Tracheostomy care
Description
A tracheostomy is surgery to create a hole in your neck that goes into your windpipe. If you need it for just a short time, it will be closed later. Some people need the hole for the rest of their life.
The hole is needed when your airway is blocked, or for some conditions that make it hard for you to breathe. You may need a tracheostomy if you are on a breathing machine (ventilator) for a long time; a breathing tube from your mouth is too uncomfortable for a long-term solution. The tracheostomy provides a way for your health care providers to gradually remove the ventilator if possible.
After the hole is made, a plastic tube is placed in the hole to keep it open. A ribbon is tied around the neck to keep the tube in place.
Alternative Names
Respiratory failure - tracheostomy care; Ventilator - tracheostomy care; Respiratory insufficiency - tracheostomy care
When You're in the Hospital
Before you leave the hospital, health care providers will teach you how to do the following:
- Clean, replace, and suction the tube
- Keep the air you breathe moist
- Clean the hole with water and mild soap or hydrogen peroxide
- Change the dressing around the hole
Do not do strenuous activity or hard exercise for 6 weeks after surgery. After your surgery, you may not be able to speak. Ask your provider for a referral to a speech therapist to help you learn to talk with your tracheostomy. This is usually possible once your condition improves.
Self-care
After you go home, follow instructions on how to care for your tracheostomy. Use the information below as a reminder.
You will have a small amount of mucus around the tube. This is normal. The hole in your neck should be pink and painless.
It is important to keep the tube free of thick mucus. You should always carry an extra tube with you in case your tube gets plugged. Once you put in the new tube, clean the old one and keep it with you as your extra tube.
When you cough, have a tissue or cloth ready to catch the mucus coming from your tube.
Your nose will no longer keep the air you breathe moist. Talk with your provider about how to keep the air you breathe moist and how to prevent plugs in your tube.
Some common ways to keep the air you breathe moist are:
- Putting a wet gauze or cloth over the outside of your tube. Keep the gauze moist.
- Using a humidifier in your home when the heater is on and the air is dry.
A few drops of salt water (saline) will loosen a plug of thick mucus. Put a few drops in your tube and windpipe, then take a deep breath and cough to help bring up the mucus.
Protect the hole in your neck with a cloth or tracheostomy cover when you go outside. These covers can also help keep your clothes clean from mucus and make your breathing sounds quieter.
Do not breathe in water, food, powder, or dust. When you take a shower, cover the hole with a tracheostomy cover. You will not be able to go swimming.
To speak, you will need to cover the hole with your finger, a cap, or a speaking valve.
Sometimes you can cap the tube. Then you might be able to speak normally and breathe through your nose and mouth.
Caring for Your Tracheostomy
Once the hole in your neck is not sore from the surgery, clean the hole with a cotton swab or a cotton ball at least once a day to prevent infection.
The bandage (gauze dressing) between your tube and neck helps catch mucus. It also keeps your tube from rubbing on your neck. Change the bandage when it is dirty, at least once a day.
Change the ribbons (trach ties) that keep your tube in place if they get dirty. Make sure you hold the tube in place when you change the ribbon. Be sure you can fit 2 fingers under the ribbon to make sure it is not too tight.
When to Call the Doctor
Contact your provider if you have:
- Fever or chills
- Redness, swelling, or pain that is getting worse
- Bleeding or drainage from the hole
- Too much mucus that is hard to suction or cough up
- Cough or shortness of breath, even after you suction your tube
- Nausea or vomiting
- Any new or unusual symptoms
Call 911 or the local emergency number if your tracheostomy tube falls out and you cannot replace it.
References
Greenwood JC, Winters ME. Tracheostomy care. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 7.
Smith SF, Duell DJ, Martin BC, Aebersold M, Gonzalez L. Tracheostomy care. In: Smith SF, Duell DJ, Martin BC, Aebersold M, Gonzalez L, eds. Clinical Nursing Skills: Basic to Advanced Skills. 9th ed. Hoboken, NJ: Pearson; 2017:chap 30.6.
Reviewed By: Denis Hadjiliadis, MD, MHS, Paul F. Harron Jr. Associate Professor of Medicine, Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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