When you have a tracheostomy, a doctor creates an opening in your neck to place a trach tube in your windpipe to help with breathing. You may need one for a variety of reasons, like an airway obstruction, chronic aspiration, or long-term mechanical ventilation.
Trach tube placement may be planned (elective) or happen in an urgent or emergency situation. It can also be temporary or permanent. Once the tube is placed, you’re in a stable condition, and you and a caregiver have been trained in tracheostomy care, you may be able to go home and get back to doing things you enjoy.
Let’s learn more about how to care for a tracheostomy at home.
Living with a Tracheostomy
Tracheostomies can introduce several challenges physically and emotionally. There are risks of mucus blocking the tube and food or liquid entering the airway. You may be limited in activities if you need a ventilator to help with breathing. And you’ll likely need new ways to communicate, which may mean writing or typing messages, learning sign language, or using a speaking valve.
But with support and adaptation, you can have a trach tube and still eat, drink, exercise, go to work or school, travel, and be at home on your own or with a caregiver.
Living with a trach tube every day means knowing your individual health limits and learning about tracheostomy maintenance and best practices.
Tracheostomy Care Basics
Healthcare practitioners will make sure you and your primary caregiver have home-care instructions and training before leaving the hospital. It’s important to know how a trach tube works and what equipment to have on hand.
Components of a Trach Tube
The hollow, curved tube placed in the trachea often has two main parts: the outer cannula and the inner cannula.
The outer cannula stays in the trachea and keeps the surgically created opening—the stoma—from closing. It may have a balloon-like cuff near the tip to help secure the tube and seal the airway.
The inner cannula fits inside the outer cannula and can be removed for cleaning.
Tracheostomy Tools and Equipment
You may have slightly different equipment at home than healthcare workers use at the hospital. These are the basic must-haves for trach tube safety, hygiene, and emergency preparedness:
- Suction Machine and Catheters: For clearing the airway
- Cleaning Supplies: Sterile water or saline, mild soap, 3% hydrogen peroxide solution, disposable trach tube brushes, cotton swabs, non-linting 4x4 gauze pads, sterile gloves, and a sterile bowl for holding cleaning solution
- Extra Trach Tubes and Ties: Same size and one size smaller for routine changes or emergencies
- Obturator: A tool with a rounded tip that guides the tube during reinsertion
- Backup Supplies and Power Sources: For ventilator-dependent patients in case of outages
- Heat and Moisture Exchanger or Humidifier: To keep the airway moist and prevent mucus plugs
- Pulse Oximeter: Optional, to help monitor blood oxygen levels
Daily At-Home Tracheostomy Care Guidance
Performing trach tube care at home every day is essential. You’ll need to know how to keep the tracheostomy components clean and clear of secretions. Proper care helps prevent infections and blockages. It may seem daunting at first, but it usually becomes second nature with practice.
If you sense there is an emergency at any time—such as a sudden difficulty with breathing, a blockage that cannot be cleared, a severe drop in oxygen levels, unconsciousness, or uncontrolled bleeding—call 911 for assistance.
These are the general procedures for suctioning, cleaning, and changing the trach tube, but always follow the instructions and training shared by your healthcare provider.
Suctioning the Trach Tube
Tracheostomy suctioning is critical before cleaning the tube, before meals, after vomiting, and whenever needed to clear excess secretions and keep a clear airway.
Signs you may need to suction the trach include a rattling or bubbling sound, fast or labored breathing, visible secretions, signs of respiratory distress like anxiety or restlessness, and a drop in oxygen level.
These are the main steps to follow for tracheostomy suctioning:
- Wash your hands thoroughly.
- Take deep breaths and cough up secretions. Wipe away anything expelled before suctioning.
- Connect a sterile suction catheter to the suction machine tubing.
- If instructed by a doctor, dip the catheter tip in sterile water or saline to moisten it.
- Insert the catheter into the trach to the premeasured length, until you feel resistance, or you start to cough (whichever comes first).
- Cover the thumb control to activate suction, then withdraw the catheter slowly using a gentle circular motion (or roll it between your fingers).
