Tracheostomy care involves maintaining the cleanliness and functionality of a tracheostomy tube, ensuring the patient’s comfort, and preventing complications. Below is a general guide to tracheostomy care:

1. Supplies Needed

• Sterile gloves
• Clean towels or drape
• Sterile water or saline
• Gauze or tracheostomy dressing
• Cotton-tipped applicators
• Suction catheter and suction machine
• Tracheostomy ties or holder
• Scissors (if needed)
• New tracheostomy tube (if replacement is necessary)
• Hydrogen peroxide (diluted, if used, but often avoided in some settings to prevent tissue damage)

2. Daily Tracheostomy Care Steps

Preparation

• Wash hands thoroughly and wear gloves.
• Position the patient comfortably, typically with the head slightly elevated.
• Gather all supplies.

Cleaning the Stoma

• Remove the old dressing gently.
• Use sterile water or saline with cotton-tipped applicators to clean around the stoma.
• Remove any secretions or crusting around the area.
• Dry the area with sterile gauze.

Inner Cannula Cleaning (if present and reusable)

• Remove the inner cannula by unlocking it (specific to the tube design).
• Soak the cannula in sterile water or a recommended cleaning solution.
• Brush or clean the inside with a small brush or pipe cleaner.
• Rinse thoroughly with sterile water.
• Reinsert the inner cannula securely.

Changing Tracheostomy Ties or Holder

• Have an assistant help stabilize the tracheostomy tube if needed.
• Remove the old ties while securing the tube in place.
• Clean the neck area to remove moisture or irritation.
• Attach new ties snugly but not too tight (you should be able to fit one or two fingers under the ties).

Changing or Replacing the Tracheostomy Tube (if required)

• This is typically done by a trained professional unless in an emergency.
• Follow aseptic technique and institutional protocols for replacing the tube.

Suctioning (if necessary)

• Turn on the suction machine and attach the suction catheter.
• Insert the catheter without applying suction until resistance is met (usually not more than 5-6 inches for adults).
• Withdraw the catheter while applying intermittent suction and rotating it.
• Limit suctioning to 10-15 seconds to prevent hypoxia.
• Allow the patient to rest between suction passes and monitor oxygen levels.

3. Key Considerations

• Infection Prevention: Maintain strict hygiene and aseptic technique.
• Comfort: Be gentle during care to prevent irritation or injury.
• Monitoring: Observe for redness, swelling, discharge, or changes in the patient’s breathing.
• Emergency Preparedness: Keep a replacement tracheostomy tube, obturator, and suction supplies nearby.

4. Signs of Complications

• Redness, swelling, or foul-smelling discharge around the stoma
• Difficulty breathing
• Excessive secretions or blockage
• Dislodgement of the tracheostomy tube
• Bleeding or skin breakdown around the site