What is it about ?
A tracheostomy is an artificial opening in the neck that allows air to enter directly into the trachea. This opening should be made in people who can no longer breathe through their nose or mouth. This problem can occur in some emergency situations. An incision is then made in the neck to insert a tube (called a cannula).
A tracheostomy can be temporary (for example after a stroke, severe pneumonia, an accident) or permanent (for example in case of throat cancer, birth defects, breathing difficulties in case of muscular or nervous diseases, long coma. duration).
A tracheostomy is associated with a large number of risks. First of all, the direct connection between the outside air and the respiratory tract is an “open door” to the development of infections. Additionally, scarring may reduce the size of the incision or the cannula may become blocked. This is why the opening of the tracheostomy and the cannula require proper and regular care.
What care should be given in the context of a tracheostomy?
It is necessary to take good care of the surgical wound and to maintain the cannula well within 48 hours of the operation, and this under completely sterile conditions. Sterile wound care is also important in patients with signs of infection or who are on life support. During care, the person should be seated in a semi-recumbent position with the head tilted back. The cannula is cleaned several times a day with hydrogen peroxide, rinsed with saline solution and dried with a sterile pad. The cannula should be replaced every 4 weeks. Cleaning and disinfection of the wound takes place daily with saline solution and a non-irritating disinfectant. The mucus and secretions that are not evacuated by coughing are aspirated. The inspired air must be moistened because it no longer passes through the nose or through the mouth. It is important to prevent the mucous membranes from drying out.
In patients who are not on life support, sterile long-term tracheostomy care is not necessary. The wound should be cleaned with saline solution. The cannula is rinsed under running water and then dried with a compress.
How do you control any complications?
Difficulty breathing (dyspnea) is the main sign of a complication. Dyspnea may be due to an improperly placed cannula, a cannula clogged with dried blood or dried mucus, or pressure on the cannula from healing the wound. In the event of a severe complication, a new intervention will be required.
How do you remove the cannula?
When normal breathing is possible again, consideration may be given to removing the cannula. The operation can be done in one go or in stages, i.e. by placing smaller and smaller cannulas, which are closed with a stopper to see if breathing remains normal. If breathing continues normally for 48 hours, the cannula can be removed. The opening is cleaned with saline solution, “re-glued” with adhesive tapes and covered with a sterile dressing.
Want to know more?
- The management of a tracheostomy for the patient and his relatives, here, Where to find on this page of Cliniques St Luc UCL
- Tracheostomy explained to children – Plaster
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