A tracheostomy tube is a hollow tube temporarily or permanently placed into a surgical opening in the neck to bypass an obstruction or to provide a pathway for mechanical ventilation. This opening, known as the stoma, leads directly into the trachea, or windpipe. The presence of this tube means the natural filtering and humidifying mechanisms of the nose and mouth are bypassed, leading to a higher risk of infection and the buildup of dried mucus secretions. Regular and meticulous cleaning of both the tube and the skin surrounding the stoma is necessary to maintain a patent airway and prevent complications like respiratory distress or localized infection.
Essential Supplies and Safety Preparation
Before beginning any cleaning procedure, gathering all necessary equipment is essential to ensure the process is uninterrupted. The supplies typically include clean or sterile gloves, sterile gauze pads, cotton-tipped applicators, a clean basin, and a specialized small brush for cleaning the inner tube. Cleaning solutions are also required, often consisting of sterile normal saline and, in some cases, a solution of half-strength hydrogen peroxide mixed with sterile water.
Preparation must always begin with rigorous hand hygiene. Setting up a clean and easily accessible workspace helps organize the procedure and minimizes the chance of contamination or accidental tube dislodgement. An extra, clean inner cannula or a spare, complete tracheostomy tube set should always be kept immediately available in case of an accidental blockage or dislodgement during the cleaning process. Finally, having clean tracheostomy ties or a neck holder ready for replacement ensures the tube remains securely in place afterward.
Daily Cleaning of the Inner Cannula
The inner cannula is the removable tube that sits inside the main outer tube and is the primary component that must be cleaned multiple times a day to prevent the accumulation of secretions. To begin the cleaning, stabilize the faceplate of the outer cannula with one hand before gently unlocking and removing the inner tube with the other. This stabilization prevents the accidental movement or dislodgement of the entire trach tube.
Once removed, the inner cannula should be immediately placed into a basin containing the cleaning solution, which helps to loosen and soften any thick, dried secretions adhering to the plastic or metal. A common cleaning mixture is a half-strength hydrogen peroxide solution, created by mixing equal parts of standard hydrogen peroxide and sterile water. After a brief soak, a specialized, soft-bristled brush or a pipe cleaner is used to thoroughly scrub both the interior and exterior surfaces of the tube. This mechanical action is necessary to dislodge all mucus and debris, ensuring the lumen is completely clear.
The tube must be rinsed completely in a separate basin of sterile water or normal saline to remove all traces of the cleaning solution. Residual hydrogen peroxide can irritate the delicate tracheal lining upon reinsertion. After rinsing, the inner cannula should be shaken to remove excess moisture and inspected visually to confirm it is entirely clean and clear of any remaining mucus or brush fibers. The clean, rinsed cannula is then gently reinserted into the outer tube and locked securely into place.
Maintaining the Stoma and Skin Area
Caring for the stoma and the surrounding skin is focused on preventing skin breakdown and infection around the entry site. The skin directly beneath the faceplate of the tracheostomy tube can easily become irritated due to moisture, friction, or drainage from the airway. Cleaning is performed using sterile gauze or cotton-tipped applicators saturated with normal saline or a mild soap and water solution, wiping in a circular motion from the stoma outward.
It is necessary to clean beneath the faceplate, taking care to avoid dislodging the outer cannula. Cotton swabs are particularly useful for cleaning the tight space between the tube and the skin surface to remove any crusted secretions. After cleaning, the area must be gently patted completely dry with a fresh piece of gauze, as persistent moisture is a leading cause of skin maceration and infection. A fresh, pre-cut tracheostomy dressing, often a slit gauze pad, is placed under the faceplate if the skin is draining or irritated. These should not be used if the skin is healthy, as they can trap moisture.
Replacing the tracheostomy ties or holder is an important part of stoma care, as soiled ties can harbor bacteria and cause skin friction. This procedure is done with extreme caution. It is recommended to keep the outer cannula secured with the old ties until the new ties are fully threaded and fastened. This two-person or “secure-first” technique prevents the tube from accidentally coming out. The new ties should be snug enough to hold the tube firmly but loose enough to allow one finger to slip comfortably between the ties and the neck.
Recognizing Signs of Infection or Blockage
Monitoring for changes in the stoma site or the respiratory status is essential for early detection of complications. Signs of a localized infection at the stoma site include:
- Increased redness
- Swelling
- Warmth to the touch
- Development of a foul odor or pus-like drainage
Any sudden onset of fever combined with these local signs suggests a systemic infection that requires immediate medical evaluation.
Changes in the respiratory secretions are an indicator of potential issues, as healthy mucus is typically clear or white. Secretions that become thick, yellow, brown, or green can signal a bacterial infection in the airway. Signs of a partial or complete blockage include:
- Difficulty breathing
- Noisy or labored respirations
- Inability to easily pass a suction catheter through the tube
If a blockage is suspected, or if the patient reports being unable to breathe normally despite coughing, immediate intervention is necessary, which includes attempting to clear the tube or replacing the inner cannula. An inability to replace the inner cannula or any visible blood around the stoma are also warnings that require prompt medical attention.