• Reference Number: HEY1097/2023
• Departments: ENT
• Last Updated: 28 April 2023

Introduction

This advice sheet has been produced to give you general information about Tracheostomy Tubes your Tracheostomy and describes how to look after your stoma and tracheostomy tube. It also lists some of the problems that you may experience and how to deal with them. I t is not meant to replace discussion between you and your doctor.  If after reading it, you require further explanation please discuss this with the relevant person who has been caring for you.

Stoma Protection

The tracheostomy tube should always be covered with either a bib protector or heat moisture exchanger (HME) filter system. The stoma is not able to perform the four essential functions of resistance, filtering, warming and moistening of the air that you breathe. Long term breathing with the tracheostomy tube uncovered will lead to irritation of the lungs which then results in increased mucus production, coughing and chestiness.

As well as assisting with breathing, stoma protection also improves appearance and protects your clothes.  Spray bottles are provided to instil water to spray over the tracheostomy 4-6 times a day to allow moistening of the trachea to prevent drying of the trachea walls.

There is a wide range of stoma protection supplies on prescription.  Your ENT nurse practitioner or specialist nurse will be happy to advise on the products most suitable for you.

Orders are generally made through the home delivery company, Country Wide Supplies or Fittleworth Supplies, these are provided via the GP.  They provide a very prompt and reliable service. You will be able to reorder as you need to using the Freephone number that will be provided with your first order.  You may also make your order online.

There are a number of items that are not currently on prescription such as decorative cravats.  Please ask your ENT Nurse Practitioner/ specialist nurse for more details or current brochures.

Cleaning your stoma and Tracheostomy Tube

 For stoma cleaning you will need:

• Water spray bottle (to use regularly throughout the day to moisten the trachea)
• Tissues
• Cotton buds (Long Stem)
• Tweezers
• Mirror
• Spare inner tube
• Cleaning brush
• Scissors
• Tracheostomy holders/dressing
• Good light source
• Gauze/wipes

Procedure:

• Wash hands thoroughly
• Sit in front of mirror with a good light shining at your stoma area.
• Spray into your stoma 2-3 times (may cause coughing). Wipe away any mucus with a tissue/cotton bud.
• Carefully ease mucus away with tweezers, using a damp tissue to loosen dry, stubborn pieces.
• Clean your tracheostomy inner tube in hot soapy water, use swabs/ brush if required for dry, stubborn mucus and allow to air-dry
• Replace with spare clean inner tube.
• Spray the bib protector and place over your stoma area.
• Check your tracheostomy regularly. It is recommended that you clean/change the inner tube at least 4 times daily.

Changing the straps and dressing

Procedure:

• Firstly prepare the tracheostomy straps, use the scissors to cut the end of the neck ties into a point, this allows easier insertion into the tracheostomy holders.
• Once prepared remove old straps and dispose making sure you have secured the tracheostomy tube by holding the tracheostomy flange with one hand, careful not to block your airway.
• Apply clean straps, one at a time making sure secure and check for two finger width gap.
• If a tracheostomy dressing is worn, also replace at time of changing straps, make sure the lower flange of the tracheostomy tube is cushioned by the dressing, as it can dig into the skin and cause damage.

Tracheostomy straps and dressing should be changed daily and / or when soiled. The trachi-dress is optional depending on patient preference or when large amount of secretions is present.

The tracheostomy tube can dislodge or fall out accidently

If the tracheostomy tube should ever drop out at any occasion ie accidently at night or during coughing (DO NOT PANIC).  You or a relative can attempt to replace if training has been given.  If unable to replace tracheostomy tube then the next step would be to use the tracheal dilators that are provided in the supply bags and call 999.

The Nurse practitioner would have referred you to the Ambulance service prior to discharge home, your details will be logged onto their system as a “neck breather” and will automatically respond as a flagged patient and send help.

Place tracheal dilator into the stoma and open gently allowing airflow, sit and wait for the arrival of the ambulance team.

If the tracheostomy tube becomes dislodged and becomes partially blocked you may feel breathing is difficult, the stoma area may also be sore. If breathing is difficult firstly check the inner tube is not blocked by replacing with the clean, spare inner tube. If no success please call 999.

This leaflet was produced by the ENT Head and Neck Surgery Department, Hull University Teaching Hospitals NHS Trust and will be reviewed in April 2026.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.