Having a tracheostomy means adjusting to changes to your daily routine. Whether the trach is temporary or permanent, understanding how to care for your devices (and yourself) is essential.

Here is what people with tracheostomy (and those caring for them) should know about caring for your equipment and stoma (the hole through your neck and windpipe, or trachea), along with what you can expect as you adjust to living with a Passy-Muir valve, eating, and other activities with a trach in place.

Trach Suctioning

The upper airway warms, cleans and moistens the air we breathe. The trach tube bypasses these mechanisms so that the air moving through the tube is cooler, dryer and not as clean. 

In response to these changes, the body produces more mucus. Suctioning clears mucus from the tracheostomy tube and is essential for proper breathing. Also, secretions left in the tube could become contaminated and a chest infection could develop. Avoid suctioning too frequently as this could lead to more secretion buildup.

Removing Mucus from Trach Tube Without Suctioning

1. Bend forward and cough. Catch the mucus from the tube, not from the nose and mouth.
2. Squirt sterile normal saline solutions (approximately 5 cc) into the trach tube to help clear the mucus and cough again.
3. Remove the inner tube (cannula).
4. Suction.
5. Call 911 if breathing is still not normal after doing all the above steps.
6. Remove the entire trach tube and try to place the spare tube.
7. Continue trying to cough, instill saline, and suction until breathing is normal or help arrives.

When to Suction

Suctioning is important to prevent a mucus plug from blocking the tube and stopping the patient's breathing. Suctioning should be considered:

• Any time the patient feels or hears mucus rattling in the tube or airway
• In the morning when the patient first wakes up
• When there is an increased respiratory rate (working hard to breathe)
• Before meals
• Before going outdoors
• Before going to sleep

The secretions should be white or clear. Yellow, brown or greenish secretions may be a sign of infection. If the changed color persists for more than three days or if it is difficult to keep the tracheostomy tube in place, call your surgeon's office.

If there is blood in the secretions (it may look more pink than red), you should initially increase humidity and suction more gently. A Swedish or artificial nose (HME) is a filtered cap that can be attached to the tracheostomy tube to help maintain humidity.

Putting the patient in the bathroom with the door closed and shower on will increase the humidity immediately. If the patient coughs up or has bright red blood mucus suctioned, or if the patient develops a fever, call your surgeon's office immediately.

Trach Suctioning

Suctioning Equipment

• Clean suction catheter (Make sure you have the correct size.)
• Distilled or sterile water
• Normal saline
• Suction machine in working order
• Suction connection tubing
• Jar to soak inner cannula (if applicable)
• Tracheostomy brushes (to clean tracheostomy tube)
• Extra tracheostomy tube

