Tracheostomy Care

Rubbing of the trach tube and secretions can irritate the skin around the stoma. Daily care of the trach site is needed to prevent infection and skin breakdown under the tracheostomy tube and ties. Care should be done at least once a day; more often if needed. Children with new trachs or children on ventilators may need trach care more often. Tracheostomy dressings are used if there is drainage from the tracheostomy site or irritation from the tube rubbing on the skin.

It may be helpful to set up a designated spot in your home for equipment and routine tracheostomy care.

Equipment

Procedure

Care of the Inner Cannula

Some older children and teens have trach tubes with an inner cannula. Some inner cannulas are disposable (DIC: Disposable Inner Cannula). These should be changed daily, discarding the old cannula. Check with your equipment vendor regarding disposable cannulas.

For the reusable cannulas, the cannula should be cleaned 1 to 3 times a day and more often if needed. Do not leave the inner cannula out for more than 15 minutes.

Equipment

Procedure

Cuffed Tracheostomy Tubes

Foam Cuff 

Foam-filled Bivona cuff tracheostomy tube
deflated (left), inflated (right)

A cuff is a soft balloon around the distal end of the tube that can be inflated to seal the trachea for children needing ventilator support or to help prevent secretions from entering the lungs.

Avoid over inflating the tracheostomy tube cuff. The pressure of the cuff against the wall of the trachea can cause damage if it is too high. Two techniques that can be used to help avoid excess pressure are the minimal occluding volume technique and the minimal leak technique.

Suction the trach tube if needed. After suctioning the tube, suction the mouth and above the trach cuff so that secretions do not go into lungs when cuff is deflated.

Cuff Deflation Techniques

Periodic measurements of the cuff volume should be noted and any changes reported to the doctor. A pressure manometer may be used to check cuff pressure on balloons filled with air. Generally, cuff pressure should be below 25 cm H2O. 

manometer 

Trach tube with cuff, pilot inflating balloon and pressure manometer
Illustration Source:
Kersten, L.D. (Ed.) (1998).  Comprehensive respiratory nursing:  A decision making approach.  Toronto:  W.B. Sauders Company.

This page updated 11/22/05