"Tracheotomy" is a surgical procedure that is usually done in the operating room under general anesthesia. A tracheotomy is an incision into the trachea (windpipe) that forms a temporary or permanent opening known as a "tracheostomy." Sometimes the words "tracheotomy" and "tracheostomy" are used interchangeably. The opening, or "stoma" is usually made in the area of the second to the fourth tracheal ring.

When a person has a tracheostomy, the air he breathes goes in and out through the neck, rather than passing through the nose, throat and larynx. This means that the air is not moisturized by the nasal membranes and that it does not pass through the vocal cords. Phonation, or speech, is not possible, therefore, unless the patient temporarily covers the stoma.

Some Airway Problems That May Require a Tracheostomy

• Tumors
• Laryngectomy
• Infections (e.g. epiglottitis)
• Subglottic stenosis or web
• Vocal cord paralysis
• Neck, larynx or mouth injuries
• Airway burns
• Need for prolonged respiratory support with ventilator
• Chest wall injury
• Neuromuscular diseases with weakened breathing muscles
• Coma

Tracheostomy Care

Movement of the trach tube and secretions can irritate the skin around the stoma. Daily care of the site is needed to prevent infection and skin breakdown. Care should be done at least once a day and more often if needed. Those with new trachs or on ventilators may need trach care more often. Tracheostomy dressings are used if there is drainage from the tracheostomy site or irritation from the tube rubbing on the skin.

Procedure

Have the patient in a comfortable position on his back with a small blanket or towel roll under the shoulders to extend the neck. After washing your hands, open Q-tips, trach gauze and regular gauze. Cut the trach ties to appropriate length (if these are to be changed).

Pour 1/2 strength hydrogen peroxide into one cup and sterile water into another. Clean the skin around the trach tube with Q-tips soaked in 1/2 strength hydrogen peroxide. Using a rolling motion, work from the center outward using 4 swabs, one for each quarter around the stoma and under the flange of the tube. Do not allow any liquid to get into trach tube or stoma.

Next, clean the area with Q-tip soaked in sterile water and pat dry with gauze pad. Change the trach ties if needed and check the skin under the ties.

Tuck pre-cut trach gauze around and under the trach tube flush to the skin. Do not cut the gauze or use gauze containing cotton because small particles may be inhaled. Use precut tracheostomy gauze or use two gauze pads, one placed under each wing of the tube. Be sure the trach dressing does not fold over and cover the tube opening. Change the dressing when moist, to prevent skin irritation.

Monitor skin for signs of infection. If the stoma area becomes red, swollen, or has a foul odor, call Doctor Caruana. Check before applying any salves or ointments near the trach. If an antibiotic or antifungal ointment is ordered by the doctor, apply the ointment lightly with a cotton swab in the direction away from the trach stoma and wash your hands thoroughly after trach care.

Care of Inner Cannulas

Some patients have trach tubes with an inner cannula. While some inner cannulas are disposable and should be discarded daily, reusable cannulas the cannula should be cleaned 1 to 3 times a day (or more often if needed). Do not leave the inner cannula out for more than 15 minutes.

Procedure

After washing your hands pour 1/2 strength hydrogen peroxide into a bowl or cup and normal saline or sterile water into another. Remove the inner cannula and place it into the 1/2 strength hydrogen peroxide. Soak it for a few seconds and use a brush to clean secretions from the inside and outside of the cannula. Place the cannula into normal saline or sterile water solution and rinse. Dry the excess water with a clean gauze pad.

Suction through the outer cannula if needed, then replace inner cannula. Make sure the cannula is "locked" in place in the trach tube and then wash your hands once again.

If you have any questions at any time about care of the tracheostomy, please call the doctor.