Eighteen Best Tips for Tracheostomy Care

For someone with no experience, imagining how to provide proper tracheostomy care can seem quite daunting. A tracheostomy certainly looks a bit intimidating, and in truth, it is – taking care of a tracheostomy requires knowledge and practice. Otherwise, the tracheostomy is very prone to infection. 

Here are the top twenty tips for the best tracheostomy, or trach, care:

1. Follow instructions perfectly. Sometimes it might look like you can cut corners, but it’s not worth it. A trach can easily get infected and require much more care than simply doing things right the first time. Even if for every hundred times you repeat the same treatment only one might cause a problem, do it right the rest of the times – you don’t know which will be the odd time out.
2. Don’t just do the daily treatments, but constantly check for signs of infection. How to do this? You’ll need to wipe down the area around the stoma several times, a little bit a time, with a new, clean wipe each time, feeling for signs of skin breakage.
3. Use normal saline solution to clean. Only use hydrogen peroxide if the area is already infected, as it can irritate the skin.
4. Preempt infection by keeping the area around the stoma completely dry. Keep sterile trach dressings under the tube flanges to soak up any mucus or sweat that can irritate the area which can lead to infection.
5. Don’t change trach tubes right after a meal. This can aggravate the insides and bring about vomiting or general stomach upset.
6. Put in the new ties before you take out the old ones. That way, everything stays in place, making the whole process much easier and greatly reducing the risk of infection. But:
7. It may not always make sense to put the new ones in first. For example, the old ones may be very soiled, which would require removing them and making sure the entire area is completely clean, so the new ties don’t become soiled from the old ones. In this case, you can use two people to do the change. One person holds the track in place while the ties are being changed, giving the person changing them better ability to make sure it’s done efficiently.
8. Cleaning the inner cannula can be tricky sometimes, since secretions can get stuck. If that happens, soak the whole thing in a picture of half hydrogen peroxide. This will help get everything off easily.
9. Always have an extra cannula available you’re changing it in case for some reason it doesn’t fit back in or there’s another reason you can’t get it back in.
10. Use a lubricant that’s water soluble when you’re inserting the cannula for a smooth insertion. An oil-based lubricant may cause skin damage over time.
11. Have the patient take a deep breath before taking out the inner cannula. This will make it more comfortable for the patient and make the entire process go more smoothly.
12. Suction the tube whenever you think it’s necessary as opposed to on a particular schedule.
13. Suction the tube first, before the patient’s nose and mouth. This is to prevent oral bacteria from entering the trach tube, which could cause infection.
14. Wash hands and wear a mask and gloves for each procedure.
15. Always give the patient extra oxygen before you start the process, since they will not have it for a few moments during the changeover.
16. Have pinpointed suctioning. Each suctioning session will deprive the patient of oxygen, and that needs to be limited.
17. All equipment necessary for an emergency should always be on hand near the patient, not just during changing and cleaning sessions.
18. Use plain, cotton ties for pediatric patients instead of velcro, which can become dislodged.
19. When a new person learns the ropes, she should be accompanied a few times until she feels skilled and confident in the process.