Tip Suctioning and Deep Suctioning Procedure

1. Wash your hands.
2. Turn on the suction machine and connect the suction connection tubing to the machine.
3. Use a clean suction catheter when suctioning the patient. If the suction catheter is to be reused, place it in a container of distilled or sterile water and apply suction for approximately 30 seconds to clear secretions from the inside. Next, rinse the catheter with running water for a few minutes, then soak in a solution of one part vinegar and one part distilled or sterile water for 15 minutes. Stir the solution frequently. Rinse the catheters in cool water and air-dry. Allow the catheters to dry in a clear container. Do not reuse catheters if they become stiff or cracked.
4. Connect the catheter to the suction connection tubing.
5. Lay the patient flat on his/her back with a small towel/blanket rolled under the shoulders. Some patients may prefer a sitting position, which can also be tried.
6. Wet the catheter with sterile/distilled water for lubrication and to test the suction machine and circuit.
7. Remove the inner cannula from the tracheostomy tube (if applicable). The patient may not have an inner cannula. If that is the case, skip this step and go to number 8.
   1. There are different types of inner cannulas, so caregivers will need to learn the specific manner to remove the one their patient has. Usually rotating the inner cannula in a specific direction will remove it.
   2. Be careful not to accidentally remove the entire tracheostomy tube while removing the inner cannula. Often by securing one hand on the tracheostomy tube’s flange (neck plate) one can/ will prevent accidental removal.
   3. Place the inner cannula in a jar for soaking (if it is disposable, then throw it out).
8. Carefully insert the catheter into the tracheostomy tube following the natural curvature of the tracheostomy tube. The distance to the location of catheter becomes easier to determine with experience. The least traumatic technique is to pre-measure the length of the tracheostomy tube and then introduce the catheter only to that length. For example, if the patient’s tracheostomy tube is 4 cm long, place the catheter 4 cm into the tracheostomy tube. Often, there will be instances when this technique of suctioning (called tip suctioning) will not clear the patient’s secretions. For those situations, the catheter may need to be inserted several millimeters beyond the end of the tracheostomy tube (called deep suctioning). With experience, caregivers will be able to judge the distance to insert the tracheostomy tube without measuring.
9. Place your thumb over the suction vent (side of the catheter) intermittently while you remove the catheter. Do not leave the catheter in the tracheostomy tube for more than 5-10 seconds since the patient will not be able to breathe well with the catheter in place.
10. Allow the patient to recover from the suctioning and to catch his/her breath. Wait for at least 10 seconds.
11. Suction a small amount of distilled or sterile water with the suction catheter to clear any residual debris or secretions.
12. Insert the inner cannula from extra tracheostomy tube (if applicable).
13. Turn off suction machine and discard catheter (clean according to step 3 if to be reused).
14. Clean inner cannula (if applicable).

How to Make Sterile Saline for Trach Suctioning

1. Start with clean hands, pans, containers and a spoon.
2. Put a clean saline storage jar and lid in one saucepan and cover with tap water.
3. Put 4 ¼ cups of tap water in a second pan.
4. Boil both pans for ten minutes.
5. Add two level teaspoons of table salt to plain boiled tap water and stir to dissolve.
6. Cool both pans to room temperature.
7. Remove storage jar and lid, touching only the outside.
8. Pour cooled salt water directly into storage jar.
9. Place lid tightly on jar.
10. Store saline in refrigerator.
11. Pour off the amount needed for each cleaning or suctioning session into a smaller container. Do not dip anything into the large supply of saline.
12. Make a new batch every day.

Tracheostomy Care

Rubbing of the trach tube and secretions can irritate the skin around the stoma ― the opening in the neck and trachea (windpipe). Daily care of the trach site prevents infection and skin breakdown under the tracheostomy tube and ties.

Stoma care should be daily and more often if needed, as may be the case for those with new trachs or on ventilators. Tracheostomy dressings can address drainage from the tracheostomy site or irritation from the tube rubbing on the skin. If the area appears red or tender, or smells bad, stoma cleaning should be performed more frequently. Call your surgeon’s office if a rash, unusual odor or yellowish-green drainage appears around the stoma.

It may be helpful to set up a designated spot in the home for equipment and routine tracheostomy care.

Stoma Care Equipment

• Sterile cotton tipped applicators
• Trach gauze
• Sterile water
• Hydrogen peroxide (1/2 strength, mixed half and half with sterile water)
• Trach ties (pieces of ribbon gauze used to secure a trach tube to the neck) and scissors (if ties are to be changed)
• Two sterile cups or clean disposable paper cups
• Small blanket or towel roll

