Tracheostomy Management

What is a Tracheostomy?

A tracheostomy is a surgically made incision (stoma) in your windpipe or trachea, through which a tube is inserted to facilitate breathing. This procedure is used in situations when the airways become blocked, preventing the free flow of air into the lungs.

Indications for a Tracheostomy

Conditions that may require a tracheostomy include:

• Breathing difficulty caused by edema (swelling), injury, or pulmonary (lung) conditions
• Airway reconstruction following tracheal or laryngeal surgery
• Airway protection after head and neck surgery
• Long-term need for ventilator (breathing machine) support
• Congenital defects of the airway
• Diaphragm dysfunction
• Infection
• Obstruction of the airway by a foreign body
• Tumors
• Vocal cord paralysis

What is a Tracheostomy Tube?

A tracheostomy tube, available in different sizes and materials, is a small tube inserted into the tracheostomy to keep the stoma open. Different types of tubes used include cuffed and non-cuffed “trach” tubes. Cuffed tubes are usually advised for patients with difficulty swallowing or receiving medical ventilation. Non-cuffed tubes are meant for patients who do not require a ventilator. Other factors influencing the type and size of the tube include the patient’s condition, neck shape and size, and reason for the tracheostomy.

Tracheostomy Procedure 

• You will normally receive general anesthesia before the procedure; however, in cases of emergencies, a local anesthetic may be used.
• The tracheostomy procedure will begin once the anesthesia starts working.
• Your surgeon will make an incision into the cartilaginous rings of the outer wall of the trachea in your neck, below your Adam’s apple.
• Your doctor may attach the tracheostomy tube to a ventilator, in cases where assisted breathing is indicated. The tube will be secured in place with a band that goes around your neck.

Post-operative care

• Your surgical team will give you specific instructions on how to care for the wound and your tracheostomy tube.
• Your doctor will inform you when you are allowed to remove the outer cannula - the outer tube that holds the tracheostomy open.
• Tracheostomy covers should be used to protect your airway from outside elements such as dust, moisture, and cold air.

Tracheostomy Tube Management after insertion

You will be given specific instructions by your doctor. In general, regular care of the tracheostomy tube should be performed at least once a day and involves the following: 

• Your hands should be thoroughly washed using soap and water.
• Position yourself in front of the mirror in a comfortable manner.
• Suction the trach tube, following the instructions provided by your doctor.
• If your tube has an inner cannula, remove it and wash it with hydrogen peroxide and pipe cleaners or a small brush, and thoroughly rinse it in normal saline, tap water, or distilled water.
• Dry the inner cannula completely with a clean fine mesh gauze pad.
• Reinsert the inner cannula and make sure it is locked in place.
• Use a cotton-tipped swab dipped in a 1:1 mixture of water and hydrogen peroxide to clean the exposed portions of the cannula and the skin around the stoma.
• Use a washcloth dipped in normal saline, tap water, or distilled water to wipe away the hydrogen peroxide.
• Use a clean towel to dry the area and change the tracheostomy tube ties.
• Inform your physician if you notice any redness, hardness, tenderness, drainage, or a foul smell around the stoma.