Cleaning and Caring for Tracheostomy Equipment

Cleaning suction catheters at home

Suction catheters must be cleaned after each session of suctioning. This helps prevent infection as well as helps cut down costs by reusing the same catheter for one week.

After suctioning the trach tube:

1.     Pour a few ounces of hydrogen peroxide into a small clean container.

2.     Suction hydrogen peroxide through the catheter until it is free of mucus. Wipe the outside of the catheter with a cloth or gauze wet with peroxide.

3.     Suction sterile salt water through the catheter until it is free of peroxide.

4.     Suction air until the catheter is free of water.

5.     Remove the catheter from the connecting tubing and let it air dry.

6.     Wrap it in a clean dry towel.

7.     Use it as needed with this cleaning process each time for up to 8 hours, then THROW IT AWAY.

8.     Follow manufacturer's instruction for cleaning and disinfecting your suction machine and humidifier. Do not allow water to stand in your humidifier when not in use.

Cleaning the tracheostomy inner cannula tube (for reusable inner cannulas only)

The tracheostomy inner cannula tube should be cleaned two to three times per day or more as needed. Please note that this only applies to reusable inner cannulas.Cleaning is needed more immediately after surgery and when there is a lot of mucus buildup.

Equipment

• Small brush or pipe cleaners
• Half-strength solution of hydrogen peroxide (1/2 water, 1/2 hydrogen peroxide)
• Saline or homemade sterile salt water
• Two small bowls

Procedure

1.     Wash your hands.

2.     Place 1/2 strength peroxide solution in one bowl and sterile salt water in second bowl.

3.     Remove the inner cannula while holding the neck plate of the trach still.

4.     Place inner cannula in peroxide solution and soak until crusts are softened or removed.

5.     Use the brush or pipe cleaner to clean the inside, outside and creases of the tube.

6.     Do not use scouring powder or Brillo pads.

7.     Look inside the inner cannula to make sure it is clean and clear of mucus.

8.     Rinse tube in saline or sterile salt water.

9.     Re-insert it while holding the neck plate of the trach still.

10.   Turn the inner cannula until it locks into position.

11.   Double check the locking pulling forward gently on the inner cannula.

Tracheostomy Complications

The surgeon will perform the first tracheostomy tube change to ensure that the stoma and tracheostomy site heal properly.  If the stoma is ready (usually 1-2 weeks after surgery), the otolaryngology team will teach the caregivers how perform a tube change.  It is important that caregivers feel confident and competent in tube changing before leaving the hospital in case an emergency tube change is needed.  The procedure is not without risks and in order to be as safe as possible, it is important to have two people present.  

Secretions from the lungs coat the inside of the tracheostomy tube requiring the tube to be changed once a week, although some patients may be fitted with a different tube that can be left in longer. The tube may have to be changed more often if secretions become very dry or if the patient has a chest infection and is producing more and thicker secretions. Always change the trach tube before a feeding or wait for at least two hours after a feeding to avoid vomiting and resulting spillage of vomitus into the windpipe.

Instructions for tube changing

1.     Prepare equipment:
- Suction catheter and suction machine in working order
- two lengths of 1/4 inch cotton tapes or Velcro strap
- new tube - check correct size and that the tube is intact and in good order
- a smaller sized tube (one incremental size smaller) in case the usual one will not go in
- water-based lubricant to prevent the tube sticking to the skin as it is inserted
- round-ended scissors

2.     Wash your hands.

3.     Prepare tube - take out of wrapping and hold by the flanges. Put in introducer (if applicable). Carefully apply a small amount of lubricant to the outer side of the end of the tube, ensuring no lubricant gets into the ends of the tube. Place the ties or strap on the new tube. Place the tube on the wrapper.

4.     Have all equipment within easy reach.

5.     Suction if necessary.

6.     Position the patient as you do for tape changing.

7.     Have one person hold the tube while the other cuts and remove the dirty tapes and place clean tapes behind the patient’s neck.

8.     The tube should continue to be held while the other person holds the new tube by the flanges and positions the tip near the patient’s neck.

9.     Gently remove the old tube following the curve of the tube.

10.   Firmly and gently slide in the new tube, again following the curve of the tube so as not to damage the trachea. Remove introducer if this has been used.

11.   Hold the new tube securely in place - changing the tube may cause the patient to cough, which could dislodge it.

12.   Allow the coughing to settle. Check air flow through the tracheostomy tube by feeling the air flow onto your hands and the patient’s breathing pattern and color. Suction if necessary.

13.   Clean and observe the skin around the tube.

14.   Tie the tapes.

15.   Do not let go of the tube until the tapes are secure.

Source:http://www.hopkinsmedicine.org/tracheostomy