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.

Purposes: 

 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

 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?

Stoma care supplies

  1. tracheostomy cleaning supplies
  2. your child’s tracheostomy change kit
  3. additional equipment and supplies

Images of tracheostomy cleaning supplies listed above.

Tracheostomy cleaning supplies

  1. Disposable container (or clean cup that you can reuse) for water
  2. Saline nebules
  3. Gauze pads
  4. Wet face cloth and dry face cloth

Tracheostomy change kit contains:Images of emergency tracheostomy supplies.

  1. Tracheostomy tube with ties attached and obturator of the same size
  2. Tracheostomy tube one size smaller with ties attached and obturator
  3. Clean pre-cut tracheostomy gauze (dressing)
  4. Manual suction device: 20 mL syringe with feeding tube attached (in case the suction machine does not work)
  5. Water soluble lubricant
  6. Round-ended scissors
  7. Normal saline nebules (small, sealed tubes filled with saline)

Images of additional tracheostomy equipment listed above.

Additional tracheostomy equipment and supplies

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?

Purposes

What are the main complications of tracheal suctioning?

Contact health care provider if: