Trachs

Most of the information on this page comes from my own experience with trachs; some of the definitions are taken from a book "Tracheostomy Tube Adult Home Care Guide".

None if this is meant to replace consulting a medical professional!!Always check with a doctor!!

A tracheostomy is a surgical opening through the lower neck and trachea to make breathing easier. A tracheostomy tube is then inserted into the opening.
Because my mother was ventilator dependant following her surgery, meaning she was unable to breathe without assistance from a mechanical device(ventilator) her first tube was "cuffed".
A cuffed tube meaning the trach tube has a cuff which, when inflated with air, acts as a seal to eliminate or reduce airflow through the mouth and nose. With the cuff inflated, breathing will be directed through the tracheostomy tube.

After she was weaned off the ventilator her cuffed tube was removed and a smaller fenestrated one inserted, a Shiley Size 6 cuffless, fenestrated, with disposable inner cannula.
Cuffless meaning a tube without a cuff that allows airflow through the mouth, nose and tracheostomy.
Fenestrated meaning a hole in the cannula that allows air to be directed past the vocal cords and through the nose and mouth. Of course the inner cannula was also fenestrated.
Fenestrated inner cannula: Removable inner tube with hole(fenestration) that permits air to pass through the outer tube hole(s), (fenestration) up, past the vocal cords and exit the mouth and nose, allowing speech. It can be easily identified by a green 15mm connector and hole, in the curved part of the body of the tube. IT SHOULD NOT BE USED WITH MECHANICAL VENTILATION.
These also come with a Decannulation Plug; attaches to the outer cannula of a fenestrated tube when the inner cannula has been removed. Blocks airflow through the tracheostomy tube and directs breathing through the nose and mouth, also allowing speech.

Disposable Inner Cannulas...The boxes say one use only, but after much controversy in my mother's case between Respiratory Therapists, nurses, and Health Supply stores, we cleaned ours using sterile water and peroxide. In Saskatchewan a box of 10 of these little plastic tubes cost around $100, no health plan we could find here covers trach supplies, and if you only use them once you could be going through boxes a week. We had a miminum of infections so I guess the therapist's care plan of cleaning them worked well for us. I still would frequently dispose them, especially if her mucous was thicker and adhering too badly to the walls of the cannula, just not after every single use.

My mother had her trach changed every 2 months and after about a year they put a different type in; it was still a Shiley Size 6, cuffless, fenestrated...but it had a reusable inner cannula that could be cleaned; it was made out of a slightly harder more durable plastic than the disposable cannulas.

Removing Secretions: If a person can be plugged, and has the strength to cough up secretions on their own through their mouth, that would be the preferred method.
Unfortunately my mother was too frail to do much of that so we either manually coughed her through her trach or suctioned.
I will explain each method as I know it as well as I can.....
Coughing Out Through Trach:
First wash hands well, and either use antiseptic hand gel or protective gloves, unplug trach, squirt saline solution into the tube, it will activate the cough reflex and loosen the secretions, the person will cough out onto a bib or towel that you would place below the trach. And stand back! If the person has a very strong cough you could get a little..covered. One of my mother's Respiratory Therapists told us how, when training novice therapists they tell them to instill the saline solution, and to stay right up close to watch...*LOL*...a little humor on the job I guess.
Suctioning:
First remove plug and insert inner cannula (inner cannula must be inserted to prevent suction catheter from getting caught in the fenestrations of the outer cannula). Make sure suction catheter is connected to suction machine, turn it on making sure suction machine is set to correct suction pressure, insert catheter in sterile container of water and apply suction.
Insert suction catheter, with thumb off y-piece, into tracheostomy tube (how far you insert catheter depends on patient...I inserted the catheter past the trach, into the lungs), place thumb on y-piece to apply suction and slowly withdraw the catheter while rolling it between your fingers to facilitate secretion removal. Rinse the catheter in sterile water to remove collected secretions and re-suction if necessary after sufficient rest periods.
The suction procedure should last no longer than a few seconds. Allow adequate time between each catheter insertion for normal breathing or mechanical ventilatory support to aid in re-oxygenation of your body.
What I would do is have my mother do a couple of deep breathing exercises before suctioning if it was not an emergency, then again after suctioning.

Trach Problems:
About the only problem I ever encountered with my mother's trach was difficulty inserting the inner cannula occasionally. Skin/tissue starts to grow through the fenestrations in the outer cannula making it a tight squeeze to get the inner cannula in. All I was advised to do was just force it through, which I did, it only caused her a moment of pain, and if I broke the skin/tissue off she would just cough it up through her trach. Plus the Respiratory Therapists said if it was happening a lot it was definetely time for a trach change.
One other problem that arose was when Shiley changed the design of their neck plate. They went from a smaller rectangular piece of hard plastic to a larger oval shaped piece of softer plastic. For my mother it just caused her pain because the larger piece was just too big for her neck; her osteo also lessening her neck space. Painkillers and an extra thick trach sponge inserted around the trach opening eased it a bit but not all.

Cleaning the Area Around the Trach Opening:
As the tracheostomy wound heals, drainage from the surgical area will decrease. If encrustations are present the skin should be cleansed. We cleaned my mothers area around her trach opening daily, my husband usually being the one who did it every evening. He found Q-Tips soaked in sterile water to be the best for getting in under the plate easiest, most days it was fairly clean but she said it just felt good to have it cleaned. Then sometimes if it was looking a bit red or sore he would apply a bit of antibiotic ointment and put a trach sponge or dressing around the trach.

TRACHEOSTOMY LINKS