Stoma Care Procedure

1. Wash your hands.
2. Make sure the patient is lying in a comfortable position 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.
3. Open cotton swabs, trach gauze and regular gauze.
4. Cut the trach ties to appropriate length (if trach ties are to be changed).
5. Pour 1/2 strength hydrogen peroxide into one cup and sterile water into the other.
6. Clean the skin around the trach tube with cotton swabs soaked in 1/2 strength hydrogen peroxide.
   1. Using a rolling motion, work from the center outward using 4 swabs, one for each quarter around the stoma and under the flange of the tube.
   2. Do not allow any liquid to get into trach tube or stoma area under the tube.
   3. Note: We recommend cleaning with just soap and water in home care, using hydrogen peroxide only to remove encrusted secretions. This is because daily use of hydrogen peroxide might irritate the skin, especially in small children.
7. Rinse the area with cotton swab soaked in sterile water.
8. Pat dry with gauze pad or dry cotton swab. No gauze should be placed under the trach tube unless recommended by the treating physician. A dry dressing is helpful if the patient has areas of skin irritation or secretions.
9. Change the trach ties if needed.
10. Check the skin under the trach ties.
11. For tracheostomy tubes with cuffs, check with your surgeon’s office for specific cuff orders. Check cuff pressure every four hours (usual pressure 15–20 mm Hg). In general, the cuff pressure should be as low as possible while still maintaining an adequate seal for ventilation.
12. Monitor skin for signs of infection. If the stoma area becomes red, swollen, inflamed, warm to touch or has a foul odor, or if the patient develops a fever, call the surgeon’s office.
13. Check with the doctor before applying any salves or ointments near the trach. If an antibiotic or antifungal ointment is ordered by a doctor, apply the ointment lightly with a cotton swab in the direction away from the trach stoma.
14. Wash your hands after each trach care.

Changing a Tracheostomy Tube

The curved tube that is inserted into a tracheostomy stoma is meant to be changed regularly. A week or two after your tracheotomy procedure, your surgeon will perform the first tracheostomy tube change to make sure the stoma and tracheostomy site are healing properly. Make sure to have your caregiver go with you to that appointment, where you will learn about how to change tubes.

It is important that caregivers feel confident and competent in tube changing before leaving the hospital in case an emergency tube change is needed. The procedure is not without risks. For optimal safety, two people should be present during a tube change. 

Tracheostomy Tube Types

A tracheostomy (trach) tube is a curved tube that is inserted into the opening made in the neck and trachea (windpipe).

A commonly used tracheostomy tube consists of three parts: an outer cannula with flange (neck plate), inner cannula, and an obturator.

The outer cannula is the outer tube that holds the tracheostomy open. A neck plate extends from the sides of the outer tube and has holes to attach cloth ties or a self-adhering strap around the neck.

The inner cannula fits inside the outer cannula. It has a lock to keep it from being coughed out, and it is removed for cleaning.

The obturator is used to insert a tracheostomy tube. It fits inside the tube to provide a smooth surface that guides the tracheostomy tube as it is being inserted.

A speaking valve is an optional device that fits over the tracheostomy and allows air to flow through the tube and out of the person’s mouth and nose. It allows a person with a tracheostomy to speak without having to block the trach with the fingers.

There are different types of tracheostomy tubes with certain features for different purposes. These are manufactured by different companies. However, a specific type of tracheostomy tube will be the same no matter which company manufactures them.

• A cuffless tube with disposable inner cannula may be the best choice for someone who is getting ready to have the tube removed. People using this type are usually able to eat and some may be able to speak without using a special device called a speaking valve. The inner cannula can be disposed of after use.
• Cuffed tubes with reusable inner cannulas also allow some people to eat and speak without a special speaking valve and may be a choice for those preparing to have the tube removed. However, the inner cannula needs to be cleaned thoroughly.
• A fenestrated cuffed tracheostomy tube may be chosen for someone who is on a ventilator but who cannot use a speaking valve.
• Fenestrated cuffless tracheostomy tubes may be appropriate for those who have difficulty using a speaking valve. These types carry a higher risk of developing granulomas (bumps) in the stoma (opening).
• Metal tracheostomy tubes may set off metal detectors, so people who have them should notify security personnel that they have one in place. They also need to notify medical personnel as they cannot have an MRI with a metal tube in place.

How to Change a Trach Tube: Instructions for Care Givers

Lung secretions (mucus) coat the inside of the tracheostomy tube requiring the tube to be changed once a week, although some patients may be fitted with a different tube that can be left in longer. The tube may have to be changed more often if secretions become very dry or if the patient has a chest infection and is producing more or thicker secretions.

Always change the trach tube before the person eats or wait for at least two hours after a feeding to avoid vomiting and the risk of aspiration (choking due to vomit entering the windpipe).

Equipment and Supplies for Trach Tube Change

• Suction catheter and suction machine in working order
• Two lengths of 1/4 inch cotton tapes or Velcro strap
• A new tube ― check correct size and that the tube is intact and in good order
• A smaller sized tube (one size smaller) in case the usual one will not go in
• Water-based lubricant to prevent the tube sticking to the skin as it is inserted
• Round-ended scissors

Trach Tube Change Procedure

1. Wash your hands.
2. Prepare tube ― take out of wrapping and hold by the flanges. Put in introducer (if applicable). Carefully apply a small amount of lubricant to the outer side of the end of the tube, ensuring no lubricant gets into the ends of the tube. Place the ties or strap on the new tube. Place the tube on the wrapper.
3. Have all equipment within easy reach.
4. Suction if necessary.
5. Position the patient as you do for tape changing.
6. Have one person hold the tube while the other cuts and remove the dirty tapes and place clean tapes behind the patient’s neck.
7. The tube should continue to be held while the other person holds the new tube by the flanges and positions the tip near the patient’s neck.
8. Gently remove the old tube, following the curve of the tube.
9. Firmly and gently slide in the new tube, again following the curve of the tube so as not to damage the trachea. Remove introducer if this has been used.
10. Hold the new tube securely in place ― changing the tube may cause the patient to cough, which could dislodge it.
11. Allow the coughing to settle. Check air flow through the tracheostomy tube by feeling the air flow onto your hands and observing the patient’s breathing pattern and color. Suction if necessary.
12. Clean and observe the skin around the tube.
13. Tie the tapes.
14. Do not let go of the tube until the tapes are secure.

If You Have Difficulty Inserting the New Tracheostomy Tube

Do not panic. Carefully follow the instructions below to ensure the patient will be oxygenated.

1. Check to make sure the patient is positioned optimally with the chin pointing toward the ceiling and the neck extended.
2. Try to reinsert the tracheostomy tube. Do not force the tube into the tract.
3. If it still does not enter, try to reinsert the old tube. Since this tube was in before, it should pass into the stoma without difficulty again.
4. If the old tracheostomy tube does not fit, try a tracheostomy tube that is smaller than the size the patient normally uses. Always keep a smaller tracheostomy tube available when changing the tube.
5. If this measure is still unsuccessful, take a suction catheter and put it in the stoma. Hold it in place and cut it approximately 5 cm or 2 inches from the stoma. This catheter will keep the stoma open.
6. Try to insert the old tracheostomy tube over the suction catheter. Always hold the catheter to prevent migration into the trachea (windpipe).
7. If the above measures fail, administer oxygen if the patient normally requires oxygen. If it is evident the patient can breathe by mouth, the Ambu bag can be used and placed over the mouth; otherwise, just direct the oxygen toward the stoma.
8. Call 911. Also remember to call your surgeon’s office.

If the Tracheostomy Tube Falls Out

1. Do not panic.
2. If the patient normally required oxygen or is on a ventilator, place oxygen over the tracheal stoma site.
3. Gather the equipment needed for the tracheostomy tube change. An assistant can do this while the other caregiver administers oxygen.
4. Always have a clean tracheostomy tube and ties available.
5. Wash your hands if you have time.
6. Put the obturator (a device that provides a smooth surface that guides the tracheostomy tube when it is being inserted) in the new tracheostomy tube and put a few drops of water on the end.
7. Remove the old tracheostomy tube if it is around the neck. If it is partially in the stoma, you can try to gently reinsert the old tracheostomy tube. If you cannot insert the old tube, go to the 7th step in the previous section.
8. Insert the new tracheostomy tube and quickly remove the obturator.
9. Reinsert the inner cannula.
10. Secure the tracheostomy ties.

Tracheostomy Humidification

The nose and mouth provide warmth, moisture and filtration for the air we breathe. Having a tracheostomy tube, however, bypasses these mechanisms. Humidification helps keep secretions thin and to avoid mucus plugs.

