Caring for Your TRACHEOSTOMY Getting On with Your Life
A New Pathway for Air Have you had a tracheostomy? Or, are you about to have one? If so, you may be wondering what the future holds for you. It s true that you ll have to make some changes in your daily life. Read this booklet to find out more about a tracheostomy and what it may mean for you. What Is a Tracheostomy? For you to breathe, air needs to flow freely into and out of your lungs. A tracheostomy (tray-kee-ahs-toe-mee) gives you a new pathway for air to go into and out of your lungs. To create this pathway, you need surgery to make a small opening in your neck. A tracheostomy tube (also called a trach tube ) is then placed into this opening. Air flows into and out of your lungs through the tube. 2 This booklet is not intended as a substitute for professional medical care. Only your doctor can diagnose and treat a medical problem. 1999, 2006, 2013, 2015 The StayWell Company, LLC. www.kramesstore.com 800.333.3032 All rights reserved. Made in the USA.
Your Healthcare Team Can Help The thought of a tracheostomy may be scary at first. You ll need time to get used to the idea. But keep in mind that your healthcare team of doctors, nurses, and therapists can help you. They can explain what your tracheostomy involves and what it may mean for you. They can also teach you how to take care of it. And they can help you adjust. If you have any questions, be sure to ask your nurse or another member of your healthcare team. What s Ahead Understanding Your Airway................................. 4 Your Trach Tube.... 6 Tracheostomy Care... 8 Learning to Communicate... 10 Eating with a Trach Tube... 11 Adjusting to Your Trach Tube.... 12 Answers to Some Common Questions... 14 Words You May Hear... 15 3
Understanding Your Airway To live, you need oxygen. You can t survive for more than a few minutes without it. Your body gets oxygen from the air you breathe. Breathing moves air into and out of your lungs. To breathe and get oxygen to your body, you need a clear airway to your lungs. When the Airway Is Clear The parts of a normal airway are described below. The larynx (voice box) is just above your trachea. The larynx contains your vocal cords. Air passing out of the lungs through the larynx makes these cords vibrate. This helps make sounds when you talk. The trachea (windpipe) is a hollow tube. Air passes into and out of the lungs through this airway. The esophagus is your food tube. Food travels through it to your stomach. The lungs are made up of many small air passages. When you breathe in air, oxygen is passed from the lungs into the blood. Carbon dioxide, a waste gas, is pulled out of the blood and into the lungs. When you breathe out, the carbon dioxide is pushed out of your lungs and body. 4
If the Airway Doesn t Work Certain things can cause the airway to stop working. If this happens, your body can t get oxygen. So you need a new pathway for air to get to the lungs. This new air passage, called a tracheostomy, is made through the front of the neck into the trachea. Having a tracheostomy may be planned ahead of time. In some cases, it must be done as an emergency procedure to get air into the lungs right away. Reasons for a Tracheostomy Some of the reasons that a tracheostomy may be needed include: way (such as from an allergic reaction) throat or trachea supplemental oxygen, such as with severe emphysema (sleep apnea) or throat that affects breathing How a Tracheostomy Works Surgery is done to make a small opening through the front of your neck into your trachea. This opening is called a stoma. A short tube (trach tube) is placed into the stoma. One end of the trach tube rests outside of your neck. The other end rests inside your trachea. When you breathe in, air flows through the trach tube into your trachea and to the lungs. When you breathe out, air flows back out of the trach tube. Some people need the new airway for only a short time. Others may need it for good. Your doctor or surgeon will discuss your needs with you. Air can t flow into lungs Blockage Air can t flow out of lungs Air flows into and out of the lungs through the trach tube Trach tube in stoma 5
Your Trach Tube Your trach tube is designed to help you breathe. Read on to learn the parts of your trach tube and what they do. Know that the type of trach tube you get depends on why you need the tube and what you and your doctor decide is best for you. The Parts of a Trach Tube Trach tubes are often made of plastic. Some are made of metal. Most trach tubes have three basic parts. These are the outer cannula (which includes a neck plate), the obturator, and the inner cannula. These parts are described and shown below. The outer cannula fits into the stoma to keep it open. The outer cannula has a neck plate that rests on the skin. The obturator is a device that guides the outer cannula into the stoma during placement of the cannula. The obturator is removed after the cannula is in place. The inner cannula fits inside the outer cannula. The inner cannula can be removed for cleaning. Neck plate Outer cannula Obturator Outer cannula Inner cannula Outer cannula 6
Different Trach Tubes for Different Needs Trach tubes come in many sizes. The size of the trach tube is chosen to fit your trachea. Your trach tube may also have special parts. Below are three common types of trach tubes. Ask your healthcare provider to check the box next to your type of trach tube. Cuffed A cuffed trach tube has a balloon (cuff) near the end of the outer cannula. The cuff blocks any air from flowing around the tube. All air must flow in and out through the tube. A pilot tube attached to the cuff stays outside the body. A syringe is used to inflate (fill with air) the cuff or deflate (take air out of) the cuff through the pilot tube. A cuffed tube is used if a respirator (breathing machine) is needed. Fenestrated A fenestrated trach tube has an opening (fenestration) in the back of the outer cannula. The front of this type of tube can be blocked so that all air flows through the opening into the upper part of the trachea. A fenestrated trach tube often has a cuff. Uncuffed and Unfenestrated Many trach tubes have no cuff or fenestration. They have a basic inner cannula and outer cannula. Most air flows through the tube. But some air flows around the tube. Cuff Fenestration Pilot tube Air through opening Fenestration Air around tube Air Cuff Air through tube 7
