Cleaning Trach Stomas

Depends on condition, what's available, and how the order reads. Most doctors write the order giving two or three choices.

Aaron's Tracheostomy is the internet's best resource for Pediatric trach care.

Site written and maintained by Cynthia Bissell, RN (started after her child had a trach desiring to share her experiences) using evidenced based practices.

Tracheostomy Care

Rubbing of the trach tube and secretions can irritate the skin around the stoma. Daily care of the trach site is needed to prevent infection and skin breakdown under the tracheostomy tube and ties.

Procedure

• Wash your hands.
  
• Explain procedure in a way appropriate for the child's age and understanding.
  
• Lay your child 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.
  
• Open Q-tips, trach gauze and regular gauze.
  
• Cut the trach ties to appropriate length (if trach ties are to be changed).
  
• Pour 1/2 strength hydrogen peroxide into one cup and sterile water into the other.
  
• Clean the skin around the trach tube with Q-tips soaked in 1/2 strength hydrogen peroxide. 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. Do not allow any liquid to get into trach tube or stoma area under the tube. Note: Some doctors 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 of some children.
  
• Rinse the area with Q-tip soaked in sterile water.
  
• Pat dry with gauze pad or dry Q-tips.
  
• Change the trach ties if needed (See Changing a Tracheostomy Tube).
  
• Check the skin under the trach ties.
  
• Tuck pre-cut trach gauze around and under the trach tube flush to skin. Do not cut the gauze or use gauze containing cotton because the child may inhale small particles. Use precut tracheostomy gauze or unfilled gauze opened full length and folded into a U shape or use two gauze pads, one placed under each wing of the tube. Be sure the trach dressing does not fold over and cover the trach tube opening. Change the dressing when moist, to prevent skin irritation. Tracheostomy dressings may not be needed for older tracheostomies when the skin is in good condition and the stoma is completely healed and free from rash or redness.
  
• For tracheostomy tubes with cuffs, check with your doctor for specific cuff orders. Check cuff pressure every 4 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.
  
• Monitor skin for signs of infection. If the stoma area becomes red, swollen, inflamed, warm to touch or has a foul odor, call your doctor.
  
• Check with the doctor before applying any salves or ointments near the trach. If an antibiotic or antifungal ointment is ordered by the doctor, apply the ointment lightly with a cotton swab in the direction away from trach.
  

My experience with Peds and adults: unless crust present, dab of liquid soap on warm wash cloth, rub to create slight lather, clean underneath flange and around neck.-rinse with another warm water only wash cloth

Crusts present -use 1/2 strength Peroxide as above. Routine use of peroxide to skin stoma tends to irritate stom skin. I fan dried skin with sterile trach dressing package then changed trach ties (velco, twill tape or cotton tape sticky side back to back--whatever insurance would cover), then applied trach dressing. Best trach dressing: use precut non-woven dressings as won't scratch skin in single layer. Mature trach without secretions don't require trach dressing.

Skin that was denuded from excessive secretions -- followed above then with Dr approval, applied skin barrier cream or dab A+ D ointment (not close to trach opening). Foam dressings can be used for severely irritated skin.

Fungal rash: RX from doc-often applied athlete's foot anti-fungal powder to 4x4 and lightly dusted skin beneath trach ties + around neck - resolved redness and moisture. Make sure you can place 1 finger beneath trach ties to prevent rubbing/tightness.

Excessive granulation tissue at trach stoma used with RX silver nitrate sticks.

AACN Procedure Manual for Critical Care:

"hydrogen peroxide is no longer recommended for cleaning inner cannulas or tracheostomy site" and to use "sterile NS or water" to clean stoma site for removal of "debris and secretions from the area".

Tracheostomy care: An evidence-based guide to suctioning

Tracheostomy Tube Care - American Thoracic Society

RN.com 1 CE article: Update on Tracheostomy Care