A tracheostomy is a surgical opening created in the neck to place a tube into the windpipe, which provides an alternative pathway for breathing. Routine cleaning of this tube and the surrounding stoma site is fundamental to tracheostomy management. This maintenance prevents severe complications, particularly respiratory tract infection and airway blockage. Regular cleaning prevents the buildup of dried secretions, ensuring the airway remains open and functional. Maintaining hygiene at the stoma site also protects the surrounding skin from irritation and breakdown caused by constant moisture and friction.
Essential Supplies and Preparation
Gathering all necessary supplies and establishing a sterile field is the first step toward safety and effectiveness.
- Sterile gloves
- A specialized tracheostomy cleaning brush
- Gauze pads and cotton-tipped applicators
- A cleaning solution (usually sterile saline)
- A clean basin for the solution
- A clean, dry towel to lay out equipment
Hand hygiene must be performed thoroughly by washing hands with soap and water for at least 20 seconds before putting on sterile gloves. A second set of gloves should be available in case the first pair becomes contaminated. An emergency kit must be kept nearby, containing a spare tracheostomy tube of the same size and one size smaller, along with the tube’s obturator for safe reinsertion if accidental dislodgement occurs. This preparation minimizes the risk of introducing pathogens and ensures a swift response to complications.
Step-by-Step Inner Cannula Cleaning
The inner cannula is removed frequently for cleaning to prevent the accumulation of thick secretions. The procedure begins by firmly stabilizing the tracheostomy tube’s neck plate with one hand to prevent movement of the outer cannula. The inner cannula is then unlocked, typically by turning a tab, and gently removed. The outer cannula must remain securely in place to maintain the airway.
If the inner cannula is disposable, it is discarded immediately, and a new, sterile one is inserted and locked into place. This is the quickest way to restore a clear airway. For reusable cannulas, cleaning requires immersion in a sterile solution, such as saline or a mixture of half-strength hydrogen peroxide and saline, to loosen tenacious mucus. The cannula should soak until secretions begin to detach.
Once soaking has softened the secretions, the inner and outer surfaces must be thoroughly cleaned using a specialized tracheostomy tube brush. Pass the brush through the lumen several times to ensure all residue is removed. After brushing, rinse the cannula completely with sterile saline to remove all traces of cleaning solution and dislodged material, as remaining agents can irritate the trachea.
Excess liquid should be gently shaken off or removed with a clean, dry gauze pad. Inspect the cannula visually to confirm it is completely clear of mucus or debris. Finally, the clean inner cannula is smoothly guided back into the outer cannula and securely locked into position. If a spare cannula was used during the cleaning process, the freshly cleaned cannula is dried and stored for later use.
Tracheostomy Site and Tie Care
Cleaning the skin around the stoma prevents irritation and infection from moisture and secretions. After the inner cannula is secured, remove the old dressing and inspect the skin under the neck plate (flange) for redness, swelling, or breakdown. Use saline-moistened gauze or cotton-tipped applicators to gently clean the skin, starting nearest the tube and wiping outward in a circular motion.
Use a fresh applicator or gauze for each wipe, always moving away from the stoma to avoid pushing contaminants into the opening. Hydrogen peroxide should not be used on the skin unless instructed by a healthcare provider, as it can cause excessive drying. After cleaning, gently pat the skin completely dry with a clean gauze pad, since residual moisture encourages bacterial growth. A clean, pre-cut dressing, slit to fit around the tube, can then be placed under the neck plate to absorb drainage.
Changing the tracheostomy ties or holder is done only after the skin is clean and dry. Because this procedure risks accidental tube dislodgement, it is safer to perform the change with two people. One person must firmly hold the neck plate in place. The second person removes the soiled tie, threads the new tie through the flange openings, and secures it. Check the final fit by ensuring only one finger can comfortably slide between the tie and the neck.
Recognizing Issues During Trach Care
Several signs indicate a problem requiring immediate attention. Signs of infection at the stoma site include increased redness, warmth, swelling, or thick, discolored, or foul-smelling drainage. A persistent fever or chills alongside these local signs suggests a systemic infection. If these symptoms are noticed, contact the care team promptly for treatment guidance.
A blocked tracheostomy tube is a life-threatening emergency, often signaled by severe difficulty breathing, noisy breathing, or the patient using accessory muscles. If a suction catheter cannot be passed through the tube, or if the patient exhibits agitation and a rising heart rate, a blockage is likely. In this event, the inner cannula must be removed and replaced immediately with a clean one, as the blockage is often a mucus plug.
Accidental dislodgement of the entire outer cannula is a severe complication, especially if the tract is less than seven days old. If the tube comes out, use the emergency kit immediately. Insert the obturator into the spare tube, gently reinsert it into the stoma, and promptly remove the obturator. The inner cannula is then placed back in and locked. If reinsertion fails, cover the stoma with sterile gauze and call emergency services while maintaining the patient’s breathing via the mouth and nose.