Tracheotomy Care

RESPIRATORY MANAGEMENT IN SPINAL CORD INJURY: BREATHING AND THE RESPIRATORY SYSTEM IN SCI: TREATMENTS FOR RESPIRATORY TRACT COMPLICATIONS: TRACHEOSTOMY CARE

Caring for your Tracheostomy

Preventing Water from Entering Tracheostomy - Following are some of the ways you can prevent water from entering your tracheostomy:

Do not swim
When showering: direct the water spray at chest level, and place the shower shield over your tracheostomy or hold a dry washcloth in your teeth.
Keep soap and water from entering your tracheostomy when washing your face
Use care when powders, after shave, or aerosols are directed toward your face
Avoid contact with people with respiratory infections (colds)

Suctioning - The following equipment is needed for suctioning your tracheostomy tube.

Sterile suction kit
Normal saline solution
Suction machine
Ambu-bag

Following is the procedure for suctioning:

Wash your hands, and then open the sterile suction kit
Put on the sterile gloves. Keep your dominant hand "sterile" by making sure you do not touch the outside of the glove that is going on your dominant hand.
Using your dominant "sterile" hand, attach the sterile suction catheter to the suction tubing which you will hold in your non-dominant "dirty" hand.
Using your non-dominant "dirty" hand, attach the ambu-bag to the tracheostomy tube and give 3-5 "deep breaths".
Remove the ambu-bag from the tracheostomy tube. With your dominant "sterile" hand, insert the suction catheter into the tracheostomy tube, keeping your non-dominant thumb off the suction port. Insert the catheter as far as it will go without using force.
Place your non-dominant "dirty" thumb over the suction port to produce suction. Rotate the catheter between your dominant "sterile" thumb and forefinger, gradually withdrawing the catheter. As you withdraw the catheter from the tracheostomy tube, apply intermittent suction by moving your non-dominant "dirty" thumb up and down on the suction port. Do not suction for longer than 10-15 seconds.
Flush the suction catheter with the sterile solution in the suction kit.
Again, attach the ambu-bag to the tracheostomy tube and, using your non-dominant "dirty" hand, give 3-5 deep breaths.

If secretions are thick, squeeze normal saline into the tracheostomy tube. With your non-dominant "dirty" hand, use the ambu-bag to give deep breaths and then repeat the suction technique. This will help "thin" secretions.

You may suction your mouth after your tracheostomy tube has been suctioned. Never suction your mouth and then your tracheostomy.

Cleaning the Suction Catheter - Suction catheters must be cleaned after each use to keep to prevent putting bacteria into your tracheostomy when you use the catheter. The following equipment is needed to clean the suction catheter:

Soap
Tap water
Cooled boiled water
Bulb syringe
Dry, clean towel or handi-wipe

Following is the procedure for cleaning the suction catheter:

Wash the suction catheter with soap and water, using the bulb syringe to force soapy water and rinse water through the catheter
Rinse catheter in boiled water
Dry catheter with lint-free cloth or handi-wipe
Store catheter in a dry towel or in a clean baggie (several catheters can be stored together)

Throw catheter away if secretions cannot be removed, or if catheter becomes cloudy or cracks.

Cleaning the inner cannula - The inner, removable tube of the tracheostomy tube is the inner cannula. Secretions must be removed from the inner cannula to keep the tracheostomy tube open. Following is the procedure for cleaning the inner cannula tube:

Wash your hands
Gently remove the inner cannula
Wash with mild soap and tap water; rinse very well in boiled water. If secretions are hard to remove, soak in Hydrogen Peroxide or normal saline; use a small percolator brush to clean secretions from the inside of the inner cannula
Suction through the outer cannula
Shake excess moisture from the inner cannula, removing lint.
Grasp the collar of the outer cannula and insert inner cannula; lock in place
Wash skin around the tracheostomy with soap and water; rinse well with tap water and dry with a clean cloth
If there are secretions around the tracheostomy tube, apply folded 4" x 4" dressing

Tracheostomy with Dressing

The inner cannula needs to be cleaned at least once a day (cleaning every 8 hours is best). Skin around the tracheostomy can also be cleaned at the same time. Do not leave a regular inner cannula out more than 10-15 minutes while cleaning. Inner cannula can be stored in a clean jar with a lid.

Cleaning connecting tubes on suction machine - These tubes must be cleaned to prevent too many bacteria from getting into the suction equipment. Clean daily with soap and water; rinse well with hot water.

Cleaning drainage bottle - The drainage bottle must be emptied once a day. Clean it with soapy water and rinse it well with hot water.

Annual Tests

Pulmonary Functions Tests (PFT's) is a series of breathing maneuvers and measurements that assess the function of the lung, diagnose pulmonary abnormalities and assess the response of the lungs to medications.

Vital Capacity is the amount of air that can be forcibly expelled from the lungs after breathing in as deeply as possible.

Surgical Interventions

Phrenic Pacemaker is an implantable diaphragmatic phrenic nerve stimulator that provides support for patients with chronic ventilatory insufficiency whose diaphragm, lungs, and phrenic nerves have little function.