Tracheostomy Humidifying Equipment

• Air compressor
• Nebulizer bottle
• Aerosol tubing
• Trach mask (a mist collar that attaches over the trach to provide moisture)
• Sterile water
• Saline ampules (bullets)
• Heat moisture exchanger (may also be called an HME, thermal humidifying filter, Swedish nose or artificial nose)
• Room or home humidifiers

Using Heated Mist

For someone who requires heated mist, you can use an electric heating rod that fits into the nebulizer bottle. Many of these heating elements do not shut off automatically. Make sure the bottle does not go dry, which could melt the plastic or even cause a fire.

More moisture will accumulate in the aerosol tubing with heated mist. Moisture that accumulates in the aerosol tubing must be removed frequently to prevent blocking of the tube or accidental aspiration (inhalation that causes choking).

Humidification Procedure

1. Attach a mist collar (trach mask) with aerosol tubing over the trach with the other end of tubing attached to the nebulizer bottle and air compressor.
2. Sterile water goes into the nebulizer bottle (do not overfill, note line guide).
3. Oxygen can also be delivered via the mist collar if needed.
4. Disconnect tubing at the trach end, empty into a container and discard. Do not drain fluid into the humidifying unit.
5. Fluid traps (or drainage bags) are helpful in preventing occlusion and aspiration. These collection devices also need to be emptied frequently.
6. Position the air compressor and tubing lower than the patient to help prevent aspiration from moisture in the tubing.

Tips

A mist collar can also be worn during the day if mucus is thick or tinged with blood.

Sterile saline drops can be instilled into the trach tube if secretions become thick and difficult to suction. A saline nebulizer treatment is also helpful to loosen secretions if the patient has a nebulizer machine. Additional fluid intake also helps to keep secretions thinner.

Secretions can be kept thin during the day by applying a heat moisture exchanger (HME) to the trach tube. An HME is a humidifying filter that fits onto the end of the trach tube and comes in several shapes and sizes, all of which fit over the standard trach tube opening. There are also HMEs available for portable ventilators. Bedside ventilators have built-in humidifiers. HMEs also help prevent small particles from entering the trach tube. Change the HME daily and as needed if soiled or wet.

Maintaining and Cleaning Trach Equipment

Keeping supplies on hand. Ensuring the tube and other equipment stay clean is essential for the health of a person with a tracheostomy.

Cleaning Suction Catheters at Home

Suction catheters must be cleaned after each session of suctioning. This helps prevent infection and helps cut down costs by reusing the same catheter for one week.

After suctioning the trach tube:

1. Pour a few ounces of hydrogen peroxide into a small clean container.
2. Suction hydrogen peroxide through the catheter until it is free of mucus. Wipe the outside of the catheter with a cloth or gauze wet with peroxide.
3. Suction sterile salt water through the catheter until it is free of peroxide.
4. Suction air until the catheter is free of water.
5. Remove the catheter from the connecting tubing and let it air dry.
6. Wrap it in a clean dry towel.
7. Use it as needed with this cleaning process each time for up to eight hours, then THROW IT AWAY.
8. Follow manufacturer's instruction for cleaning and disinfecting your suction machine and humidifier. Do not allow water to stand in your humidifier when not in use.

Cleaning the Tracheostomy Inner Cannula Tube

If your tube uses a reusable inner cannula, the tube should be cleaned two to three times per day or more as needed. Please note that this only applies to reusable inner cannulas. Cleaning is needed more immediately after surgery and when there is a lot of mucus buildup.

Inner Cannula Tube Cleaning Equipment

• Trach care kit
• Small brush or pipe cleaners
• Half-strength solution of hydrogen peroxide (1/2 water, 1/2 hydrogen peroxide)
• Saline or homemade sterile salt water
• Two small bowls

Inner Cannula Tube Cleaning Procedure

1. Wash your hands.
2. Place 1/2 strength peroxide solution in one bowl and sterile salt water in second bowl.
3. Remove the inner cannula while holding the neck plate of the trach still.
4. Place inner cannula in peroxide solution and soak until crusts are softened or removed.
5. Use the brush or pipe cleaner to clean the inside, outside and creases of the tube.
6. Do not use scouring powder or steel wool pads.
7. Look inside the inner cannula to make sure it is clean and clear of mucus.
8. Rinse tube in saline or sterile salt water.
9. Re-insert it while holding the neck plate of the trach still.
10. Turn the inner cannula until it locks into position.
11. Double check the locking, pulling forward gently on the inner cannula.

