Ear, nose and throat (Otolaryngology)

A guide for tracheostomy care at home

Introduction

A guide for tracheostomy care at home (© 2009 Children's Memorial Hospital)

These pages have been written to help you learn how to take care of your child at home with a tracheostomy. As you learn about the care your child needs, you may have a wide range of feelings. Please feel free to talk about your feelings or concerns with the nurses and doctors who are caring for your child. (Note to parents and professionals: Purchase a tracheostomy DVD and book set online; English and Spanish are available»)

Remember, before you leave the hospital, you will have many chances to practice all of the things that you will need to do at home. A nurse will always be with you as you are learning. You may find that reading these pages answers many of your questions. It may also help you to think of more questions. Please write down your questions so that you can ask the right people when you see them. If anything in these pages is confusing, please ask your nurse to explain it. The more you understand about your child's medical condition and care, the more comfortable you will feel at home.

Figure 1. Anatomy of the airway with tracheostomy tube inserted (© 2009 Children's Memorial Hospital)

Normal breathing

Normal breathing takes little effort or thought. Air is inhaled through the nose and passes through the breathing passages into the lungs (Figure 1). As air passes from the nose to the lungs, it picks up moisture and heat from the body. Oxygen from the inhaled air passes from the lungs into the bloodstream so that it can be used by the tissues and organs of the body.

The tracheostomy

Figure 2. Shiley trach tube (plastic) (© 2009 Children's Memorial Hospital)

You may already know the reason that your child needs a tracheostomy. If you are not sure, ask the doctor or nurse to explain your child's medical condition to you.

A tracheotomy is an operation in which a small opening is made into the windpipe (trachea) through a cut made in the skin on the neck. After the skin has healed, the opening is called a stoma or tracheostomy. A tracheostomy tube is kept in the stoma to keep the hole open. Sometimes you may hear people refer to the tracheostomy
simply as the “trach.”

There are two different kinds of tracheostomy tubes in this hospital:

• Plastic trach tubes, also known as Shiley tracheostomy tubes (Figure 2); and
• Silicone trach tubes, otherwise known as Bivona tracheostomy tubes (Figure 3).

Home care vs. hospital care

Figure 3. Bivona trach tube (silicone) (© 2009 Children's Memorial Hospital)

While your child is in the hospital, you will notice that the nurses will practice sterile technique (only used in the hospital) versus the clean technique which you will be using at home.

Sterile technique includes:

• Hand washing
• Wearing sterile gloves
• Using a new trach tube and tie

Clean technique includes:

• Hand washing
• Using gloves is optional
• Re-using a trach tube that has been properly cleaned
• Re-using the same trach ties if they are not soiled or wet

Since the home environment has fewer germs and fewer sick contacts, the clean technique can be used. For this reason several adaptations have been made. At home you may reuse tracheostomy tubes by using the proper technique for cleaning trach tubes. You may also reuse suction catheters but only in emergencies (for example if your size suction catheter is on backorder from your home health company or if you are traveling and have underestimated the amount of catheters you would need while away).

Information in this book will cover the following topics:

• Tracheostomy skin care
• Suctioning the tracheostomy
• Changing the tracheostomy tube
• Cleaning the tracheostomy tube
• Emergency care
• Daily activities

Content last reviewed: September 2009