable, powder-free gloves.

2. Hold the neck plate with 1 hand. With the other hand, unlock the inner cannula. Gently remove the inner cannula. Don’t remove the outer cannula.

3. If you have trouble removing the inner cannula, don't force it. Call your doctor. Ask what to do.

Step 3. Clean the inner cannula

To clean the reusable inner cannula, follow the instructions below. (Don’t clean a disposable inner cannula. That type is meant to be used only 1 time.)

1. Soak the reusable inner cannula in the bowl of solution that your doctor has instructed. (If you have a metal inner cannula, don't use hydrogen peroxide. It can damage the cannula. Use only saline.)

2. Clean the inner cannula with a trach tube brush. Don’t use a toothbrush. Rinse fully with plain saline solution.

3. Put the wet inner cannula back into the outer cannula. Lock the inner cannula in place.

Step 4. Clean the neck plate and skin

1. Remove the gauze from behind the neck plate. Check the area for signs of skin breakdown or infection.

2. Clean the neck plate and the skin under it. Use clean gauze pads or other non-fraying material dabbed in saline solution. A complete cleaning method is done by cleaning the stoma one section at a time. This pattern can also be followed on the skin and tube flange:

   • Use a new gauze pad for each section.

   • Start at the 12 o'clock position and wipe to the 3 o'clock position.

   • Next, clean from 12 o'clock to 9 o'clock.

   • Next, clean the 3 o'clock to 6 o'clock position.

   • Last, clean from the 9 o'clock to 6 o'clock position.

   • Gently pat the skin dry.

3. Don't use a hydrogen peroxide mixture directly on your skin unless your doctor tells you to. Hydrogen peroxide can irritate the skin. It can increase the risk for infection. If you are told to use a hydrogen peroxide mixture on your skin, rinse the area with saline afterward.

4. Put a clean, precut gauze pad under the neck plate. This pad protects your skin. Don't cut a gauze pad. The frayed edges of gauze will increase the risk for infection. A loose thread could be inhaled into the trach.

Step 5. Change the neck ties

The neck plate is held in place with cloth or hook and loop ties. If these get dirty, they should be changed. You will need another person to help you change the ties. This is to make sure the neck plate does not move out of place. To replace them:

1. Ask your helper to wash their hands. Then they need to put on a pair of clean, disposable, powder-free gloves.

2. Have a clean set of ties ready to be attached to the neck plate.

3. While one of you holds the neck plate in place, the other person loosens the ties on the neck plate and removes them. Discard the soiled ties.

4. While the neck plate is still held in place, attach the clean ties to the neck plate and secure them. Make sure the ties are snug enough to keep the neck plate from moving too much, yet loose enough to be comfortable. You should be able to insert 1 finger between the trach tie and the skin.

If your trach tube gets plugged

It's normal to have some mucus in your airway. But mucus can build up and thicken. If this happens, your trach tube can become plugged. Follow the steps below and any other guidelines you have been given to clear your trach tube.

1. Prep your space. Find a clean, well-lighted space near a sink and mirror. Collect your supplies. You will need a suction machine and a small bowl of saline solution. You will also need a clean suction tube (catheter). Your doctor will tell you which type of catheter and suction process is right for your trach tube.

2. Clean your hands. Wash your hands with soap and clean, running water. Then put on clean, disposable, powder-free gloves.

3. Get ready to suction. Turn on the suction machine to the setting your doctor told you. Attach the suction catheter to the suction machine. Make sure the suction is working by first suctioning saline from the bowl.

4. Insert the catheter. Take a few deep breaths to fill your lungs with oxygen. Gently insert the catheter into your trach tube. While you are inserting the catheter, don’t suction. Stop inserting the catheter when you start to cough or are to the distance instructed by your doctor.

5. Apply suction. At the same time, slowly pull the catheter out of your trach tube. Move the catheter tip in a circle as you pull the catheter out. Take 5 to 10 seconds to remove the catheter fully from your trach tube. If you need to suction more, relax and breathe for 30 seconds to a few minutes before you start again.

6. Rinse and repeat. Before suctioning again, rinse the catheter with saline. Limit each suctioning session to a maximum of 3 passes.

7. Clean up. When you are finished, turn off the suction machine. Discard the used catheter, water, and gloves.

When to contact your doctor

Contact your doctor right away if you have:

• Coughing.

• A red or painful stoma.

• A small amount of bleeding from the stoma or tube.

• A fever of 100.4°F (38°C) or higher, or as directed by your doctor.

• Chills.

• Yellow, bad-smelling, bloody, or thick mucus.

• Vomiting that doesn’t stop.

When to call 911

Call 911 if you have:

• A lot of bleeding, or ongoing bleeding, from the stoma or tube.

• Coughing up blood.

• Swelling around the trach tube.

• Trouble breathing.