Tracheostomy care
A tracheostomy is a surgical opening in the windpipe that is made to help with breathing. In head and neck cancer patients undergo this to bypass an obstruction in the upper part of the airway, which include the upper windpipe, voicebox, upper throat or the back of the mouth. They are usually placed for short periods of time (usually under two weeks, to tide over a temporary obstruction in the airway, such as swelling immediately after surgery) or longer periods of time (for months or for the foreseeable future, when it is unclear if and when the airway obstruction will resolve).
Types of tubes
Tubes are usually made out of metal (preferred for long-term use) or plastic. They can be single-lumen tubes or double-lumen tubes (a tube-inside-a-tube design). The inner tube fits within the outer tube and locks into place. The inner can be fenestrated (have a hole which allow some degree of speaking) or non-fenestrated (do not have a hole, to prevent leakage of fluid past the tube in to the lungs). Some tubes also have ‘cuffs’, which are small balloons on the side of the tube that prevent liquid trickling down beside the tube in to the lung, where they can cause aspiration and infection.
Routine tube care
Cleaning: Both the tube and skin around the tube require special care to prevent damage and infection
The skin needs to be cleaned at least once a day with water and a soft, non-abrasive cloth or gauze. If there is discharge around the tube, this need to be done more often, and medicated solution (like Betadine) and dressing may be required as advised by your surgeon
Cleaning the inner tube of the double lumen tracheostomy tube is vital to prevent blockage; failure to do this can result in life threatening breathing difficulty. To clean the inner tube, wear gloves, remove the tube and soak it for a few minutes in a bowl of 50% water and 50% hydrogen peroxide. A small brush or pipe cleaners can be used to clear tough secretions within the tube. The tube can then be air-dried and stored in a closed envelope, container or bag
Change the tracheostomy ties at least once a week
Replacement of the tube: Replace the inner tube if it is damaged, cracked or leaking. The outer tube should be changed at least once in three months, by your surgeon, at least the first few times
Clearing of secretions: The best way to clear airway secretions is to practice coughing in conjunction after steam inhalation and chest physiotherapy. This will prevent accumulation of secretions and infection. Routine suctioning of the tracheostomy is not indicated unless there are excessive secretions or the patient is not able to cough effectively
In case of emergency: It is important to realize when the tube is blocked; any noisy breathing through the tube or difficulty breathing indicates a blockage. Another way to assess patency is to feel the ‘blast’ of air when the patient expires. For double lumen tubes, immediately remove the inner tube and clean it. If the blockage is still persisting and the patient is unable to breathe freely, the outer tube needs to be removed as well, but only if the tracheostomy is over two weeks old.
Additional accessories: Heat moisture exchangers contains sponges and can be attached to the end of tracheostomy to make the air that you inhale humid and breathing more comfortable. A speaking valve can help patients on a tracheostomy speak.