Tracheostomy Care: Practical Guide for Clinics And Home Settings

Tracheostomy continues to accompany patients from the intensive care unit to the home environment. Whether in a clinic or hospital equipped with advanced instruments and medical staff, or in the relatively resource-limited daily home environment, ensuring the safety, patency, and cleanliness of the tracheostomy site depends on continuous and meticulous care. Therefore, mastering scientific, standardized, and practical nursing knowledge is crucial to the patient’s recovery process, the prevention of complications, and the improvement of overall quality of life.

What Is Tracheostomy Care?

The core of tracheostomy care consists of a series of meticulous and continuous daily interventions, designed to provide both safety and comfort for patients who depend on a tracheostomy for breathing. The primary focus is to ensure the absolute patency of this vital airway—timely removal of airway secretions to guarantee smooth and unobstructed breathing. Nursing measures also rigorously prevent infection risks: from cleaning and disinfecting the stoma site to maintaining aseptic handling of all care instruments, each step aims to block the intrusion of harmful microorganisms. Proper fixation and secure positioning of the tracheostomy tube, preventing accidental displacement or removal, is another critical safeguard.

These seemingly detailed and even repetitive procedures are not merely technical; they directly form the cornerstone of patient safety. If mismanaged, airway obstruction, severe infection, or tube dislodgement may instantly threaten life. Moreover, high-quality tracheostomy care is essential for patient recovery, reducing the suffering caused by complications, preserving basic dignity, and enhancing overall quality of life. In essence, meticulous care sustains the patency and stability of this unique airway, serving as a lifeline of peace and safety.

How to Do Tracheostomy Care

The core tasks focus on several aspects: timely removal of airway secretions to prevent obstruction, keeping the stoma and surrounding skin clean and dry to avoid infection, and ensuring the tracheostomy tube is always securely fixed in the correct position to prevent accidental displacement or dislodgement.

Below are the tracheostomy care steps:

1.Hand and Equipment Preparation

· Wash hands thoroughly, wear a mask and sterile gloves to create a clean operating environment.

· Prepare all sterile supplies, such as normal saline, sterile cotton swabs, sterile gauze, suction catheter set with sterile water, fixation tapes, etc. Check that the suction device is functioning properly.

2.Airway Maintenance

· Secretion Removal: Perform suctioning promptly according to the patient’s respiratory status. Gently insert a moistened sterile suction catheter to an appropriate depth, avoiding excessive depth or force. Withdraw the catheter while applying negative pressure and rotating gently, performing the maneuver quickly and softly. Each suctioning attempt should not exceed 10–15 seconds. Closely monitor the patient’s response.

· Cleaning the Inner Lumen: If a tube with an inner cannula is used, it must be removed regularly for thorough cleaning and disinfection. Perform the procedure according to manufacturer recommendations or physician’s instructions. During the process, ensure the outer cannula remains properly fixed and immobile.

· Maintaining Humidification: Whether in hospital or at home, ensuring adequate humidification of inspired air is essential. Use a heat and moisture exchanger (HME) or humidifier as prescribed to prevent airway dryness and crust formation.

3.Stoma Site Care

· Carefully remove contaminated stoma dressings.

· Use a sterile cotton swab dipped in normal saline to gently clean from the center of the stoma outward in a spiral motion, removing secretions or crusts under the tube flange. Use one swab for each area only to avoid cross-contamination.

· Once the skin is completely dry, gently place a new sterile split gauze around the stoma. Do not use cotton balls or linty materials.

4.Tube Fixation

· Check Fixation Tapes: During each care session, check the cleanliness, tightness, and security of the fixation tapes. They should allow one finger to pass easily underneath—neither too loose (causing risk of displacement) nor too tight (causing skin injury).

· Replacing Fixation Tapes: Replace tapes when they become soiled, damaged, or when dressings need to be changed. This must be done with two people whenever possible: one stabilizing the tracheostomy tube and the other removing the old tape and securing the new one. Knots must be firm and safe without compressing the neck’s blood vessels or nerves. Always ensure a one-finger space remains.

5.Post-Care Observation

· After all procedures, reconfirm that the tracheostomy tube is securely in place and stable.

· Assess whether the patient’s breathing is steady, and check for redness, swelling, or abnormal secretions around the stoma that may indicate infection.

· Document the entire care process, all observations, and any interventions taken.

Tracheostomy Care at Home

1.Home Preparation and Environmental Management

· Clean Environment: Provide the patient with an independent, quiet, well-ventilated, and easy-to-clean room. Limit unnecessary traffic, and avoid dust or smoke exposure.