Day-to-Day Life with a Tracheostomy

Can you talk with a tracheostomy?

Many people with a trach can speak, after time and practicing with or without special equipment. Normal speech relies on a steady stream of air that comes from the lungs and passes through the vocal cords. When the trach tube is inserted, most of the air bypasses the vocal cords and goes out through the tube. Some air may leak up to the vocal cords, but it may not be forceful enough to drive the vocal cords into vibration, or it may only allow enough force for very short utterances. 

All trach tubes should fit easily into the airway with some space around the tube. If the tube fits snugly inside the trachea, all the exhaled air will leave the body through the tracheostomy tube and no air can pass through the vocal cords.

Ways to Achieve Vocalization with a Tracheostomy

A person with a trach can cover the tube by holding a finger or placing a cap over the tube for short periods, but this may make it harder for the person to breathe, and may not be tolerable for everyone. Also, this practice can introduce germs and contaminants from the hand or fingers into the body and cause an infection, a particularly critical problem for those at risk for aspiration. Some may get enough air for speech without blocking the tube, but may not have the awareness, muscle movement or muscle tone to speak in this way.

Speaking Valves

Several types of valves can be attached to the tracheostomy tube to help a person speak. These valves allow air to enter through the tube and exit through the mouth and nose. Use of certain valves may also help reduce secretions, increase sense of smell, reducing choking risk, increase blood oxygenation and make it easier to remove the trach tube for people whose tracheostomy is not permanent.

Because all valves do not produce the same quality of speech or the same benefits, a valve for a specific patient should be selected carefully, based on scientific and clinical results.

Using a Passy-Muir Valve

The Passy-Muir speaking valve is commonly used to help people with a tracheostomy speak more normally. This one-way valve attaches to the outside opening of the tracheostomy tube and allows air to pass into the tracheostomy, but not out through it. The valve opens when the patient breathes in. When the person breathes out, the valve closes and air flows around the tracheostomy tube, up through the vocal cords allowing the person to make sounds. The patient breathes out through the mouth and nose instead of through the tracheostomy.

Some people may immediately adjust to breathing with a Passy-Muir valve in place. Others may need to gradually increase the time the valve is worn. Breathing out with the valve (around the tracheostomy tube) is harder work than breathing out through the tracheostomy tube. People may need to build up the strength and ability to use the valve, but most children will be able to use the speaking valve all day after a period of adjustment.

How to Use the Passy-Muir Speaking Valve

1. Suction the tracheostomy tube as needed before placing the valve. It may not be possible to use the valve if the patient has a lot of secretions or very thick secretions.
2. If the tracheostomy tube has a cuff, deflate it (remove the air from it) before placing the valve.
3. Suction the patient’s mouth and nose as needed before deflating the cuff so that secretions do not trickle into the trachea (windpipe) and bronchi.
4. Attach the valve to the top of the tracheostomy tube with a twisting motion to the right (clockwise) approximately ¼ turn. This will prevent it from popping off with coughing.
5. To remove the valve, twist off to the left (counterclockwise).

Tips

• Humidity can be used with the valve in place.
• Oxygen can be given with the valve in place.
• Remove the valve during aerosol treatments. If it is left on, remove it and rinse it to remove any medications that could cause the valve to stick or not work well.

Care of the Valve

1. Clean the valve daily with mild soapy water.
2. Rinse thoroughly with cool to warm water. Do not use hot water as it may damage the valve.
3. Let the valve air dry completely before using it again.
4. Do not use a brush, vinegar, peroxide, bleach or alcohol on the valve.
5. Replace the valve when it becomes sticky, noisy or vibrates.

