Tracheostomy Stoma Care

Tracheostomy is a life-saving procedure, which results in an opening or stoma in the neck to allow the placement of a tube in the patient’s windpipe. Aside from the ability of this diversion to help a patient get back to a healthier lifestyle, it can also result in some complications. It is crucial to take care of the skin around the stoma to prevent irritation, infection, and odor. For this purpose, you will need to clean the stoma and the skin around it at least twice a week. It will help clear the buildup of mucus and rubbing of the tracheostomy tube.

Equipment that you will require for the cleaning procedure may include:

• Facecloth
• Cotton-tipped applicators
• Normal saline
• Hydrogen peroxide
• Telfa or sof-wik 2x2 dressing

The procedure of cleaning involves the following steps.

• First and foremost, clean your hands by washing them thoroughly.
• If there is any dressing around the stoma, remove it. You will not need to remove the tubing, though.
• Dip the cotton-tip applicators in the peroxide solution and start cleaning the stoma and the skin around it. You can use saline if peroxide is too irritating. You will need to start close to the tracheostomy tube and then work away from it.
• Repeat the process above until the debris and mucus are cleared.
• To dry the skin around the stoma, use a facecloth or cotton tip applicator.
• Unless your treating physician recommends, avoid putting gauze under the trach tube. If there are areas of skin irritation or secretions, you can consider placing a dry dressing. You can discuss with your physician how to apply the dressing.

Daily care

The skin around the stoma can develop irritation due to rubbing of the trach tube or secretions. If you want to prevent infection and skin breakdown under the tracheostomy site, you will need to stick to a daily care routine. Make sure to practice daily care steps at least once a day. Patients with new tracheostomies or ones on ventilators may need to trach care more often during the day. Tracheostomy dressing can be quite beneficial if there is excess drainage from the tracheostomy site. This dressing also reduces the rubbing of the tube on the skin.

Equipment required for daily care may include the following.

• Cotton tipped applicators
• Trach gauze
• Sterile water
• Hydrogen peroxide
• Sterile cups
• Trach ties and scissors
• Towel roll or small blanket

Here is the procedure involved in the daily care.

• Start by washing your hands.
• The patient should lie back in a comfortable position. The body should be covered in the blanket or towel roll, extending the neck to allow easier visualization.
• Open the tip applicators, trach gauze, and regular gauze.
• Cut trach ties in lengths that seem appropriate.
• Pour sterile water in a cup and hydrogen peroxide in the other.
• Clean the skin around the stoma using tipped applicators. Perform the cleaning using a rolling motion to avoid rubbing. You may need to change the swabs. Make sure that o liquid gets into the trach tube or stoma under the tube.
• Rinse the area using a water-soaked cotton-tipped applicator.
• Pat the skin dry.