· Strict Disinfection: Wash hands thoroughly before any care. Disinfect hands before touching the patient, the tube, or the stoma area. Regularly wipe down surfaces frequently touched by the patient (e.g., tables, bedside rails, door handles) with disinfectant.

· Supply Management: Keep a dedicated sterile care kit at home, containing sufficient normal saline, sterile gloves, cotton swabs, multiple spare suction catheters, sterile split gauze, fixation tapes, and spare tracheostomy tubes (as prescribed). Store all items in a clean, dry cabinet away from dust, arranged by expiration date to avoid contamination. Maintain adequate reserves of disposable sterile supplies. Ensure suction equipment is functioning properly (electric suction machines are recommended), as well as humidification devices (such as a heat and moisture exchanger or humidifier).

2.Tube System Maintenance

Cleaning the Inner Cannula:

· As prescribed, spread a sterile drape on a clean work surface.

· Remove the inner cannula (if using a double-lumen tube) and immediately place it in a designated container with sufficient sterilizing/disinfecting solution.

· Wearing sterile gloves, thoroughly clean away mucus under running water, brushing the inner lumen carefully. After rinsing, immerse the cannula in fresh disinfectant solution for the recommended duration (strictly following the manufacturer’s instructions or medical advice).

· During the process, avoid contaminating the inner wall or connectors. After disinfection, rinse thoroughly with sterile saline. Ensure it is completely dry before reinsertion.

Spare Tube Management:

Spare tubes must remain in sterile packaging or be stored in a closed container filled with sterilizing solution. Regularly check the validity and concentration of the solution to ensure sterility. Before use, always verify expiration date and packaging integrity.

3.Emergency Response Plans

Tube Dislodgement:

· Calm the patient and encourage them (if conscious) to remain as still as possible.

· Early Dislodgement: If the tube slips out, carefully remove it and assist the patient into a head-tilt, chin-lift position (only if no neck injury risk exists).

· While maintaining airway patency, immediately call emergency services and clearly report “complete tracheostomy tube dislodgement.” If a sterile spare tube is available and the caregiver is trained and confident, an emergency reinsertion may be attempted (high-risk procedure). Otherwise, maintain the airway position and stay with the patient until emergency personnel arrive. Every second counts.

Tube Obstruction:

· Signs include sudden respiratory distress, labored breathing, cyanosis, inability to advance suction catheter, and failure to expel thick secretions.

· Immediately attempt suctioning, and instill a few drops of sterile saline to help loosen mucus plugs. Never insert the suction catheter forcefully.

· If the inner cannula is blocked, remove and clean or replace it while ensuring the outer tube remains fixed (for trained caregivers only).

· If initial measures fail or the patient’s condition deteriorates rapidly, with severe breathing difficulty, call emergency services at once. Do not delay.

Tracheostomy Risks and Challenges

1.Tube Displacement

· Manifestations: The tracheostomy tube may slip out of the trachea or be positioned abnormally (too deep or too shallow).

· What to Do: Ensure that fixation straps are properly tightened (leaving one-finger space), kept clean, and securely fastened. Use reliable fixation devices made of flexible, non-slip materials. Avoid excessive pulling or tugging of the tube during patient movement.

2.Infection of Tracheostomy

· Manifestations: Local infection at the stoma site and lower respiratory tract infections (such as pneumonia).

· What to Do: Strictly follow aseptic techniques. Perform thorough hand hygiene before and after any care. Keep the skin around the stoma clean and dry. All consumables (saline, suction catheters, dressings) and humidification water must be sterile. Maintain appropriate airway temperature and humidity.

3.Dislodged Tracheostomy Tube

· Manifestations: The tracheostomy tube completely falls out of the trachea.

· What to Do: Select a tracheostomy tube of appropriate size and stable design, with fixation straps that are resistant to breakage, wear, and pulling. Frequently check the condition of the device. Handle the patient gently during activities to prevent strong traction on the tube.

4.Complication Management

· Manifestations: Potential issues include postoperative bleeding, excessive granulation tissue growth in the trachea leading to obstruction, tracheal stenosis or tracheomalacia, and subcutaneous emphysema.

· What to Do: Choose high-quality tracheostomy tubes with low-irritation materials and soft cuff edges to minimize mucosal damage. Accurately monitor cuff pressure to avoid pressure injuries. Perform suctioning gently. Detect early warning signs promptly and take immediate measures.

What to Do If a Tracheostomy Comes Out?