Safety Precautions

• Patients must not use the valve while sleeping.
• The valve should only be used under direct supervision of caregivers who know how it works and how to correctly use it.
• Remove the valve immediately if the patient has difficulty breathing. Suction or change the tracheostomy tube if needed.
• The entire manufacturer’s instruction booklet must be read before using the Passy-Muir Valve.
• The valve must not be used on tracheas that have the cuff inflated.

Ventilator Users

For some patients, a tracheostomy tube alone may not be enough. The tube may need to be connected to a breathing machine (ventilator) that provides a mixture of gases for life support. Patients on ventilators can speak if the tracheostomy tube allows flow through the larynx (voice box) and vocal cords. However, the speech patterns of ventilator users can be challenging to hear and understand.

For people who are mechanically ventilated, a more fitted trach may help. If the airway is very small, scarred, or has a granuloma, the person may not be able to move enough air past the vocal cords to vocalize. If the vocal cords are scarred or paralyzed, the person’s voice may sound hoarse or unusual.

Because of the design of the ventilator, speech occurs during the breathing-out cycle of the ventilator. Then there is a long pause until the next exhale. During this silence, the patient may lose his or her turn to talk as conversation partners fill the silence with their own speech. Listeners may also find it hard to follow the patient's speech because the normal rhythm of conversational give-and-take is disrupted.

Making simple adjustments to ventilator settings can improve the person’s ability to speak, particularly if no other problems exist besides breathing insufficiency. There is also at least one speaking valve available that can be used with a ventilator.

People with a trach in place benefit greatly from friends and family who make an extra effort to talk with them, even if they cannot vocalize. If the person cannot speak, alternative methods of communication can be used, such as sign language, picture cards and communication boards.

Speech-Language Pathologist and the Rehabilitation Team

It takes a team to support a person’s ability to speak with a tracheostomy, including physicians, nurses, respiratory therapists, dietitians, speech-language pathologists and others. Working together, these health practitioners can recommend the options that best meet the person's needs.

The speech-language pathologist assesses the patient's cognitive and language abilities to determine communication potential, evaluates oral-motor and swallowing functions, and assesses the patient's ability to produce voice in different situations that may include using a speaking valve. The speech-language pathologist plays a central role in helping people with trachs optimize their ability to communicate, speak and swallow.

Can you eat with a tracheostomy?

Yes. Having a tracheostomy usually will not affect a person's eating or swallowing patterns. Sometimes there are changes in swallowing, but most people can adapt in a short time. Caregivers should always observe the person while he or she is eating to ensure food does not get into the trach.

Swallowing problems are usually due to limited elevation of the larynx or poor closure of the epiglottis and vocal cords, which allow food or fluids into the trachea and cause choking. An otolaryngologist and speech pathologist can be consulted for an evaluation, which may include a video fluoroscopic swallowing study or other procedures to make sure the person is swallowing safely. The speech pathologist may recommend ways to improve swallowing.

Signs of a Swallowing Problem

• Difficulty eating or refusing to eat
• Anxiety or no reaction to food in the mouth
• Choking and coughing while eating or drinking
• Vomiting
• Evidence of food in tracheostomy secretions
• Excessive drooling
• Large amounts of watery secretions from trach
• Congested lung sounds
• Frequent respiratory infections

If the patient eats by mouth, it is recommended that the tracheostomy tube be suctioned before eating. This may prevent the need for suctioning during or after meals, which may stimulate excessive coughing and could result in vomiting.

Encouraging fluid intake is helpful for a patient with a tracheostomy. Increased fluid intake will thin and loosen secretions, making coughing and suctioning easier.

Traveling with a Tracheostomy

People with a tracheostomy can travel domestically or abroad with a few extra preparations. The surgeon’s office can provide more information about traveling with a tracheostomy.

