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A tracheostomy requires regular care to keep the area clean and to prevent infection and skin breakdown. Clean and check skin at least 1 time(s) a day. Some doctors will advise cleanings twice daily or more. Change the trach tube every 10 days or as often as you have been told by your health care provider. If possible, have two adults present when changing the trach tube. Follow the general guidelines below and any other specific instructions you are given.
Some people find it helpful to set up and do changing and cleaning in the same place each time. Choose a clean, well-lighted space near a sink. Supplies you will need for cleaning and changing include:
Rolled-up towel or pillow
Liquid soap, alcohol, or disinfectant foam
Clean, disposable, powderless gloves
Normal saline solution
Trach ties and scissors, cut to the right length
Two sterile or disposable cups
Ask your health care provider whether or not a tracheostomy dressing is needed. If so, change this gauze when cleaning the trach site. Do not use gauze containing cotton because your child may inhale the tiny fibers. Only use pre-cut gauze. Cutting gauze on your own will result in frayed edges that increase risk for infection.
Have your child lie on his or her back in a comfortable position. Put a rolled-up towel under the shoulders.
Wash your hands and put on disposable gloves.
Clean the neck plate and the skin under it. Use clean gauze pads or other non-fraying material dabbed in normal saline solution.
A thorough cleaning technique you may consider 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 and lastly from the 9 o'clock to 6 o'clock position.
Pat the area dry with clean gauze.
Check the skin for signs of infection, such as redness, swelling, or warmth.
Wash your hands when you finish.
Ask the doctor about whether or not to use an obturator, which may make it easier to insert the tube. Its rounded edges also protect the stoma during insertion. If you need to use a lubricant, be sure to ask the doctor how much to use. Have a suction machine ready, if needed. Depending on the age of your child, explain the procedure as well as you can. If two people are available, one person removes the old trach tube and the other secures the new one.
Have your child lie on his or her back in a comfortable position. Put a rolled–up towel under the shoulders.
Wash your hands with liquid soap and warm water. Dry well. You may also use alcohol or disinfectant foam.
Put on disposable gloves.
Get the new trach ties ready by draping them around your child’s neck.
Open the trach tube package and insert the obturator (if you’re using one) into the new trach tube.
Remove the entire old trach tube and lay it down on the towel. Remove gauze if you have used it.
Immediately replace the old trach tube with the new one. While holding the edges of the tube, remove the obturator right away, if you’re using one. Your child cannot breathe if it is left in place.
Secure the trach ties.
Unless the area is infected, it is now recommended to avoid the use of hydrogen peroxide mixture directly on the skin. This is because it causes inflammation and increases infection risk. It can also cause mucosal irritation and increase tracheal secretions. Be sure to ask your child's doctor when and if the use of a hydrogen peroxide mixture is appropriate for your child before using it. If a hydrogen peroxide mixture is used on an infected site, it is important to rinse the area with normal saline solution afterward.
Be sure to not get soap or water into the stoma or trach tube. Watch for signs of infection: swelling, heat, redness, smelly discharge, fever, or pain when suctioning. If you suspect that the tracheostomy is infected, call your child’s doctor right away.
Red, painful, or bleeding stoma
Yellow or green, smelly, bloody, or thick mucus from the stoma
In an infant under 3 months old, a rectal temperature of 100.4°F (38.0°C) or higher
In a child 3 to 36 months, a rectal temperature of 102°F (39.0°C) or higher
In a child of any age who has a temperature of 103°F (39.4°C) or higher
A fever that lasts more than 24-hours in a child under 2 years old, or for 3 days in a child 2 years or older
Your child has had a seizure caused by the fever
Swelling around the trach tube
Pain when you suction the trach tube
Shortness of breath or any trouble breathing
Trach tube or suction catheter that is difficult to insert