Tracheostomy tubes need to be kept clear and clean. Taking good care of your tracheostomy will help prevent infection, plugs or blockages, and breathing problems.
When your tracheostomy is new and you're still getting used to it, your health care team will handle caring for it. If you’re going home with a tracheostomy, your health care team will be sure you know how to take care of your tracheostomy, that you have the supplies you need, and that your caregiver knows what to do too. You will probably have help from home health care nurses to get you settled at home.
Securing your tracheostomy tube will help prevent the tube from accidentally coming out (dislodging or displacement). A tracheostomy opening will close up if the tube comes out and this can be dangerous. There is a higher chance of this happening in the first week or two while the tissue in the opening is still healing. If the tube does come out, you won’t be able to breathe well, and might not be able to breathe at all if the stoma closes off completely.
Your health care team will be sure your tracheostomy is secured using a dressing and tape. Sometimes patients have stitches when their tracheostomy is very new. If your tracheostomy is in place for a long time or is permanent, the dressing and tape might not be needed after a certain amount of time has passed and when certain complications are not expected.
Regular suctioning of a tracheostomy is often needed to keep the tube and opening free from extra mucus and drainage (secretions) that come from the lungs and tissue around the stoma. Sometimes these secretions can be cleared by coughing, but sometimes they can cause the tube to become plugged. This is more likely to happen when a tracheostomy is new or if you have other problems that are causing lots of secretions. Your health care team will listen to your lungs and chest area, and will monitor your oxygen level and amount of secretions.
If your tracheostomy needs to be suctioned, a clear tube called a suction catheter is put into the tube and hooked up to a machine that sucks out the extra secretions. This can be uncomfortable, but is needed to keep your airway clear.
If your tracheostomy has an inner cannula (a liner), it needs to be cleaned. Some inner cannulas are disposable, and others are reused after being cleaned. The cannula can be replaced with a new cannula if damaged or if a blockage cannot be cleared.
If secretions are very thick, or too thick to suction easily, you may have a humidifier in your room or at your bedside. A humidifier will help warm, moisten, and filter secretions so they are easier to clear and remove. Your health care team may also use small amounts of a solution when they are cleaning and suctioning to help loosen secretions.
How often suctioning is done depends on many factors. Newer tracheostomies may be suctioned frequently. The number of times a tracheostomy is suctioned per day will decrease over time, as long as the secretions are able to be cleared by coughing and no other problems happen. But sometimes the amount of secretions can change, so suctioning needs will vary.
If your tracheostomy has an inner cannula, the cannula is removed regularly to be cleaned. This is to be sure it doesn’t become plugged. You may also have an extra inner cannula to keep at your bedside in case the one being used can’t be cleared or comes out.
When taking a bath or shower, you should avoid getting water into the tracheostomy. Water that gets in can go into your lungs. It’s a good idea to cover the tube with something that still allows air to get in but doesn’t let water in, such as a piece of gauze. You can also shower with your back to the water.
You do not need special clothes for everyday wear. But you’ll want to avoid clothing that’s too snug or that blocks the tube so your airway stays clear.
Your health care team will clean the area around your stoma regularly. They will use different supplies depending on the type of tracheostomy and any problems you may be having.
If you’re going home or caring for your tracheostomy yourself, it’s important to let your health care team know of any reddened or swollen areas that you notice around your tracheostomy tube. This can be a sign of infection or other problems.
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American Thoracic Society. Living with a tracheostomy. Am J Respir Crit Care Med. 2016;194:5-6. Accessed at https://www.thoracic.org/patients/patient-resources/resources/tracheostomy-in-adults-2.pdf on October 2, 2019.
American Thoracic Society. Tracheostomy in adults. Am J Respir Crit Care Med. 2016;194:3-4. Accessed at https://www.thoracic.org/patients/patient-resources/resources/tracheostomy-in-adults-1.pdf on October 2, 2019.
American Thoracic Society. Use of a tracheostomy with a child. Am J Respir Crit Care Med. 2016;174:11-12. Accessed at https://www.thoracic.org/patients/patient-resources/resources/tracheostomy-in-child.pdf on October 2, 2019.
Patton J. Tracheostomy care. British Journal of Nursing. 2019;28(16):1060-1062.
Smiths Medical. A handbook for the home care of an adult with a tracheostomy. Accessed at https://www.smiths-medical.com/~/media/M/Smiths-medical_com/Files/Import%20Files/TR194416EN_LR.pdf on October 2, 2019.
Last Revised: October 16, 2019