Trach-ties
Tracheostomy Care
Trach-ties
Home care of a Tracheostomy
Once your tracheostomy is put in you will hopefully have had teaching by the team caring for you. Each person has their own idiosyncrasies, but the basics are pretty steadfast. How many secretions you have will determine how often you clean your trach. The minimum is once daily. Some prefer twice or more. Its mostly personal preference.
Trach Care
How you do trach care can vary. New trachs and those of persons who are immunocompromised should be done using as sterile/aseptic technique as possible. “Older” trachs and those who have normal functioning immune systems can use a clean technique.
Sterile/Aseptic Technique means using sterile materials and solutions. Taking care not to contaminate the inner cannula. This will prevent any bacteria or viruses being introduced into the trachea.
Clean technique means using ‘clean’ technique rather than sterile. Sterile materials and solutions are not required, but clean as possible is preferred. Tap water can be used rather than sterile water. Clean basins and brush rather than a sterile trach kit is acceptable.
The one common denominator to any good trach care is good handwashing. Good handwashing is basic to any infection control plan. Antibacterial soaps are not required. Some feel they do a better job using them. Studies have shown that good handwashing techniques and regular soap and water works just as well. The basis of good handwashing is time and friction. One easy way to make sure you have routinely washed your hands adequately is to wash for 15 seconds, the time it takes to sing one verse of “Yankee Doodle”. That suffices for basic handwashing. Handwashing prior to trach care needs to be a bit longer, preferably 3 to 5 minutes.
Sterile Technique:
Trach care kit consisting of :
- sterile gloves
- sterile trach brush
- sterile pipe cleaners
- sterile cotton tip applicators
- sterile basins
- sterile gauze
- sterile trach dressing
- trach tie (twill tape or other type of choice)
- sterile forcepts
- sterile saline or sterile water
- hydrogen peroxide
1. Assemble supplies and wash hands. After hands are washed carefully open the Trach kit being careful not to touch inside the kit until your sterile gloves are on. They are usually draped across the top of the kit for easy removal without contaminating your kit.
2. Pour approximately an inch of saline/water into one basin and
pour 1:1 of saline/water and peroxide into the other.
3. Remove inner cannula and place into basin with peroxide solution.
4. Apply sterile gloves
5. Allow inner cannula to soak.
6. While inner cannula soaking, clean skin at stoma and under faceplate with peroxide solution then saline. Use the cotton tip applicators in
behind the faceplate to clean around stoma. The opening of the outer
cannula may be cleaned using cotton tip applicators, but DO NOT insert them past the immediate opening.
7. Clean the inner cannula with the peroxide solution. Using the brush/pipe cleaners to clean any secretions inside the inner cannula. Use the brush around the outside of the inner cannula as well if needed.
8. Using sterile forcepts place the cleaned cannula into the sterile saline/sterile water solution to rinse well.
9. Dry outside of inner cannula using sterile gauze.
10. Reinsert the inner cannula, using caution to only touch the part of the cannula that is outside the outer cannula (the thick white end of the cannula), or contaminating the inner cannula during reinsertion.
11. Change trach tie. Be sure whether tie or velcro that it can accommodate two fingers inside the tie and that it is fastened securely. (If using a twill tape trach tie, double knots are preferred since a bow can easily become untied.)
12. Apply sterile trach dressing.
13. Dispose of solutions appropriately (preferrably into a toilet).
Remaining saline/sterile water may be kept for 24 hours after opening.
14. Dispose of dirty materials used (disposables may be thrown away into trash).
Clean Technique:
1. Wash hands and assemble supplies
- Clean basins
- Clean Trach brush/ pipe cleaners
- Clean trach tie
- Water/saline
- Warm soapy water or peroxide
- Clean Cotton Tip Applicators
- Clean forcepts
- Clean Trach Dressing
2. Remove inner cannula and place into warm soapy water or 1:1 peroxide/water solution.
3. Clean stoma using warm soapy water.
4. Clean inner cannula using brush/pipe cleaners.
5. Rinse inner cannula well in plain water/saline in basin or under running tap water.
6. Dry using gauze.
7. Apply clean trach dressing as above.
8. Apply clean trach tie, as above.
9. Dispose of solutions, collect materials to be reused to be cleaned. (Reusable materials such as basins and brushes are to be cleaned in warm soapy water, soaked in 1:3 vinegar/water solution for 30 minutes, rinsed well, allowed to air dry then placed into clean zip lock baggies until their next use.)
Solutions are considered sterile for 24 hours after opening. Refrigeration can increase the ‘clean’ lifespan of solutions for up to 3 days.
Some apply ointments to the area adjacent to the stoma. Some use bacitracin, desitin, A&D ointment, or other prescription ointment. The important issue is to apply thin and clean it off daily or more frequently if needed. Do not allow ointments onto the outer cannula as this will allow the ointment to travel into the trachea. Ointments contain an oil base which can lead to aspiration pneumonias. Many find simply using a small telfa or gauze between the trach faceplate and the neck is sufficient in preventing any rash or yeast infection, changing as needed. Another time proven tip: clean the trach area using a clean baby wipe (ones with aloe and vitamin E have worked best for me at keeping the site clean, and yeast and irritation-free.
Some utilize HME (heat, moisture exchanger) or a type of speaking valve. HME’s are to be changed daily.
Speaking valves must be cleaned daily in mild soap and water and allowed to air dry. Many do this as part of their evening routine so that it will dry overnight and be ready for use in the morning.
How often you clean the inner cannula is an individual decision. Most say a minimum of once a day once your trach is established. Others will remove the inner cannula and do a quick ‘clean’ technique cleaning or run it under tap water after each time they cough. What ever works best for you, and keeps your infection rate down, is what you need to do.
For those who are away from home and tend to rinse out their trachs frequently, you may want to pack a bottle of saline or unopened bottled water into your ‘travel kit’ for use when away from home.
Typical Trach Cleaning Tray
Containing:
- sterile gloves (optional)
- sterile forcepts
- 2 basins
- twill tape trach tie
- sterile cotton tip applicators
- sterile cannula brush
- sterile gauze
- sterile pipe cleaners
- sterile pre-cut trach dressing
Tracheostomy Care Links
University of California - Davis Trach Care
Contact Trach ties at
Email: trachties@gmail.com
Disclaimer; In no way are these web pages or links intended to replace care by a qualified medical professional. They are here for information only. If you feel you fit any of the symptoms listed in any of these links you should seek care from a qualified medical professional.
