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Tracheostomy education: three things to teach patients

82628294 - nurse use suction machine, prepare to suction patient's mucus.A tracheostomy is a major, life-altering and potentially permanent procedure that will affect every part of a patient’s life. In addition to the medical treatment, tracheostomy education will be essential for recovery.

Tracheostomy education is an important part of the respiratory consultant’s job. Here are three things to ensure the tracheostomy patient or their caregiver understands before they’re discharged from the medical facility.

Three basics of tracheostomy education for patients

Regular cleaning is essential. The first lesson in tracheostomy education is to train the patient or caregiver how to clean the tube and the skin around it every day, or more often if the physician directs.

Gather these materials:

  • sterile gauze pads or other material that does not fray
  • cotton swabs
  • trach tube brush
  • bowl filled with saline solution or a mixture of saline and hydrogen peroxide, as recommended by the physician.

Ensure you have enough supplies for emergencies, including extra trach tubes, a manual ventilator bag, and a suctioning device with suction tubes.

  1. Wash your hands with soap and warm water, and put on clean, disposable, powderless gloves.
  2. To remove the inner cannula, or trach tube, hold the neck plate in one hand and use the other hand to unlock the inner cannula and gently remove it. Do not force it. If it won’t come out, contact your doctor.
  3. Soak a reusable inner cannula in the bowl of saline or hydrogen peroxide/saline solution. If you have a reusable inner cannula made of metal, use only saline solution, as peroxide can damage it. Throw out disposable inner cannulas.
  4. Clean the inner cannula with the trach tube brush. Do not use a toothbrush. Then rinse thoroughly in saline.
  5. Put the wet inner cannula back into the outer cannula and lock it into place.
  6. To clean the neck plate and skin, remove the gauze from behind the neck plate, checking for infection or damage to the skin. Use the clean gauze pads dabbed in saline to clean the neck plate and skin. Don’t use hydrogen peroxide on your skin unless your physician tells you to. Then rinse thoroughly in saline solution.
  7. Replace the gauze pad under the neck plate with a fresh, pre-cut one.
  8. Change any dirty cloth or Velcro ties that hold the neck plate in place. The patient will need someone to help.

Second: What to do if your trach tube gets plugged.

Mucus in the airway can sometimes build up and get thicker, which can plug up the trach tube. Patients or caregivers can follow these steps to clear the tube:

  1. Find a clean, well-lit place near a sink and mirror.
  2. Gather a suction machine, a clean suction catheter, and a small bowl of saline solution.
  3. Wash your hands in soap and warm water, and put on clean, disposable, powderless gloves.
  4. Attach the suction catheter to the machine and ensure it’s working by suctioning saline from the bowl. Set the power to the level the health care provider suggested.
  5. Take a few deep breaths (or have the patient take a few breaths).
  6. Insert the suction catheter into your (or the patient’s) trach tube, or cannula without turning on the suction. Stop when the patient begins to cough.
  7. Turn on the suction while slowly pulling the catheter out, moving it in a circle. If you (or the patient) need to suction more, relax and wait for at least 30 seconds. Rinse the catheter in normal saline before inserting it again.
  8. Don’t do more than three suctionings.
  9. When finished, turn off the machine, and discard the used catheter, water and globes.
  10. Know when to call the doctor. Call the doctor immediately for any of the following symptoms:
  • coughing, wheezing or shortness of breath
  • swelling around the opening
  • fever or chills
  • yellow, thick or bloody mucus
  • continued vomiting.

Where to go for tracheostomy education

For information, advice and help with tracheostomy education in Chicago Illinois, talk to the respiratory consulting specialists at PEL/VIP.