Tracheostomy: What to Expect at Home

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Your Recovery

After surgery, your neck may be sore, and you may have trouble swallowing for a few days. It may take 2 to 3 days to get used to breathing through the tracheostomy (trach) tube. You can expect to feel better each day, but it may take at least 2 weeks to adjust to living with your trach (say "trayk").

At first, it may be hard to make sounds or to speak. Your doctor, nurses, respiratory therapists, and speech therapists can help you learn to talk with your trach tube or with other speaking devices. When you speak, your voice may sound deeper and scratchier than normal.

Your trach tube may be sewn or tied to your skin. If you have stitches, the doctor will remove them about 1 week after your surgery. He or she may also take out your original tube and put in a new tube 5 to 10 days after surgery.

Taking good care of your trach is very important. It can prevent infections and help keep you breathing easily.

This care sheet gives you a general idea about how long it will take for you to recover. But each person recovers at a different pace. Follow the steps below to get better as quickly as possible.

How can you care for yourself at home?

Activity

  • Rest when you feel tired. Getting enough sleep will help you recover.
  • You may need to take at least 2 weeks off work. It depends on the type of work you do, your employer, your ability to speak, how you feel, and other health problems you may have. Some people are not able to return to their previous job.
  • Try to walk each day. Start out by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation.
  • Avoid strenuous activities, such as biking, jogging, weight lifting, and aerobic exercise, for 6 weeks.
  • You may drive when you are no longer taking prescription pain medicine and can quickly move your foot from the gas pedal to the brake.
  • You may take a bath in shallow water. Do not splash water into your trach.
  • You may take a shower. Aim the shower head at your lower body or back. Cover the tube so that no water gets in but you can still breathe.
  • Do not swim.

Diet

  • You should be able to eat without problems. If food or liquid gets into your tracheostomy tube, suction it out right away. Sit up while you eat.
  • If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
  • Drink plenty of fluids (unless your doctor tells you not to).
  • You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fibre supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

Medicines

  • Your doctor will tell you if and when you can restart your medicines. He or she will also give you instructions about taking any new medicines.
  • If you take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin, be sure to talk to your doctor. He or she will tell you if and when to start taking those medicines again. Make sure that you understand exactly what your doctor wants you to do.
  • Take pain medicines exactly as directed.
    • If the doctor gave you a prescription medicine for pain, take it as prescribed.
    • If you are not taking a prescription pain medicine, take an over-the-counter medicine such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). Read and follow all instructions on the label.
    • Do not take two or more pain medicines at the same time unless the doctor told you to. Many pain medicines contain acetaminophen, which is Tylenol. Too much acetaminophen (Tylenol) can be harmful.
  • If you think your pain medicine is making you sick to your stomach:
    • Take your medicine after meals (unless your doctor tells you not to).
    • Ask your doctor for a different pain medicine.
  • If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Incision, stoma, and tube care

Your doctor or nurse will give you instructions on how to take care of your trach. This will include how to suction your trach, how to clean the opening in your neck (stoma), and how to clean and replace your trach's inner tube (inner cannula). Be sure to follow all of your doctor's instructions closely.

  • Suctioning

    Always have suction supplies ready, including a fully charged suction machine. Suction as often as needed, but at least 3 or 4 times a day. For example, two of the times could be before you go to bed and when you wake up in the morning. You will need suction catheters, a suction machine, saline fluid, a small cup, and a mirror. These should be delivered to your home before you arrive there. Here are the steps to take:

    1. Wash your hands with soap and water for at least 30 seconds.
    2. Pour saline fluid into the cup.
    3. Connect a catheter to the suction machine tubing. Dip the catheter tip into the saline fluid. Insert the wet catheter into the trach. Push the tube in gently, about 7 to 10 centimetres, until you feel it hit something.
    4. Slowly pull the catheter out of the trach, rolling it back and forth between your fingers, with your thumb over the control valve (this turns the suction on). Do not keep the suction on for more than 10 seconds at a time.
    5. Wait about 30 seconds, and repeat inserting and pulling out the tube until all the mucus has been removed. Then suction the saline left in the cup.
    6. Catheters can be used again if you clean them properly. Ask your doctor how to do this. Throw away used catheters if your doctor tells you to.
  • Stoma care

    Clean and dry the stoma 3 times a day. Apply ointment to keep the skin healthy. Do not let crust form on the skin at the stoma. You will need hydrogen peroxide, tap or sterile water, 8 or 10 cotton swabs, 2 small cups, a dry cloth, a mirror, and ointment for the skin. Follow these steps:

    1. Wash your hands with soap and water for at least 30 seconds.
    2. Fill one cup with equal amounts of water and hydrogen peroxide. Put 3 or 4 cotton swabs in the cup. Fill the other cup with water, and put 3 or 4 swabs in that cup.
    3. Clean and remove dried mucus around the stoma with the cotton swabs in the peroxide cup. Then clean off any peroxide with the swabs in the water cup.
    4. Dry your skin with the cloth. If your doctor tells you to use skin ointment for your stoma, apply it with the remaining swabs.
    5. Wash your hands again.
  • Cleaning the inner cannula

    If you are not using the disposable type of cannula, clean and replace the inner cannula 2 or 3 times each day. You will need 2 small bowls, a small brush, hydrogen peroxide, water, and a mirror. To clean the inner cannula:

    1. Wash your hands with soap and water for at least 30 seconds.
    2. Pour equal amounts of water and hydrogen peroxide into one bowl. Pour a small amount of water in the other bowl.
    3. Unlock the inner cannula, and remove it by gently pulling it out and down. Put this into the peroxide bowl to soak. Clean the inside and outside of the cannula with the brush.
    4. Rinse the cannula under tap water, then let it soak in the bowl of water. Shake the cannula out, and slide it gently back into the outer cannula. Turn it to lock it in place. Make sure it is locked in place and you cannot pull it out.
    5. Wash your hands again.

Other instructions

  • Wear clothes that are loose around your neck.
  • If you are outside, wear a loose covering over your trach, such as a scarf or other cloth, but avoid clothing with loose fibres. Covering your trach prevents dust, dirt, and bacteria from getting into it. You can also use special trach "bibs" to cover your trach and to protect your clothing from mucus when you cough. You can buy trach bibs at a medical supply store.
  • Try not to breathe in anything that might irritate your trach. This includes small bits of food, smoke, powders, aerosol sprays, and dust.
  • Keep the air in your home moist with a room vaporizer or humidifier.
  • If you have thick mucus plugging your trach tube, ask your doctor about squirting a small amount of saline down your trach to help clear the tube.
  • Carry an extra cannula with you at all times, in case your tube becomes blocked.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

When should you call for help?

Call 911 anytime you think you may need emergency care. For example, call if:

  • You passed out (lost consciousness).
  • You have severe trouble breathing, and coughing and suctioning do not help.
  • Your trach falls out and you cannot get it back in, and you are not able to breathe.

Call your doctor or nurse call line now or seek immediate medical care if:

  • Your trach falls out and you cannot get it back in, but you can still breathe.
  • You have trouble breathing after suctioning.
  • Your skin around your trach (stoma) has signs of infection, such as:
    • Increased pain, swelling, warmth, or redness.
    • Red streaks leading from the area.
    • Pus draining from the area.
    • A fever.
  • You have pain that does not get better after you take pain medicine.
  • You are sick to your stomach and cannot drink fluids.
  • Your secretions change.

Watch closely for any changes in your health, and be sure to contact your doctor or nurse call line if:

  • You do not get better as expected.

Where can you learn more?

Go to https://www.healthwise.net/patientEd

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