Tracheostomy Care You need to take care of your trach tube, your stoma, and the skin around the stoma. You will be told how to do this. The guidelines below may also help you. Be sure that you know what to do if your outer cannula comes out. Keeping the Tracheostomy Clean To take care of your skin and prevent infection, you need to keep your tracheostomy clean. You will be shown how to do this. Clean the tracheostomy at least once a day. Clean more often, if you need to. Your Trach Ties Trach ties fit around your neck to hold your tube in clean. Fabric ties need to be changed when they are dirty. You will be shown the best way to change your ties. The ties are not too tight or too loose if you can fit two fingers between the ties and your neck. Keeping the Trach Tube Clear There is always some mucus in your airway. But mucus can build up and thicken. If this happens, your trach tube can become plugged. This may make it hard for you to breathe. To keep the trach tube clear of mucus buildup, you may need to do one or more of the following: Suction the mucus out of the airway. To do this, you use a special machine. You will be told how to suction and how often. Moisten the air you breathe. Normally, the nose moistens air as it is breathed in. With a tracheostomy, you need another way to moisten the air. Ask your healthcare provider what method of moistening the air you should use. You will be told ahead of time what to do if your tube becomes plugged. If you ever have trouble breathing, call 9-1-1 (emergency) right away. Wearing Identification (ID) bracelet that says you breathe through a trach tube. It is very important that people know this in an emergency (especially if your outer cannula has come out). Trach ties fit right if you can put two fingers between the ties and your neck. 8
If the Outer Cannula Comes Out Never remove the outer cannula unless your doctor tells you to. But know how to put the outer cannula back in if it happens to come out. Stay calm, and follow the steps below. If you get the tube back in yourself, have your doctor check it as soon as possible. Call 9-1-1 (emergency) right away if you can t get your outer cannula back in or if you have trouble breathing. 1 2 3 4 Remove the inner cannula from the outer cannula. If you have a cuff, deflate it. If you can, rinse the tube with water, and put water-soluble lubricant on the cannula tip. Insert the obturator into the outer cannula. Lean your head back. Use your fingers to spread your stoma open. Using the obturator, slide the outer cannula back into your stoma. Stay as relaxed as you can. Holding the neck plate firmly, remove the obturator as soon as the tube is in place. Tie the trach plate until the trach ties are tied. Put the inner cannula back into the outer cannula. Turn the neck of the inner cannula so it locks. Have your doctor check the tube right away. When to Call the Doctor Call your doctor right away if you have any of these problems: or thick mucus 9
Learning to Communicate Having a tracheostomy may mean learning new ways to communicate with others. Your healthcare providers will help you as you adjust. If you cannot talk, you can learn other ways to express your thoughts and feelings to others. If You Can Talk Whether you can talk after a tracheostomy depends on why you have the tube. Many people with trach tubes still have vocal cords and can use these cords to talk. Certain trach tubes are designed to help with talking. Your healthcare team can help you decide whether one of these tubes is right for you. You may see a speech therapist (a person trained to help people who have problems speaking). He or she can help you learn ways to make talking easier. If You Can t Talk If you can t talk after your tracheostomy, you can still communicate. The tips below can help you do this. Ask your healthcare team for other suggestions. or a wipe-off board with you. Use them to write quick notes to others. such as thirsty or restroom. letters of the alphabet on it. hand gestures with friends and family members. as a smile. They can say a lot. To speak, you may need to cover the end of your trach tube with a finger or trach cap. Carry a pen and a notepad and use them to write notes to others. Trach cap 10
Eating with a Trach Tube You can still eat many of the same foods you did before you had the tracheostomy. But there are a few things to keep in mind. Your doctor or other healthcare provider may advise you to eat or avoid certain foods. Be sure to follow his or her advice. Try the tips below. Tips for Eating with a Trach Tube whether you should deflate it before you eat. thin and prevent mucus buildup. At first, drink thicker fluids, such as soups and nonalcoholic blended drinks. As you get used to the tube, you may be able to drink thinner liquids, such as water, again. plenty of fiber. This is found in whole grains, bran, fruits, vegetables, and beans. aspirate food (it goes into your airway), stay calm. Try to suction the food out through your trach tube. If you can t do this, call 9-1-1 (emergency) right away. Cut food into small pieces to make swallowing easier. 11
12 Adjusting to Your Trach Tube It may take you some time to adjust to your tracheostomy. You may wonder how it will affect your daily life. You will need to make some changes. But you can get used to having a trach tube. Your family, friends, and healthcare providers can help. Learning to Adjust At first, you may be scared, angry, or depressed about having a trach tube. This is common. You need to give yourself time to adjust. Using and caring for your trach tube will get easier and less awkward with time. Also, you may find that some people may be curious about your tube. They may stare or ask you questions. And remember that your friends and family still love you for who you are, with or without the trach tube. Living Your Daily Life To make living with your trach tube easier and safer, try these tips: you bathe or shower. A hand-held shower nozzle may be helpful. Use a shower shield, if you are told to. tube that doesn t belong there. Never smoke through your trach tube. If you smoke, your healthcare provider can help you quit. a thin, damp cloth or bandage over the end of the tube to act as a filter. Be sure that air can still get into and out of your tube. you feel upset or begin to gag. Breathe slowly and deeply. If this is a problem for you, tell your doctor. He or she can help you learn to relax. Wearing a scarf can help make the trach tube less noticeable. But be sure air can still get in and out of the tube. When you shower or bathe, keep water away from the trach tube opening.
