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September 5, 2023/Health Conditions/Lung

How To Do Trach Care at Home

Practice and patience are key

person in wheelchair at home with tracheostomy tube

A tracheostomy is a hole, or stoma, that surgeons make in the front of your throat to help you breathe. With the help of loved ones or caregivers, managing a new tracheostomy (trach) at home can become second nature.

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“Trach care is a team sport,” says head and neck specialist William Tierney, MD. “Tracheostomy care can and should be done safely to maintain the health of your trach, prevent complications and get you through this rough period and eventually decannulated, which is when a doctor removes your trach tube.”

Dr. Tierney says trachs are highly individual — care of a tracheostomy often depends on why you have one and other personal factors. Here, he explains how to do trach care at home — and when to reach out to your healthcare provider for help.

What you need to care for your tracheostomy at home

Typically, a social worker or case manager ensures you have everything you need (or a way to get it) before you leave the hospital. But if the buck stops with you, make sure you get a prescription for the right supplies from your medical team. Then, send your prescription to a medical supply company near your home.

“Find a company that does respiratory care. If you can’t, be specific about your needs,” advises Dr. Tierney. “Unfortunately, medical supply companies in some parts of the country don’t have employees who know what equipment is necessary.”

The type of tracheostomy you have and the recommendations of your surgical team determine what supplies you need. In general, you’ll need some variation of this list of supplies:

  • Inner and outer cannulas.
  • Suction machine and suction tubing.
  • Tracheostomy ties and padding.
  • Replacement tracheostomy tubes delivered at regular intervals.

Using and caring for trach supplies

It’s important that you properly care for your trach supplies and that you use them the correct way. Dr. Tierney offers some guidance.

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Tracheostomy tubes

A tracheostomy tube is the piece of medical equipment your surgeon placed inside your windpipe during a tracheotomy procedure. The outer cannula is usually a hard tube that keeps your stoma open and the inner cannula fits within it. Some tracheostomy tubes have an inner cannula and others don’t.

How to care for tracheostomy tubes

Replace your tracheostomy tubes based on the manufacturer’s recommendations — usually every 28 days.

“You and your provider should develop a plan for tracheostomy tubes changes. Initially, your provider should do it. But eventually, we recommend that patients and families get comfortable replacing tracheostomy tubes on their own,” says Dr. Tierney. “Should the trach dislodge at home, you then have a way to replace it. You can get back to safe breathing without a visit to the emergency department, which could be an hour away.”

Inner cannulas

Inner cannulas are removable plastic tubes that fit inside the outer cannula. They act like liners, making it easier to clean and maintain your tracheostomy. If the inner cannula is blocked with mucus, you can simply remove it while leaving the tracheostomy tube in place and continuing to breath safely. Your trach may require reusable or (nondisposable) or disposable inner cannulas.

“If it’s reusable, clean the inner cannula and reinsert it after. If it gets soiled, you can throw it away and put in a new one,” says Dr. Tierney. “If disposable, you’ll need a lot of inner cannulas, so it’s important to develop a relationship with your medical supply company. Then, you can reorder them when you’re running low.”

If using reusable cannulas, you may want to keep several on hand to make cleaning easier.

How to care for inner cannulas

Replace disposable cannulas or clean reusable cannulas at least daily, advises Dr. Tierney.

“As a safety measure, we usually have people put in another inner cannula while they clean the other,” he adds.

To clean reusable cannulas:

  1. Wash your hands before handling your trach equipment.
  2. Remove the inner cannula.
  3. Soak it in a sterile solution for about five minutes. You can use tracheostomy cleaning kits or make a solution that’s one-quarter or half hydrogen peroxide and the rest water. This process softens up secretions within the tube.
  4. Remove the inner cannula from the solution and clean it. “Special trach cleaning kits with little brushes are available to remove debris and mucus,” notes Dr. Tierney. “Or you can use clean pipe cleaners or cotton swabs.” If you have any questions, you should address them with your tracheostomy provider.
  5. Dry the cannula with a dry paper towel or pipe cleaner that won’t leave debris in the tube.
  6. Reinsert the inner cannula into the tracheostomy tube.

