A tracheostomy is a surgically created opening (stoma) in the neck leading directly into the trachea (windpipe). A tracheostomy tube is inserted to maintain an open airway, often needed for long-term breathing support or to bypass an obstruction. Consistent, sterile cleaning of the tube and the surrounding stoma site is necessary to prevent mucus blockage and lower the risk of infection. Failure to perform this routine care can lead to serious complications, such as respiratory distress or pneumonia.
Essential Supplies and Preparation
Gathering all necessary equipment ensures the cleaning process is uninterrupted and sterile. A designated tracheostomy cleaning kit usually contains the required items. Common supplies include clean or sterile gloves, pre-cut sterile gauze pads (drain sponges), and a new tracheostomy tube holder or ties.
Cleaning solutions include sterile saline or water for rinsing, and a mixture of half-strength hydrogen peroxide with sterile water for cleaning reusable components. Specialized small brushes or pipe cleaners are used to scrub secretions from the inner surfaces of the tube. Preliminary steps include setting up a clean, well-lit workspace and performing thorough hand hygiene to minimize the risk of introducing pathogens.
Step-by-Step Inner Cannula Cleaning
The inner cannula is a removable tube inside the main tracheostomy tube, designed to prevent secretion buildup. To remove it, stabilize the outer tube’s flange with one hand while gently unlocking and removing the cannula with the other. If disposable, discard it immediately and insert a new, sterile one to maintain airway patency.
If the cannula is reusable, immediately insert a cleaned and dried spare cannula into the outer tube to protect the airway. Place the removed cannula in the cleaning solution (e.g., half-strength hydrogen peroxide) to loosen dried mucus. Use a specialized brush or pipe cleaner to meticulously scrub all surfaces, removing visible secretions without damaging the plastic.
After scrubbing, thoroughly rinse the cannula in sterile water or saline to remove all traces of the cleaning solution. Inspect it for residual secretions or damage, then allow it to air dry completely in a clean area for future use. The entire cleaning and re-insertion process must be done quickly to avoid prolonged obstruction.
Routine Stoma Site Care and Dressing Change
Stoma site care prevents skin breakdown and infection. Begin by visually assessing the skin for irritation, redness, or discharge. Carefully remove the old tracheostomy dressing (often a pre-split gauze pad) from underneath the neck plate and discard it.
Clean the stoma using sterile gauze or a cotton-tipped applicator moistened with sterile saline. Wipe the skin from the stoma outward in a circular motion, using a fresh piece of gauze for each section to move debris away from the airway. Gently pat the skin completely dry. Apply a fresh, pre-cut drain sponge beneath the flange, ensuring the slit points upward toward the chin.
Changing the tracheostomy ties or holder should be performed with assistance to prevent accidental tube dislodgement. The assistant must firmly hold the tracheostomy tube in place while the clean tie is threaded through the flange openings. Secure the new tie before removing the old one. Check the fit, ensuring only one finger fits comfortably between the tie and the neck.
Recognizing and Handling Tracheostomy Complications
Recognizing complications allows for timely intervention, as issues can quickly compromise the airway.
Signs of Infection
Signs of stoma site infection include increased redness, swelling, warmth, or foul-smelling, discolored discharge. A sustained fever may also indicate a systemic issue.
Airway Blockage and Dislodgement
Airway blockage is an emergency signaled by difficulty or noisy breathing, the use of neck muscles to breathe, or blue-tinged lips (due to low oxygen). If a blockage is suspected, immediately remove the inner cannula, as this may clear the obstruction and restore airflow.
If the patient is unable to breathe, or if the tracheostomy tube is accidentally dislodged, immediate action is required because the airway is unprotected. The emergency protocol involves attempting to replace the tube with a spare one of the same size, or one size smaller. If replacement is unsuccessful, emergency services must be called without delay. Significant bleeding from the stoma site also warrants an immediate call to a healthcare provider.