For Family and Friends A person with a tracheostomy needs to learn a new way to breathe. He or she needs time to adjust. Be patient and supportive. Know that the person you love hasn t changed. Try to keep in mind the points below: help. Ask a healthcare provider to help you learn what to do. one has a hard time breathing, call 9-1-1 (emergency) right away. Having a tracheostomy can be frustrating, especially at first. out. Help him or her get used to being in public with the trach tube. 13
14 Answers to Some Common Questions Here are answers to some common questions. If you have other questions, ask a member of your healthcare team. Q: How long will I have my trach tube? A: This depends on why you have the tube. Often, the new airway is needed for only a short time. But sometimes the new airway must stay in for good. The tube is removed when it s no longer needed. Q: If the trach tube is taken out, will it leave a hole? A: If the stoma is no longer needed, it is covered up and allowed to close on its own. Tracheostomy stomas often heal nicely and leave only a small scar. Q: Can I swim with a tracheostomy? A: You can t put your tube under water. But you can wade or sit in water if you keep your stoma and tube dry. Q: I sometimes feel like I m gagging. Is this normal? A: Until you get used to breathing through the trach tube, you may feel that it is hard to breathe or swallow. Stay calm. Take some deep breaths. As you relax, the feeling should go away. It is normal to gag a little when you suction. Q: Can my trach tube fall out? A: Your trach ties should keep your tube from falling out, even if you cough. But you should know what to do if the tube does come out. Q: Why is it harder to pass stool? A: A person who breathes through the nose or mouth can hold his or her breath to help push stool out. You can t do this, so stool may be harder to pass. If this is a problem for you, talk to your doctor. He or she may suggest a high-fiber diet or laxatives.
Words You May Hear The list below defines some words used in this booklet. Other words that you may hear while you learn to take care of your tracheostomy are also defined. Aspiration: When food, liquid, or other substances enter the trachea. Cuff: A part of the outer cannula of some trach tubes. When it is inflated, air can t flow around the tube. Fenestration: A hole in one side of some trach tubes. It allows air to flow up into the larynx. Inner cannula: The tube that fits inside the outer cannula. This tube can be removed for cleaning. Some people will have a disposable inner cannula, or DIC. This type of cannula is discarded and replaced each time. Larynx: Also called the voice box. It contains your vocal cords. It is on top of your trachea. Mucus: A thick, sticky fluid made by the airway walls. This fluid cleans air as it passes through the airway and carries the dirt out of the body. If mucus builds up, it can plug the trach tube. Neck plate: The part of the outer cannula that rests against your skin. Ties attached to the neck plate help keep the trach tube in the stoma. Obturator: A device that helps guide the outer cannula into the stoma. The obturator is removed as soon as the outer cannula is in place. Outer cannula: The tube that is placed directly into the stoma. This tube includes the neck plate. Stoma: A hole through the front of the neck into the trachea. Suctioning: A way of cleaning mucus and other substances out of the trach tube using a special machine. Trach cap: Used only with a fenestrated tube. A trach cap prevents air from flowing into the trach tube. All air must come in and go out through the mouth or nose. This may be used to help patients talk, or to block the tube when it is not needed. Trachea (windpipe): The hollow tube through which air flows between your throat and lungs. Tracheostomy: An opening on the front of the neck into the trachea that allows you to breathe air in and out. Tracheotomy: The surgery that makes the opening into the trachea. Trach ties: The laces that attach to the neck plate to hold the outer cannula in the stoma. These laces can be made out of many kinds of materials, including plastic, cotton, or Velcro. Vocal cords: The parts of your larynx that vibrate to make sounds when you talk. Air must pass through them to make them vibrate. 15
Getting Support If you have questions that this booklet doesn t answer, your doctor, nurse, and other healthcare providers can help. For more information and guidance, call the organizations below. Or, look them up on the Internet. You may also want to join a support group. This is a group of people who share similar concerns or problems. Call your local hospital to find out whether there is a support group near you. American Lung Association American Cancer Society 800-586-4872 800-227-2345 lung.org www.cancer.org Consultant: Jean C. Young, RN, MS, Critical Care Nursing With contributions by: Marilyn E. Hudak, RN, BSN, MS, CORLN, Head and Neck Nursing www.kramesstaywell.com 800.333.3032 11133 1412