Tracheostomy Stoma Care

Tracheostomy Stoma Care

The buildup of mucus and the rubbing of the tracheostomy tube can irritate the skin around the stoma. The skin around the stoma should be cleaned at least twice a day to prevent odor, irritation and infection. If the area appears red, tender or smells badly, stoma cleaning should be performed more frequently. Call your surgeon’s office if a rash, unusual odor, and/or yellowish-green drainage appears around the stoma.

Equipment:

• Face cloth
• Cotton-tipped applicators
• Hydrogen peroxide (1/2 strength - equal parts peroxide and water)
• Normal saline
• Vaseline guaze 2x2 dressing (optional)

1.     Wash your hands.

2.     Remove any dressing around the tracheostomy (if applicable). The tube should not have to be removed to clean the stoma.

3.     Dip the cotton tip applicators in the hydrogen peroxide (saline can be used if the peroxide is too irritating) and use it to clean around the stoma site. Start as close as possible to the tracheostomy tube then work away from it.

4.     Repeat the process until debris and/or mucus is removed.

5.     Use a dry cotton tip applicator or face cloth to dry the skin.

6.     No gauze should be placed under the trach tube unless recommended by the treating physician.  A dry dressing is helpful if the patient has areas of skin irritation or secretions. 

Daily 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. Patients with new trachs or 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 the home for equipment and routine tracheostomy care.

Equipment

• Sterile cotton tipped applicators (Q-tips) 
• Trach gauze
• Sterile water
• Hydrogen peroxide (1/2 strength with sterile water)
• Trach ties and scissors (if ties are to be changed) 
• Two sterile cups or clean disposable paper cups
• Small blanket or towel roll

Procedure

1.     Wash your hands. 

2.     Make sure the patient is laying in a comfortable position on his/her back with a small blanket or towel roll under his/her shoulders to extend the neck and allow easier visualization and trach care.

3.     Open sterile cotton, trach gauze and regular gauze.

4.     Cut the trach ties to appropriate length (if trach ties are to be changed).

5.     Pour 1/2 strength hydrogen peroxide into one cup and sterile water into the other.

6.     Clean the skin around the trach tube with sterile cotton soaked in 1/2 strength hydrogen peroxide. Using a rolling motion, work from the center outward using 4 swabs, one for each quarter around the stoma and under the flange of the tube. Do not allow any liquid to get into trach tube or stoma area under the tube.  Note: We recommend cleaning with just soap and water in home care, using hydrogen peroxide only to remove encrusted secretions. This is because daily use of hydrogen peroxide might irritate the skin, especially in cases with small children.

7.     Rinse the area with cotton soaked in sterile water.

8.     Pat dry with gauze pad or dry sterile cotton.

9.     Change the trach ties if needed.

10.   Check the skin under the trach ties.

11.   For tracheostomy tubes with cuffs, check with your surgeon’s office for specific cuff orders. Check cuff pressure every 4 hours (usual pressure 15 - 20 mm Hg). In general, the cuff pressure should be as low as possible while still maintaining an adequate seal for ventilation.

12.   Monitor skin for signs of infection. If the stoma area becomes red, swollen, inflamed, warm to touch or has a foul odor, or if the patient develops a fever, call your surgeon’s office.

13.   Check with the doctor before applying any salves or ointments near the trach. If an antibiotic or antifungal ointment is ordered by one of our doctors, apply the ointment lightly with a cotton swab in the direction away from the trach stoma.

14.   Wash your hands after each trach care.