- Do not suction for longer than 10 seconds at a time.
- Wait 30 seconds between suctioning passes. Focus on deep breathing and coughing during this time.
- Repeat until all secretions have been removed. (Tip: If secretions are thick, have sterile water or saline in a cup nearby to clear the catheter between passes.)
- If it remains clear, you can use the same catheter for multiple passes, but switch to a new catheter if it becomes clogged.
- Clean up and dispose of used supplies. Wash your hands again.
Cleaning the Inner Cannula
You should clean the inner cannula every day using the following steps:
- Wash your hands thoroughly.
- On a clean surface nearby, lay out a tracheostomy care kit that includes the listed cleaning supplies as well as trach ties, and arrange them on a clean surface.
- Fill the bowl with a 3:1 mix of sterile water or saline and hydrogen peroxide. Set aside.
- Suction the trach.
- Unlock and remove the inner cannula. Place it in the bowl with the solution and let it soak until it stops foaming.
- Use the small brush to clean the cannula inside and out.
- Rinse the cannula with water or saline and dry thoroughly before reinserting.
- Hold the trach carefully in place, remove the old trach ties, and clean the neck with water or saline. Look for redness or irritation that needs to be treated.
- Dry the area and replace the ties with clean ones. The ties should hold the trach securely in place, but you should be able to fit two fingers between the tie and the neck.
- Clean up and dispose of used supplies. Wash your hands again.
Caring for the Stoma
Cleaning the stoma at least once a day and keeping it dry can help prevent skin problems and infections. Follow these steps for proper stoma care:
- Wash your hands thoroughly.
- Remove any dressing and inspect the stoma for redness, broken skin, or moisture.
- Clean around the tube and under the flanges with a clean cloth or cotton swabs moistened with sterile water or saline.
- Dry the area thoroughly and apply any ointments or dressings as prescribed.
- Clean up and dispose of used supplies. Wash your hands again.
Changing the Outer Cannula
You may need to change the outer cannula on occasion. Your healthcare provider will tell you how often you should change it, but always keep a fresh one on hand just in case.
- Wash your hands thoroughly.
- Ensure the new outer cannula and new inner cannula are free of damage, odors, and oily substances.
- Try the obturator on the outer cannula to be sure it’s easy to insert and remove.
- Attach clean ties to one side of the new tube.
- Lubricate the tip of the new tube, if recommended. Set aside.
- Suction the trach that’s already in place before removing it.
- Have a helper hold the trach tube already in place while you remove the ties.
- Remove the old tube and use the obturator to place the new tube in the stoma with a smooth, curving motion.
- Hold the new tube in place and remove the obturator.
- Have a helper secure the ties while you hold the tube in place.
- Attach the new inner cannula.
- Clean up and dispose of used supplies. Wash your hands again.
What to Know About Pediatric Tracheostomy Care at Home
Caring for a child with a tracheostomy may present additional or different challenges compared with adults. You’ll need pediatric-specific equipment and techniques and should be prepared to provide age-appropriate emotional support.
A child's anatomy is smaller and more delicate, and so is the tracheostomy equipment. Cannulas can become clogged more easily and may need to be suctioned more often. Pediatric caregivers may also need extra support if the child is unable or unwilling to cooperate with tube care.
It can help to have a daily routine that feels as normal as possible, but children may need closer monitoring and more help adjusting than adults. Try to normalize the experience through play, and explore different ways to support communication, especially if the child is preverbal or nonverbal.
How BrightStar Care Supports In-Home Tracheostomy Care
Tracheostomy care at home is achievable with the right training and equipment. Ongoing education and communication with healthcare providers will go a long way to help you feel confident in caring for yourself or a loved one who has a tracheostomy tube. Professional caregivers are also available, if you need trach tube care help or respite care.
After a tracheostomy, BrightStar Care® can help you get the care you need. Whether you're looking for in-home care services for yourself or your loved one or a reliable medical staffing partner for your organization, our experienced local care team members are ready to help. Find a location near you, contact us online, or call (866) 618-7827 to learn more about how BrightStar Care offers A Higher Standard®.