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Medical Terminology - Tracheostomy (Care)*

Tracheostomy

Tracheostomy tubes are inserted to provide and maintain an airway.  It is important to keep this airway open.

Two or more people should learn to suction and care for the patient with a tracheostomy.  Your nurse will help you learn the skills necessary to care for a tracheostomy.

General Considerations

Keep supplies well stocked and set up for use at all times.

Do not allow water, powder, aerosols, such as hair spray, dust, fumes, etc. to enter the tracheostomy.

Do not swim - use caution bathing.

A cool air humidifier is helpful in keeping secretions loose.

Suction the tracheostomy when necessary but the less frequent the suctioning the better.

Notify Your Doctor If:

1. The patient runs a fever.
2. There is difficulty breathing not relieved by suctioning.
3. There is an increase in secretions.
4. Secretions are foul smelling or there is a change in color of the secretions.
5. There is bleeding from the tracheostomy.
6. The skin around the tracheostomy becomes red or sore.
7. Notify the doctor immediately if the tracheostomy tube comes out.

Suctioning A Tracheostomy

A tracheostomy is suctioned when the patient's breathing is difficult or noisy.  Suctioning clears the tracheostomy of secretions that close off the tracheostomy or may strangle the patient.  Your nurse will help you learn this skill.

1. Wash hands
2. Have the patient sitting, raise the head of the bed or prop the patient up on several pillows.
3. Place a towel on the patient's chest below the tracheostomy opening.
4. Pour a small amount of normal saline or boiled water into a container.
5. Turn on the suction machine and set the pressure on a medium setting.
6. Attach the suction catheter to the suction machine tubing.
7. Suction a small amount o normal saline or sterile water through the catheter to be sure the suction is working.
8. Without using suction, insert the catheter 4-5 inches into the tracheostomy tube or until patient coughs.
9. Suction 5-10 seconds rotating the catheter between you thumb and forefinger while slowly withdrawing it..
10. Withdraw the catheter completely and flush the catheter with normal saline or boiled water.
11. Allow the patient to breathe deeply and cough between suctioning.
12. Do not suction more than 3-5 minutes.
13. Turn off suction-disconnect the catheter.
14. Clean the equipment with warm soapy water.
15. Empty suction collections bottle into toilet when half full.
16. Restock supplies for next use.

Tracheostomy Stoma Care

The skin around a tracheostomy tube must be cleaned daily and more often if needed.  Your nurse will help you learn how this is done.

Equipment Needed:

2 clean basins
hydrogen peroxide
normal saline or boiled tap water
gauge pads without cotton
cotton tipped applicators
pipe cleaners or a small brush
tracheostomy ties
wash clothes
towel
scissors

1. Wash hands
2. Pour normal saline or boiled water into one basin.
3. Pour hydrogen peroxide into another basin.
4. Ask patient to cough and then suction the tracheostomy tube.
5. Remove the inner cannula and place it into the basin of hydrogen peroxide so that is is covered by the peroxide.  Let is soak.
6. Remove the dressing from the tracheostomy and throw it away.
7. Clean the skin around the tracheostomy tube using a gauge sponge or a cotton tipped applicator moistened with hydrogen peroxide.  Do not allow peroxide to run down into the tracheostomy.
8. Use another gauge sponge or cotton tipped applicator moistened in normal saline or  boiled water to clean of the peroxide.
9. Gently pat the skin dry.  Notice the condition of the skin.  It should be  a normal, healthy color and unbroken.
10. Change the tracheostomy ties if needed.  Hold the tracheostomy tube in place while changing the ties.  Keep the tracheostomy tube in place at all times by either holding in place or with ties.
11. Replace dressing around the tracheostomy tube using special tracheostomy gauge.
12. Clean inner cannula with a small brush or pipe cleaners.
13. Rinse the inner cannula with the normal saline or boiled water in the second basin.
14. Dry the inner cannula well and replace it.
15. Clean equipment with warm soapy water.

Mouth Care

If a person cannot clean his mouth himself it should be cleaned for him.  Do this 3-4 times daily and as needed.  Your nurse will answer any questions you may have.

1. Place a towel under the chin.
2. Use gauge covered tongue blades or cotton tipped applicators moistened with water and clean mouth well.
3. You may then use a clean gauge covered tongue blade or cotton tipped applicator moistened with mouth wash to freshen the mouth.
4. Apply lip moisturizer such as vasoline or mineral oil.

Be very careful not to allow any liquid to run back into throat and strangle the patient.

To Make Normal Saline:

To a quart of water add 3 teaspoons of table salt and boil 10 minutes.  Cool.  Place in jars which have been boiled 10-20 minutes.

To Make Sterile Water:

Boil tap water 10 minutes.  Cool.  Place in jars that have boiled 10-20 minutes.

To Sterilize Reusable Equipment:

Place in a pan and cover with water and boil 10-20 minutes.  If desired place items in a strainer to keep them off the bottom of the pan.  Place in a clean dry towel and store in a drawer or cabinet.

Sources:

1. St. Dominic Nursing Service Procedures Manual
2. Home Care Manual, Ravinski/Zastocki
3. Textbook of Medical-Surgical Nursing Sixth Edition, Brunner/Suddarth
4. Helping a Laryngectomy Patient Go Home by Rita Patry-Lahey, RN, BSN, MA
   Article in Nursing '85, March
5. Fundamentals of Nursing, Third Edition, by Barbara Kozier, Glenora Erb

This is only a guide.  It is not meant to supercede any physician's or manufacturer's instructions.