Tracheostomy : Stoma care and Management
A tracheostomy is a surgical opening into the trachea below the larynx through which an indwelling tube is placed to overcome upper airway obstruction, facilitate mechanical ventilator support and/or the removal of tracheo-bronchial secretions.
Stoma Care: Daily cleaning of the stoma with sterile water and cotton swabs at least twice daily is recommended.
- To maintain airway patency by removing mucus and encrusted secretions.
- To maintain cleanliness and prevent infection at the tracheostomy site
- To facilitate healing and prevent skin excoriation around the tracheostomy incision
- To promote comfort
- To prevent displacement
Tracheostomy Tube Changes (see diagram)
The average trach tube is changed every 1-2 weeks, but the range is from daily to every 2 months. Patients with chronic lung disease and/or increased secretions often need more frequent changes.
Trach ties are made of several different products including cotton twill, foam backed, or stainless steel. They may connect by tying or velcro. Patients often develop rashes and/or skin breakdown under them because of leaking secretions, perspiration, the short length of a child’s neck, and/or skeletal deformities such as torticollis or scoliosis.
How do I prepare to clean my child's stoma?
- Make sure your child’s tracheostomy tube has been suctioned and your child has recovered (is breathing normally again and not coughing). Keep the suction catheter clean and available in case you need it again during the stoma cleaning.
- Make sure the tracheostomy tube is stable and not at risk of falling out while you clean the skin.
- Gather your equipment and supplies.
Stoma care supplies
- tracheostomy cleaning supplies
- your child’s tracheostomy change kit
- additional equipment and supplies
Tracheostomy cleaning supplies
- Disposable container (or clean cup that you can reuse) for water
- Saline nebules
- Gauze pads
- Wet face cloth and dry face cloth
Tracheostomy change kit contains:
- Tracheostomy tube with ties attached and obturator of the same size
- Tracheostomy tube one size smaller with ties attached and obturator
- Clean pre-cut tracheostomy gauze (dressing)
- Manual suction device: 20 mL syringe with feeding tube attached (in case the suction machine does not work)
- Water soluble lubricant
- Round-ended scissors
- Normal saline nebules (small, sealed tubes filled with saline)
Additional tracheostomy equipment and supplies
- Sterile water and container
- Good source of light
- Suction machine, tubing and adjuncts
- Manual resuscitation bag with tracheostomy adaptor and the appropriate sized mask
- Oxygen, if needed
- Oximeter and probes
- Small towel or blanket, to help your child stay in position
Suctioning a Tracheostomy Tube
Suctioning of tracheostomy tube is only done as necessary. Sterile technique must be observed. Nurses should be aware that there is a frequency for the need of suctioning during immediate postoperative period.
How to suction a tracheostomy tube?
- Removes thick mucus and secretions from the trachea and lower airway to maintain patent airway and prevent airway obstructions
- To promote respiratory function (optimal exchange of oxygen and carbon dioxide into and out of the lungs. lungs
- To prevent pneumonia that may result from accumulated secretions
What are the main complications of tracheal suctioning?
- Acute airway obstruction.
- Blocked tube (occluded cannula or mucous plugging)
- Infection (localised to stoma or tracheo-bronchial)
- Tracheal trauma.
- Dislodged tube.
- Stomal or tracheal granulation tissue.
- Tracheal stenosis.
Contact health care provider if:
- Tracheostomy tube becomes displaced
- Childs develops fever
- Child is having an increased amount and frequency of mucus production
- Mucus is green or dark in color and/or is foul smelling.