Trach

Tracheotomy Care
 
WHAT YOU SHOULD KNOW

When a severe lung disorder, neurological problem, or infection makes it impossible to breath, your doctor may do a tracheostomy (TRAY-kee-AH-stuh-mee) to keep your windpipe open and supply you with air. During the procedure, the doctor makes a small opening called a stoma through the skin on your throat, then inserts a breathing tube directly into the windpipe (trachea). This tube, called a "trach" (trayk) for short, has three parts. One, called the obturator (AHB-ter-A-ter), is used to pass the trach into your windpipe. When this part is removed, an outer cannula (tube) remains. This outer cannula has a plastic "trach plate" that lies against the skin on your neck and holds the trach in place. Finally, there's an inner cannula that fits inside the outer one and locks into place. The trach tube is sometimes sewn to the skin around the stoma. It can also be held in place with trach ties. Some trach tubes have an inflatable cuff near the outer end to keep them from coming out and to prevent air from leaking around them. As long as the trach is in place, you'll need to clean the inner cannula on a daily basis. Whenever the tube threatens to become clogged with mucus, you'll have to suction it clear. Both procedures are important. A dirty cannula could lead to infection. And if the trach clogs up, you'll be unable to breath.

WHAT YOU SHOULD DO

Cleaning the Trach: To prevent infection, clean the inner cannula at least once each day.
You will need a small bowl, a small brush (like a toothbrush), liquid soap, a gauze pad, and scissors.
Position a mirror so that you can see your face and throat.
Wash your hands with soap and water.
Unlock the inner cannula and remove it by pulling it gently out and down.
Put a clean wet inner cannula inside the outer cannula. Lock the inner cannula in place.
Clean the dirty cannula by soaking it in liquid soap and water. Scrub it with the small brush. If it is very dirty, soak it in 3 percent hydrogen peroxide. As the hydrogen peroxide works, it will bubble,when the bubbling stops, clean the cannula with the brush.
Rinse the inner cannula under running water. Make sure that all the soap and hydrogen peroxide have been rinsed off well.
Using a Trach Bib: A trach bib is used to catch any secretions that come from your stomach and could make your skin sore. Open a 4-inch by 4-inch gauze pad. Unfold it completely, then fold it in half (the long way). Turn down the corners to form a center opening about 1 to 2 inches long. The gauze should now be shaped like a "U." Place the bib under the trach plate with the "U" upright.
Making Sterile (germ-free) Water: Place a glass jar and its lid separately in a pan and cover them with water. Boil for 5 minutes. Once they are sterilized, do not touch the inside of the jar or lid. In another pan, boil normal tap water for 5 minutes. Pour the sterile water into the sterile jar. Put the sterile lid on the jar.
Suctioning the Trach Tube: When you can't cough up mucus that is blocking your windpipe, you need to suction your trach tube.
You will need a suction machine with suction tubing, a small bowl, sterile water, a suction catheter, and sterile surgical gloves.
Turn on the suction machine. Set the dial between -80 and -120 mm Hg. Attach suction tubing to the suction machine.
Fill the small bowl with some of the sterile water. Put the sterile lid back on the jar of sterile water without touching the inside of either jar or lid. Set the small bowl to the side of your work table.
Wash your hands with soap and water. Dry them, then put on sterile gloves.
Take the suction catheter out of its package. Hook it to the suction tubing on the suction machine. Dip the catheter tip into the sterile water. This will make the catheter easier to put into your trach. To keep the catheter sterile, do not let it touch anything that is not already sterile.
Take a few deep breaths. Gently thread the wet catheter into the trach tube. Advance the catheter 5 to 8 inches, until you feel it pushing against something. Do not cover the catheter's control valve while inserting the catheter. The control valve is the small hole near the end that is in your hand. Covering it starts the suction.
Slowly pull the catheter out of your trachea, rolling it back and forth between your thumb and fingers. As you pull it out, use your thumb to cover and uncover the control valve. This will start and stop the suction. Do not keep the valve covered for more than 10 seconds at a time. If you suction longer than that, you'll pull too much oxygen from your lungs.
When finished suctioning, dip the tip of the catheter into the sterile water. Put your thumb over the control valve to clear the suction catheter and tubing. Turn off the suction machine, then remove the catheter from the suction tubing and throw it away in a plastic-lined trash can. Clean the small bowl and the collection bottle from the suction machine with soap and water.
Always keep a bulb syringe handy in case the suction machine doesn't work or the electricity fails.
Don't be afraid if you cough out the trach tube. You can put it back in with the following steps:
First use a syringe to take the air out of the cuff on the inner cannula, and then remove it from the outer cannula. Put the obturator into the outer cannula.
Insert the obturator and outer cannula through your stoma. Pull out the obturator while pressing the trach plate firmly against your neck.
Put the inner cannula down the outer cannula and turn it clockwise until it locks in place. Inserting the inner cannula can make you cough or gag, so hold the trach plate firmly. Now inflate the cuff so the trach won't fall out again. Tie the trach ties and put a trach bib under the trach plate.

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