Suction machine

Mucus secretions are a natural part of breathing. But when you have a tracheostomy, at first your body makes more mucus than usual as it adjusts to the change.

“Your airway gets dry, so you’ll produce more mucus until you get used to having the trach,” explains Dr. Tierney.

When you have too much mucus in your trach tube, it can affect your ability to breathe. A suction machine clears out the mucus. It may come with disposable suction cannulas.

When to suction

Dr. Tierney recommends suctioning anytime you feel like you have excessive mucus. The right suction depth is not one-size-fits-all: Do it at a depth that doesn’t cause coughing and irritation.

He usually has his patients start suctioning at least three times per day. Over time, they can choose to do it more or less based on what it takes to keep their trach clean and clear.

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“Suctioning too much can irritate your airway, leading to bleeding or extra mucus. Suctioning too little can lead to more frequent mucus blockages in the inner cannulas,” further explains Dr. Tierney. “If you have any questions, your provider can walk you through how to safely do it.”

Tracheostomy ties and padding

Tracheostomy ties are the collars you wear around your neck to anchor your trach in place. Your tracheostomy tube has a plate (flange) that sits against your skin on the outside of your throat.

The trach tie goes around your neck and connects to both sides of the plate on the outer cannula. Padding makes trach ties more comfortable to wear.

Fitting your tracheostomy ties

Return your trach tie to the right tightness after replacing or loosening it.

“Get the right fit by putting two fingers flat on your neck between the trach tie and your neck. Then tighten it,” instructs Dr. Tierney. “When you remove your fingers, it should be tight enough to keep the trach in, but loose enough so the tie isn’t too tight.”

How to care for the skin around your stoma

A good skin care regimen can protect your skin.

“If mucus sits on your skin too long, it can cause irritation. And if it’s neglected too much, it can eventually cause some skin breakdown,” warns Dr. Tierney.

A split gauze is a 4-inch-by-4-inch gauze square with a cut down the middle that makes it look like a “U.” It sits between your skin and trach. Dr. Tierney recommends changing it at least daily and whenever it gets wet or soiled.

“It can be tricky, but you should learn how to do this before you leave the hospital,” he adds. “If you didn’t, contact a healthcare provider who can teach you how.”

To place a new piece of split gauze:

  1. Put the gauze underneath your trach plate in a “U” configuration. The trach tube should split the two sides of the “U.”
  2. Make sure the split gauze lays flat against your skin and underneath the plate. Be careful to keep the trach in your neck as you do it.

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Trach care cautions

Dr. Tierney says follow these four tips to prevent — and handle — tracheostomy complications:

  • When cleaning around your stoma. Some redness and tenderness may happen as you start caring for your new tracheostomy. But it should clear up as you get more experienced. If it doesn’t, or you notice worsening symptoms — such as a rash, odor or yellow or green discharge — call your surgeon.
  • If your trach tube falls out. If your tube falls out partially, don’t panic. Dr. Tierney says you can usually push it back in on your own. But seek emergency care if you can’t reinsert it. “Also, if you’re having trouble breathing, call 911,” he says. “You should also seek emergency treatment if your trach falls out completely. A stoma will close within hours of a trach falling out.”
  • When bathing. Don’t submerge your tracheostomy tube or run water directly over it. Unfortunately, that means swimming is out until your trach is also out. “When showering, position the shower head so water doesn’t run over your neck,” Dr. Tierney adds. “Once you’re done, carefully replace your wet trach ties with dry ones.”
  • When preparing for decannulation. Decannulation is when your surgeon removes your trach. Your surgical team may plug, or cap, your tracheostomy to check your readiness for this procedure. Follow their directions to prevent complications. “A tracheostomy cap should only be placed under the supervision or direction of a medical provider,” states Dr. Tierney. “And don’t wear one while sleeping unless your provider tells you to.”

Now for the good news: Dr. Tierney says that most tracheostomies are temporary. With practice and patience, you can successfully care for one at home.

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