Tracheostomy Care

Many quadriplegics with spinal cord injuries cannot breathe properly on their own, at which point a tracheostomy is necessary. A tracheostomy is a surgical procedure that creates an opening through the neck into the trachea (windpipe). A tube is usually placed through this opening to provide an airway and to remove secretions from the lungs. This tube is called a tracheostomy tube or trach tube.

Rubbing of the trach tube and secretions can irritate the skin around the insertion site. 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. Tracheostomy dressings are used if there is drainage from the tracheostomy site or irritation from the tube rubbing on the skin.

Equipment

• Sterile cotton tipped applicators (Q-tips) 
• Trach gauze and "unfilled" gauze 
• Sterile water
• Hydrogen peroxide (1/2 strength with sterile water)
• Two sterile cups or clean disposable paper cups
• Small blanket or towel roll

Procedure

• Wash your hands, and apply latex gloves for your safety and protection. 
• Explain procedure in a way appropriate for the patient's specific age and understanding. 
• Patient should be lying 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.
• Open Q-tips, trach gauze and regular gauze.
• Pour 1/2 strength hydrogen peroxide into one cup and sterile water into the other.
• Clean the skin around the trach tube with Q-tips soaked in 1/2 strength hydrogen peroxide.
• Apply preferred sterile tape on both sides of tube for support, or sterile plastic supporter as shown above.
• This procedure should be repeated daily, if not more, on an as needed basis.