A tracheostomy is an opening - made by a surgical incision or by making an incision in the skin - at the front of the neck and penetrates into the trachea (windpipe). A plastic tube is inserted through the incision to keep the airway open and allow the patient to breathe. This procedure is often performed in an emergency situation with the aim of preventing the throat from an allergic reaction or tumor growth. Tracheostomy can be a temporary or permanent procedure. Performing treatment for a permanent tracheostomy requires a lot of knowledge and attention, especially for patients and their caregivers – family/friends who live with the patient and look after/care for them – while at home and away from the hospital. Ensure that you receive thorough training from a healthcare professional before attempting to treat a patient with a tracheostomy.
Step
Part 1 of 4: Performing Hose Suction
Step 1. Prepare the necessary equipment
Suctioning the tracheostomy tube is important because it will help free the airways from the production of secretions (mucus / mucus), thus allowing the patient to breathe better and reducing the risk of lung infection. Improper suctioning is the main cause of infection in people who use a tracheostomy tube (tracheostomy tube). The equipment required includes:
- Suction machine
- Catheter tube for suctioning (adult sizes 14 and 16 are used)
- Latex sterile gloves
- Physiological saline solution (Sodium Chloride/NaCl 0, 9%)
- Physiological saline solution ready to use or in the form of a 5ml spray/injection.
- Clean bowl filled with tap water
Step 2. Wash your hands thoroughly
Caregivers (whether in hospital or at home) should wash their hands before and after tracheostomy care. This action is mainly to protect the patient from infection due to bacteria entering through the hole in his neck. Wash your hands with soap and warm water for at least 20 seconds and don't forget to scrub the areas between your fingers and under your nails.
- Dry your hands using a paper towel or clean cloth/rag.
- Turn off the faucet using a paper towel or cloth to prevent your hands from getting contaminated again.
- Alternatively, soap your hands with an alcohol-based cleaning gel/liquid and then air dry them.
Step 3. Prepare and test the catheter
The suction machine package must be opened carefully, when carrying it do not touch the tip of the catheter. However, the vent control located at the tip of the catheter can be touched, so don't worry about that. The catheter is usually attached to a tracheal tube that is connected to a suction machine.
- Turn on the suction machine and do a test through the tip of the catheter to see if the machine is working or not. Test by closing your thumb over the catheter opening and then removing it.
- It may be that the tracheal tube has one or two openings, and may also be cuffed - which can be adjusted to reduce the risk of aspiration - or without a balloon (uncuffed), perforated (allows for speech) or not perforated.
Step 4. Prepare the patient and take the saline solution (NaCl)
Ensure that the patient's head and shoulders are slightly elevated/raised. Both should be comfortable during the treatment procedure. To calm him down, allow the patient to take three or four deep breaths. As soon as the patient is in the correct position, insert 3-5 milliliters of 0.9% NaCl solution into the catheter tube. This will help stimulate the patient to expel mucus and add moisture to the mucous membranes. 0.9% NaCl solution should be used regularly during the suctioning process to prevent the formation of thick mucus plugs in the throat, which can obstruct the airway.
- The number of times NaCL 0.9% should be administered is different for one patient and another depending on how thick and how much mucus is produced by his throat.
- Caregivers should check the color, smell, and thickness of the mucus in case of infection – the mucus turns grayish green and smells bad.
Step 5. Insert the catheter and attach the suction
Gently guide the catheter into the tracheal tube until the patient begins to cough until the cough stops and does not continue. In most cases, the catheter tube should be inserted into the tracheostomy tube to a depth of about 10.2 to 12.7 cm. The natural curvature of the catheter should follow the curve of the tracheal tube. The catheter should be pulled back slightly before suctioning is performed, which will make the patient feel more comfortable.
- Attach the suction by closing the vent valve while pulling the catheter from the tracheal tube in a slow, circular motion. The suction should not be used for longer than about ten seconds, during which time the catheter will continue to twist and be pulled out. The sucker will come off.
- Tracheostomy tubes are made in several sizes and materials such as semi-flexible plastic, hard plastic and metal. Some types of hoses are made for single use (disposable), while others can be used repeatedly.
Step 6. Allow the patient to breathe for a moment
Allow the patient to inhale slowly and deeply 3-4 times between suctioning stages, because when the suction machine is running very little air can enter the patient's lungs. The patient should be given oxygen after each suction stage or allow time to breathe depending on the patient's condition.
- With the catheter removed, suck tap water through the tube to remove any thick mucus, then rinse the catheter with hydrogen peroxide.
- Repeat the process as long as necessary if the patient produces more mucus being sucked out of the tracheal tube.
- Suction is repeated until the airway is clear of mucus.
- After suctioning, the oxygen flow is returned to the baseline level as before.
Part 2 of 4: Cleaning the Tracheal Hose
Step 1. Gather equipment
It is important to keep equipment clean and free of slime and other debris. So you should clean the equipment at least twice a day, ideally in the morning and evening. However, the more often the better. Here are the things you will need:
- Sterile saline solution
- Semi-liquid Hydrogen Peroxide (½ part water mixed with part hydrogen peroxide)
- Clean little bowl
- Clean soft brush
Step 2. Wash your hands
It is very important to wash your hands and get rid of all germs and dirt. This will help prevent any infections caused by unhygienic care.