When a life-sustaining tracheostomy tube accidentally falls out, every second is critical. The core of emergency response lies in recognizing the environmental differences and acting against time.

1.In Medical Facilities

Immediately activate the emergency call system and clearly report: “complete tracheostomy tube dislodgement”. Before professional medical staff arrive, if qualified, attempt to use sterile technique to replace the tube with a spare and re-establish the airway. If not absolutely confident, prioritize maintaining the patient’s airway by gently tilting the head back (if cervical spine injury is excluded) and clearing oral and nasal secretions to ensure basic airflow patency.

2.What to Do If Tracheostomy Tube Comes Out at Home

Maintaining Airflow:

Quickly assist the patient to extend the neck and slightly tilt the head back (if no risk of cervical injury exists). Rapidly clear visible oral and nasal secretions to keep the natural airway as open as possible. This is the key step in buying time for subsequent emergency measures.

Active Intervention (only if properly trained and equipped):

· Only if all the following are met:

*The family member/caregiver has received hands-on training and can perform the procedure competently.

*A sterile spare tracheostomy tube is immediately available.

*The patient is positioned stably, and the stoma is clearly visible.

Only then can a rapid sterile tube replacement be attempted — this is a high-risk maneuver and should be considered only as a temporary bridge. Even if successful, the patient must be sent to the hospital immediately for confirmation and further care.

Activating Emergency Support:

Regardless of whether reinsertion is attempted, call emergency services immediately. Clearly inform them of the patient’s condition: “Tracheostomy tube completely dislodged, patient in respiratory distress/critical condition”. Follow the dispatcher’s instructions carefully until professional rescue arrives.

3.Prevention Is Key

The risk of tube dislodgement is essentially a “preventable crisis”. Healthcare institutions bear an inescapable responsibility: before patient discharge, caregivers must receive repeated, standardized, and practical emergency simulation training. This ensures that family members can competently: rapidly recognize signs of dislodgement; maintain a safe airway-opening position; clearly understand the strict prerequisites and risk boundaries for using a backup tube; and promptly seek precise medical assistance without hesitation.

Tracheostomy Recovery and Healing

1.Recovery Timeline

The recovery time after a tracheostomy varies among individuals. Initial stabilization of the incision usually takes several weeks, while overall recovery until decannulation or complete closure of the stoma typically requires several weeks to months, depending on underlying conditions and quality of care.

2.Can It Heal?

Most temporary tracheostomy stomas gradually close on their own after decannulation, relying on the body’s natural healing ability. Long-term cannulation or cases with complications may require medical intervention.

3.How to Eat with Tracheostomy?

· Early Stage: Swallowing function is often impaired in the initial postoperative period. Strict fasting from water is required, with nutrition supported via enteral or parenteral routes.

· Transition Stage: Safe oral intake must be confirmed through swallowing studies (videofluoroscopy) or endoscopy, and a plan should be developed by a therapist.

· Stepwise Diet:

*Prefer thickened purees: mashed foods and thickened drinks (to reduce aspiration risk).

*Gradual progression of texture: soft, easy-to-chew foods → finely chopped regular foods → normal diet, with continuous monitoring for coughing or choking.

· Continuous Supervision: A speech therapist guides swallowing muscle exercises and safe eating techniques throughout the process.

How to Clean Tracheostomy Tube

The primary principle is strict asepsis. Before any procedure, thoroughly wash hands and wear sterile gloves. All instruments or items that come into contact with the tube must be sterile to minimize the risk of infection.

Proper Cleaning of the Inner Cannula. The inner cannula typically needs to be removed and cleaned multiple times per day. It must be fully soaked and scrubbed using a specialized disinfectant, followed by thorough rinsing to remove any residual disinfectant. After cleaning, immediate high-pressure steam sterilization or reliable boiling disinfection is required. During this cleaning and sterilization process, a sterile backup inner cannula should be promptly substituted to ensure continuous airway patency. Certain tubes made of special materials require the use of appropriate cleaning agents according to medical guidance to prevent damage to the tube wall.

Use of Supporting Consumables. A clean, single-use suction catheter must be used for each suctioning procedure. The depth of insertion into the airway should be appropriate, and the motion must be gentle. High-concentration oxygen should be administered before and after suctioning to reduce the risk of patient hypoxia. The humidification system’s liquid must be replaced daily with fresh sterile solution, and any condensation in its connecting tubing must be promptly removed, strictly avoiding backflow into the airway. The entire humidification setup must be disinfected regularly according to protocol or replaced entirely.