Tracheostomy skin care, changing the tracheostomy dressing, changing the inner cannula of a tracheostomy (if present)

Indications:

Since the tracheal cannula flanges rest directly on the skin, humidity and secretions can accumulate behind them. Skin that is constantly damp can be easily irritated and become less resistant to infection. In order to prevent irritation of the skin causing discomfort and possible infection, it is very important that the skin around the tracheostomy and the skin under the tracheostomy ties (Velcro®, cotton ribbons), be cleaned and dried regularly.
The 2 piece tracheal cannula, used primarily in adolescents and adults, is composed of an inner cannula that fits into the outer cannula. Once locked into the tracheal cannula, the inner cannula stays in place but it must be changed and cleaned (if reusable) or changed (if disposable).
The placement of a dressing helps protect the skin against irritation, by preventing the rubbing of the tracheal cannula flanges directly against the skin and by absorbing dampness and excess secretions.
Below is a suggested method that can serve as a guide; discuss the specific type of medical supplies and equipment used for your child with the healthcare team.

Considerations:

Another adult should always be present when you provide tracheostomy care in order to assist in the event of an emergency.
It is recommended to wash the skin around the tracheostomy with warm, sterile or boiled cooled water. Use a mild, oil and perfume free soap (eg, Dove), if recommended by your child’s healthcare team.
Never use:
- perfumed products with additives (they can irritate and damage the skin surrounding the tracheostomy),
- antibacterial soaps, antiseptics or disinfectants (they decrease the skin’s natural protection barrier against infection),
- bar soaps (they leave a residue on the skin which may be irritating),
- baby wipes, baby oil, powder, balm or lotion.
Encrusted secretions around the tracheostomy can be dislodged with a diluted 1.5% hydrogen peroxide solution.
Never use spray-on skin protectors near the tracheal cannula, the aerosolized particles may accidentally enter the tracheostomy.
Good handwashing is essential before and after providing care.
Ensure the comfort of your child during care by using different positioning and distraction techniques.

Frequency:

To prevent irritation and infection, the skin around the tracheostomy must be cleaned 1 to 2 times a day and as needed.
Cleaning must be done more often if the skin is red, sensitive, has a foul odour or if secretions are seeping out around the tracheostomy.
If your child is on a respirator, he/she may need more frequent cleaning of the skin around the tracheostomy.
If a tracheostomy dressing is used, it must be changed after each cleaning procedure or when it becomes wet or soiled.
Cleaning of the reusable inner cannula or the replacement of a disposable inner cannula, must be done 1 to 2 times a day or more often, depending on the recommendations made by the healthcare team.

Required materials:

Cleaning/soaking solution: boiled cooled water (homemade sterile water) or sterile water as recommended by your child’s healthcare team

Preparation of boiled water solution:
– Clean the containers (pickling jars or jars with plastic lids) in the dishwasher and let dry.
– If you don’t have a dishwasher, wash containers in hot soapy water, rinse and then dry in the oven set at 250⁰F for 15 min (metal lids only).
– Boil tap water in a pot for 10 min at a rolling boil and let cool.
– Fill the clean containers with boiled cooled water, write the date prepared on the container.

Shelf life:
– Closed container: 5 days in fridge or 2 days at ambient temperature.
– Container, once opened: 2 days in fridge, 1 day at ambient temperature.

Discard of the solution used after providing care.

Small container used to hold a small amount of cleaning/soaking solution)
Cotton tips or clean dressings (gauze compresses)
Rolled towel to place under the child’s shoulders

If needed:

Mask and non-sterile gloves (if the person providing the care has a cold or the flu)
Mild, non-perfumed, non-oily soap (eg, “Dove”)
Hydrogen peroxide solution 1. 5% if your child is less than 3 years old

Preparation of 1.5% hydrogen peroxide solution:
– For 15 ml of solution: mix 7.5 ml of 3% hydrogen peroxide and 7.5 ml boiled water solution and store in a resistant container.

Shelf life:
– Closed container: 5 days in fridge.
– Container, once opened: 2 days in fridge.

The solution should produce a white foam when applied to the skin. If this is not the case, discard and prepare a fresh solution.

Discard of the solution used after providing care.

Small container used to hold a small amount of hydrogen peroxide solution
1 tracheostomy dressing, if needed
Tracheostomy ties (Velcro® or cotton ribbons)
Round-ended scissors (to cut the tracheoostomy ties)
Suction device and catheters
If using a reusable inner cannula:
- clean inner cannula replacement
- soapy water (for cleaning of the reusable inner cannula)
- containers to soak the inner cannula (hydrogen peroxide and soaking solution)
- brush to clean the inside of the inner cannula
- clean, dry container with lid (to store the inner cannula once cleaned)

Keep all medical supplies and equipment required for emergency purposes close at hand.

The following method is for care of a simple cuffless and non-fenestrated tracheal cannula.

Refer to your child’s healthcare team if the material or the sequence of steps you have been taught is different than those described.

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