Proper hand washing procedures have been discussed in the previous section. The most important thing to remember is to use a mild type of soap, lather well, rinse it off, and dry it with a clean, dry towel
Step 3. Soak the tracheal tube
Place of the hydrogen peroxide solution in one bowl, while in the other add the sterile saline solution. Carefully lift the inner tracheal tube while holding the neck plate/fange, which should be taught to you by the doctor or nurse while the patient is still in the hospital.
- Place the tracheal tube in a bowl of hydrogen peroxide solution and allow it to fully submerge until the crust and particles are softened, dissolved, and released.
- Some tracheal tubes are made for single use and do not need cleaning if you have a replacement.
Step 4. Clean the tracheal tube
Clean the inside and outside of the tracheal tube using a soft-bristled brush. Do it carefully and make sure the hose is clean of mucus and other debris. Be careful not to scrub too vigorously and avoid using a coarse/bristle brush to clean the tracheal tube as this may damage it. Once you've finished cleaning, put the tube in the saline solution for 5-10 minutes to soak and sterilize it.
- If you don't have more brine, soaking it in white vinegar diluted with a little water will work just as well.
- If you are using a disposable plastic tracheal tube, skip this step.
Step 5. Reinsert the tube into the tracheostomy opening
As soon as you handle a clean, sterile (or new) tracheal tube, be careful to insert it into the tracheostomy opening while still holding the neck plate. Twist the inside of the hose until it snaps back into a secure position. You can gently pull the hose forward to check/make sure that the inside of the hose is locked into place.
The cleaning procedure that you have done is complete and works well. Performing this procedure at least 2 times a day can prevent infection, duct blockage, and various other complications
Part 3 of 4: Cleaning the Stoma
Step 1. Examine the stoma
A stoma is another term for an opening in the neck/trachea where a tracheostomy tube is inserted so the patient can breathe. The stoma should be checked after each suctioning procedure for any skin irritation and signs of infection. If any signs of infection appear (or if anything seems suspicious) consult a doctor immediately.
- Symptoms of a stoma infection can include: redness and swelling, pain and the production of an unpleasant-smelling mucus from pus.
- If the stoma is infected and inflamed, the tracheal tube will be more difficult to insert.
- If the stoma is pale and bluish, it may indicate a problem with blood flow to the tissues, and you should contact your doctor immediately.
Step 2. Clean the stoma with an antiseptic
Each time you remove the tracheal tube, clean and disinfect the stoma. Use an antiseptic solution such as betadine solution or another similar solution. The stoma should be cleaned in a circular motion (with sterile gauze) starting at the 12 o'clock position and wiping it down to the 3 o'clock position.
To clean the bottom half of the stoma, wipe a new piece of gauze from the 3 o'clock position up to the 6 o'clock position. Then wipe again from the 9 o'clock position moving down to the 6 o'clock position
Step 3. Change pads regularly
The dressing around the tracheostomy opening should be changed at least twice a day. Changing the dressing helps prevent infection in the stoma area and in the respiratory system (lungs). Changing pads also supports skin hygiene. The new bandage helps isolate the skin and absorbs the production of secretions/mucus that may leak around the stoma.
- Wet pads should be changed as soon as possible. Wet pads tend to be mixed with bacteria and can lead to health complications.
- Don't forget to replace the tape (string) holding the tracheal tube if it looks dirty or wet. Be sure to hold the tracheal tube in place when changing the tape/strap.
Part 4 of 4: Mastering Daily Care
Step 1. Protect the tracheal tube when outside
The reason why doctors and health care professionals constantly close the tracheal tube is because dirt and foreign particles can get into the unsealed tube and eventually enter the patient's windpipe. Foreign particles include dust, sand and various pollutants present in the atmosphere. All of these particles can trigger irritation and even infection, so they should be avoided.
- The entry of feces into the tracheal tube triggers excessive mucus production in the windpipe, which can clog the tube and cause difficulty breathing and infection.
- Be sure to clean the tracheal tube more often if the patient spends a lot of time outdoors, especially if it is windy and/or dusty.
Step 2. Avoid swimming
Swimming can be very dangerous for a tracheostomy patient. While swimming, the tracheostomy opening or the cap on the tube is not completely watertight. As a result, while swimming, water is more likely to enter directly into the tracheostomy tube/tube, which can trigger a condition called “aspiration pneumonia/lung infection” – water entering the lungs that triggers contraction.
- Aspiration pneumonia, even after the introduction of even a small amount of water, can lead to death by suffocation.
- The entry of water into the lungs even in small amounts can also increase the risk of infection by bacteria.
- Close the hose and also be careful when showering or under the shower.
Step 3. Maintain to breathe in moist air
When a person breathes through their nose (as well as the small sinuses behind the cheekbones and forehead) air tends to retain more moisture, which is better for the lungs. However, people with tracheostomy no longer have this ability, so what they breathe is air with the same humidity as the outside air. In dry climates this can be problematic, so it is important to try and keep the patient as humid as possible.
- Apply a damp cloth over the tracheal tube and keep it moist.
- Use a humidifier to help humidify the air during dry conditions in the house..
Tips
- Make sure the tracheal tube is clear of mucus plugs, and always carry a spare tube with you for each treatment.
- After coughing make sure to always wipe the mucus with a cloth or tissue.
- See a doctor immediately if there is bleeding from the tracheostomy opening or if the patient has difficulty breathing, has a cough, chest pain, or has a fever.
