How to Clean Newborns Tracheostomy Tube

A tracheostomy tube, or trach tube, allows a person to breathe without using his or her nose or mouth. A trach tube may be made up of one tube called an outer cannula. Or, it may be made up of an outer cannula and a second tube called an inner cannula.

Keeping a trach tube clean prevents infection and makes breathing easier.

Supplies needed:

• Towel.
• Suction supplies.
• Sterile trach care kit. The kit should contain:
  • 4 x 4 inch (10 x 10 cm) gauze pads.
  • Cotton-tipped swabs.
  • Trach bandage (dressing).
  • Container.
  • 0.9% saline solution or sterile water.
  • Roll of twill tape, trach ties, or trach holder.
  • Scissors.
• Clean reusable inner cannula or new disposable inner cannula, if your baby’s trach tube has one.
• Clean gloves.

How to clean your baby’s tracheostomy tube

1. Have all supplies ready and available.
2. Wash your hands well.
3. Put on clean gloves.
4. Suction the trach tube as needed.
5. Throw out the soiled items in this way:
   1. Coil the suction catheter and soiled dressings into the palm of your hand.
   1. Pull your glove off inside out, starting from the wrist and down over the hand and fingers. These soiled items should be in the glove.
   1. Throw away the glove.
   1. Remove the other glove in the same way.
6. Wash your hands.
7. Open the sterile trach care kit.
8. Spread the outer wrapping on a flat surface to provide a clean place to work.
9. Put on clean gloves. From this point on, plan to only use your dominant hand to handle the inner cannula and your other hand for the other tasks.
10. Fill the container with 0.9% saline solution or sterile water, according to the manufacturer’s directions.
11. Give your baby oxygen if:
    1. Your baby’s mouth, fingers, or toes start to turn blue.
    1. Your baby starts breathing faster or slower than normal.
    1. The saturation number on the machine that monitors heart rate and blood oxygen level (pulse oximetry machine) drops below 90%.
12. If an oxygen delivery device was used, remove it.
13. Clean the inner cannula, if your baby’s trach tube has one.
    1. If the inner cannula is non-disposable:
       1. Unlock and remove the inner cannula. Make sure to touch only the outer part of the trach tube.
       1. Drop the inner cannula into the appropriate solution.
       1. Choose the next step that applies to you:
          1. If you have a previously cleaned inner cannula, insert it into your baby’s trach tube. Turn the inner cannula clockwise until the markings on the inner and outer cannulas line up.
          1. If you do not have a previously cleaned inner cannula, hold the inner cannula over the container and rinse it with the appropriate solution. Pat the inner cannula dry with gauze, then insert it into your baby’s trach tube. Turn the inner cannula clockwise until the markings on the inner and outer cannulas line up.
       1. Suction your baby’s trach tube and apply the oxygen delivery device.
    1. If the inner cannula is disposable:
       1. Unlock and remove the inner cannula. Follow the manufacturer’s directions on how to do this. Make sure to touch only the outer part of the trach tube.
       1. Suction your baby’s trach tube, if needed.
       1. Quickly replace the old cannula with the new cannula. Make sure to touch only the outer part of the cannula. Turn the inner cannula clockwise until the markings on the inner and outer cannulas line up.
       1. Suction your baby’s trach tube and reapply the oxygen delivery device.
       1. Throw away the old cannula in the container labeled for biohazard materials.
       1. Dry the skin and the outer cannula by patting the area gently with a gauze pad.
14. Clean the outer cannula surfaces with gauze or cotton-tipped swabs, extending 2–4 inches (5–10 cm) in all directions under the neck plate.
15. Using a cotton-tipped swab, clean the area of the skin where the trach tube enters the body (stoma). Clean it in a spiral motion from the stoma site outward.
16. Secure the trach tube with trach ties or a trach holder.
17. Place a dressing around the trach site.
18. Place your baby in a crib or other safe place.
19. If your baby has a non-disposable inner cannula and you have not already rinsed it:
    1. Hold the cannula over the container and rinse it with appropriate solution.
    1. Shake off any excess fluid.
    1. Place the cannula on paper towels or gauze and let it air dry.
    1. Place the cannula in a clean container and keep it with your baby’s supplies.
20. Give oxygen again if:
    1. Your baby’s mouth, fingers, or toes start to turn blue.
    1. Your baby starts breathing faster or slower than normal.
    1. Your baby’s saturation number drops below 90% on the pulse oximetry machine.
21. Throw away used supplies.
22. Remove your gloves.
23. Wash your hands well.

Contact a health care provider if:

• Your baby has swelling, redness, warmth, drainage, or tenderness around the stoma.

Get help right away if:

• Your baby has trouble breathing even after suctioning and cleaning.
• Your baby has trouble swallowing.
• Your baby has unusual sounds coming from the airway or continues to cough after suctioning.
• Your baby’s trach tube becomes clogged and you cannot clear it.
• Your baby’s trach tube falls out and you cannot put it back in.
• Your baby is bleeding from the stoma.
• Your baby has bright red blood in his or her mucus.

If you think your baby’s breathing or heart function is in danger because of a blocked or dislodged trach tube, follow instructions from your baby’s health care provider. If you are not able to do this, call your local emergency services (911 in U.S.) for help.

Summary

• A tracheostomy tube is commonly known as a trach tube.
• The tracheostomy tube must be kept clean to help prevent infections and to prevent trach tubing from plugging.
• Your baby’s breathing or heart may stop working if the trach tube falls out, becomes kinked, or gets blocked.
• If your baby’s breathing or heart function is in danger because of a blocked or dislodged trach tube, call emergency services for help.