Discharge Instructions: Caring for Your Tracheostomy Tube and Stoma

Choose a clean, well-lighted space near a sink and mirror. Spread a clean towel on a surface, and put these supplies on it:

• Gauze pads or other non-fraying material advised by your healthcare provider
• Cotton swabs
• Trach tube brush
• Bowl filled with the type of solution advised by your healthcare provider. They may advise you to use saline solution. Or they may advise you to use a mixture of equal parts saline and hydrogen peroxide. A saline and hydrogen peroxide mixture is often used to clean tracheostomy equipment.

1. First, wash your hands with soap and clean, running water. Put on clean, disposable, powder-free gloves.
2. Hold the neck plate with 1 hand. With the other hand, unlock the inner cannula. Gently remove the inner cannula. Don’t remove the outer cannula.
3. If you have trouble removing the inner cannula, don't force it. Call your healthcare provider. Ask what to do.

To clean the reusable inner cannula, follow the instructions below. (Don’t clean a disposable inner cannula. That type is meant to only be used 1 time.)

1. Soak the reusable inner cannula in the bowl of solution your healthcare provider has instructed. (If you have a metal inner cannula, don't use hydrogen peroxide. It can damage the cannula. Use only saline.)
2. Clean the inner cannula with a trach tube brush. Don’t use a toothbrush. Rinse fully with plain saline solution.
3. Put the wet inner cannula back into the outer cannula. Lock the inner cannula in place.

1. Remove the gauze from behind the neck plate. Check the area for signs of skin breakdown or infection.
2. Clean the neck plate and the skin under it. Use clean gauze pads or other non-fraying material dabbed in saline solution. A complete cleaning method is done by cleaning the stoma 1 section at a time. This pattern can also be followed on the skin and tube flange:
   • Use a new gauze pad for each section.
   • Start at the 12 o'clock position and wipe to the 3 o'clock position.
   • Next, clean from 12 o'clock to 9 o'clock.
   • Next, clean the 3 o'clock to 6 o'clock position.
   • Last, clean from the 9 o'clock to 6 o'clock position.
   • Gently pat the skin dry.
3. Don't use a hydrogen peroxide mixture directly on your skin unless your healthcare provider tells you to. Hydrogen peroxide can irritate the skin. It can increase the risk for infection. If you are told to use a hydrogen peroxide mixture on your skin, rinse the area with saline afterward.
4. Put a clean, precut gauze pad under the neck plate. This pad protects your skin. Don't cut a gauze pad. The frayed edges of gauze will increase risk for infection. A loose thread could be inhaled into the trach.

The neck plate is held in place with cloth or Velcro ties. If these get dirty, they should be changed. You will need another person to help you change the ties. This is to make sure the neck plate does not move out of place. To replace them:

1. Ask your helper to wash their hands. Then they need to put on a pair of clean, disposable, powder-free gloves.
2. Have a clean set of ties ready to be attached to the neck plate.
3. While one of you holds the neck plate in place, the other person loosens the ties on the neck plate and removes them. Discard the soiled ties.
4. While the neck plate is still held in place, attach the clean ties to the neck plate and secure them. Make sure the ties are snug enough to keep the neck plate from moving too much, yet loose enough to be comfortable. You should be able to insert 1 finger between the trach tie and the skin.