Cleaning Your Tracheostomy Inner Cannula and Skin
Call 911 (emergency) right away if you ever have trouble breathing.
Clean your trach tube and the skin around it at least once a day. Your doctor may tell you to clean it more often. Cleaning your trach tube is important for these reasons:
Regular cleaning prevents skin irritation that can lead to infection around the stoma site.
It reduces the risk for respiratory infections.
Cleaning prevents buildup of dried secretions that can block the tracheostomy tube.
Research has proved that secretions can be harmful to skin health and increase the risk for infection.
When cleaning your tracheostomy, it is important to be well prepared with the right supplies in case of an emergency. For example, have extra trach tubes, a manual ventilator bag, an obturator that is your size, and a suctioning device with catheters available.
To clean your tracheostomy site and inner cannula, follow these steps and any other guidelines your doctor gives you.
Step 1. Collect your supplies
Choose a clean, well-lighted space near a sink and mirror. Collect your supplies: gauze pads or other non-fraying material your doctor advises, a trach tube brush, and a bowl filled with the solution recommended by your doctor. Your doctor may tell you to use a salt solution (normal saline) alone or a mixture of normal saline and hydrogen peroxide in equal parts. The normal saline and hydrogen peroxide mixture is used to clean tracheostomy equipment.
Wash your hands with soap and warm water. Put on clean, disposable, powderless gloves.
Step 2. Remove the inner cannula
Hold the neck plate with one hand. With the other hand, unlock the inner tube (cannula). Gently remove the inner cannula. If you have trouble removing the inner cannula, don’t force it. Call your doctor to find out what to do.
Don’t remove the outer cannula.
Depending on your health history, your doctor may tell you to insert a previously cleaned spare inner cannula right away after removing the one in use and before going on to the cleaning step.
Step 3. Clean the inner cannula
Soak the reusable inner cannula in the bowl of solution as instructed by your doctor.
Disposable inner cannulas don’t need to be cleaned, because they are meant to be used only one time. If you have a metal inner cannula, don’t use hydrogen peroxide to clean it. It can damage the cannula. Use only normal saline in this case.
Clean the inner cannula with a trach tube brush. Don’t use a toothbrush. Rinse thoroughly with plain normal saline solution.
If you have not already inserted a spare inner cannula, put the wet inner cannula back into the outer cannula. Lock the inner cannula in place.
Step 4. Clean your neck plate and skin
Remove the gauze from behind the neck plate. Look at the area to see if there is any skin breakdown or infection.
Clean the neck plate and the skin under it. Use clean gauze pads or other non-fraying material dabbed in normal saline solution. One cleaning method involves cleaning the stoma in a step-wise fashion, one quarter at a time. Start at the 12 o’clock position wiping to the 3 o’clock position. Then with a new gauze pad for each section, clean from 12 o’clock to 9 o’clock, followed by the 3 o’clock to 6 o’clock position. Last clean from the 9 o’clock to 6 o’clock position. This pattern can be followed on the surrounding skin and tube flange. After cleaning, gently pat the skin dry.
You shouldn’t use a hydrogen peroxide mixture directly on your skin unless your doctor specifically tells you to. Hydrogen peroxide can irritate the skin and increase the risk for infection. If you are told to use a hydrogen peroxide mixture on your skin, be sure to rinse the area with normal saline solution afterward.
Put a clean, precut gauze pad under the neck plate. This pad protects your skin. Don’t cut a gauze pad. The frayed edges will increase risk for infection and a loose thread could potentially be inhaled into the trach.
Step 5. Changing the trach ties
The neck plate is held in place with cloth or Velcro ties. If these become soiled, they should be changed. You will need another person to help you change the ties and make sure the neck plate does not get displaced.
Your helper should first wash his or her hands. Then he or she should put on a pair of clean, disposable, powderless gloves.
Have a clean set of ties ready to be attached to the neck plate.
While one of you holds the neck plate in place, the other person loosens the ties on the neck plate and removes them. Discard the soiled ties with the rest of the used cleaning supplies.
While the neck plate is still being held in place, attach the clean trach ties to the neck plate and secure them. Make sure the ties are snug enough to keep the neck plate from moving too much, yet loose enough to be comfortable. You should be able to comfortably insert one finger between the trach tie and the skin.