• Make sure you have adequate insurance provisions in case you need to be flown home quickly. As with all insurance documents, be sure to carefully read the small print.
• If flying, advise the airline of the equipment that will be taken on board, either as carry-on or checked luggage. Please note that not all airlines allow suction machines on board.
• Feel free to request oxygen that is readily available on board.
• If traveling by car, drivers and caregivers can buy an additional internal mirror to easily check on the patient in the back seat.
• Take enough supplies to last the duration of the travel time as well as a few extras just in case. The travel bag should always include:
• Suction catheters
• Gloves
• Normal saline bullets
• Tissues
• Scissors
• Extra trach tubes (same size and one size smaller)
• Trach ties/Velcro strap
• Disposable humidity devices
• Bulb syringe
• Portable suction machine
• Oxygen (if needed)
• Apnea monitor/oximeter (only needed under special circumstances)
• Medicines
• Ambu bag (a self-inflating, manually operated resuscitator that provides positive pressure ventilation to address breathing problems)
• Bottles/food/snacks

Swimming with a Tracheostomy

Can you swim with a trach? Yes, if you use specialized equipment to stop water from going into the stoma. These devices are necessary for swimming until the stoma site has closed and healed completely.

Tracheostomy Supplies

Caring for a tracheostomy requires special equipment and other items to keep your tube and stoma clean and clear. Here are the supplies you and your caregiver will want to keep on hand:

• Tracheostomy tubes of the appropriate type and size
• Tracheostomy tube (one size smaller)
• Trach tube ties or Velcro strap
• Dressing supplies, gauze
• Hydrogen peroxide, sterile water, normal saline
• Water-soluble lubricant
• Blunt-end bandage scissors
• Tweezers or hemostats
• Sterile cotton swabs
• Trach care kits and/or pipe cleaners (double cannula trach tubes)
• Luer lock syringes for cuffed trach tubes

Suction Equipment

• Portable battery-powered suction machine
• Suction connecting tubing
• Suction catheters
• Normal saline solution
• Sterile jars with screw tops (sterile specimen containers or sterilized baby food jars work well)
• Saline ampules (“bullets“): small plastic containers of salt water solution
• Bulb syringe
• Suction trap or syringe with catheter
• Hand-powered suction devices: a suction unit for first responders, and a reliable backup for emergency health care providers.
• Yankauer suction handle
• Sims connector

Humidification System

• Air compressor: A machine that provides air or oxygen under pressure to make breathing easier for a patient with breathing problems
• Nebulizer bottles: Bottles used to turn saline or a liquid medication into smaller droplets to be delivered to a patient’s nose, throat or lungs through the nose, mouth or a breathing tube.
• Tracheostomy mask
• Aerosol tubing: A piece of tubing used to deliver inhaled medicine (breathing treatment) to people with tracheostomy or breathing tube
• Water trap
• Heat moisture exchanger, or HME: A humidifying filter that fits onto the end of the trach tube and comes in several shapes and sizes. Also called a thermal humidifying filter, Swedish nose or artificial nose. You can also use a room humidifier.
• Sterile water
• Mist heater (if ordered)
• Croup or mist tent (rarely ordered today)
• A high velocity therapy device (Vapotherm)

Optional Trach Care Supplies

• Hand washing supplies
• Cleaning supplies
• Mucus traps for sputum specimens
• Sterile or clean paper cups
• Tissues
• Manual resuscitation (Ambu) bag with mask and trach adapter
• Intercom, baby monitor or video monitor
• Thermometer
• Stethoscope
• Disposable gloves (powder-free)
• Trach scarf or bib
• Rolled up towel
• Speaking valves
• Trach guard
• Cardiac/apnea monitor (a device used to detect slowed or absent breathing in patient with a breathing tube [endotracheal tube] or a tracheostomy tube that is hooked to a ventilator)
• CO₂ monitor
• Pulse oximeter
• Oxygen
• Oxygen concentrator
• Oxygen supply tubing
• Ventilator (breathing machine)
• BiPAP
• Nebulizer equipment (aerosolized medication delivery system)
• Portable compressor/nebulizer
• A compact compressor/nebulizer
• A valved holding chamber
• Pressure manometer to check trach cuff pressure on cuffed tubes
• Extra smoke detectors and a fire extinguisher suitable for electric as well as regular fires.
• Consider an emergency generator if you have frequent power failures.