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Tracheostomy Care at Home: What Families Need to Know

Bringing a loved one home with a tracheostomy can feel frightening. Yet many people live at home with one. With training from the hospital team, the right equipment and a clear emergency plan, families can learn to manage it safely.

What Is a Tracheostomy and Why Is It Done?

A tracheostomy is an opening made at the front of the neck into the windpipe (trachea). A tube goes through this opening, called the stoma, and the person breathes through the tube. Doctors may advise it to:

• Help a person breathe when the airway is blocked or injured
• Help clear mucus from the lungs when the person cannot cough it up well
• Connect a person to a ventilator (breathing machine) for a long time, for example after a severe illness such as pneumonia or stroke

Training Before You Leave Hospital

Before discharge, the hospital team should show the patient and family carers how to look after the tracheostomy, and check that they can do it safely. Training usually covers:

• Cleaning the stoma and the skin around it, and changing the dressing
• Cleaning the tube, including the inner tube (inner cannula) if it has one
• Keeping the air the person breathes moist
• Suctioning mucus, if the team says it is needed
• Using the equipment you will take home
• What to do in an emergency, such as a blocked tube or a tube that comes out

Practise in front of the nurse, and write down the tube type and size. If you do not feel confident yet, tell the team before discharge.

Daily Care, as You Were Trained

Care depends on the type of tube and whether the person uses a ventilator, so follow what the team taught you. In general:

• Clean hands: wash your hands well before and after caring for the tracheostomy.
• Stoma and skin: the area around the stoma is cleaned every day, as often as the team advises, to remove dried mucus and keep the neck dry. Wet skin can get a rash.
• Dressing: the gauze between the tube and the neck catches mucus and stops the tube rubbing. It is changed when dirty, and at least once a day.
• Inner tube: if the tube has an inner cannula, it needs regular cleaning so dried mucus does not build up.
• Ties: the ties hold the tube in place. Change them when dirty, holding the tube still. You should be able to fit two fingers under them, so they are not too tight.

A small amount of mucus around the tube is normal. A healthy stoma usually looks pink and is not painful.

Humidity and Secretions

Normally the nose moistens the air we breathe. With a tracheostomy it does not, so mucus can thicken and form plugs that block the tube. Ask the team how to keep the air moist, for example with a damp gauze or cloth over the outside of the tube, or a humidifier when the air is dry, such as when a room heater is on in winter. The team may also show you how saline drops can loosen thick mucus.

Suctioning removes mucus the person cannot cough up. Only suction if you have been trained, using the method the team taught you. It can cause coughing and brief breathlessness.

Equipment to Keep Ready

Arrange equipment before the patient comes home, as the team advises. This often includes:

• A spare tracheostomy tube, kept close to the patient at all times (sometimes one size smaller as well, for emergencies)
• A portable suction machine, suction catheters and saline
• Gauze dressings, spare ties, cotton swabs and tracheostomy covers
• Oxygen, a ventilator or a hand-held breathing bag (ambu bag), if the doctor has advised them

Everyone caring for the patient should know how to use each item. Read more about renting or buying medical equipment for home care.

Speaking, Eating and Everyday Life

Speaking: many people can learn to talk with a tracheostomy, often with a speaking valve and a speech therapist’s help, but not everyone can. Until then, use writing or gestures. Use a cap or valve only if the team has advised it.

Eating: some people can eat and drink normally. Others need a feeding tube for a while and must relearn safe swallowing, so food does not go into the lungs. Follow the team’s advice.

Everyday life: water, food, dust and powder must not get into the tube. Use a waterproof cover when bathing, never swim, and cover the stoma with a cloth or tracheostomy cover outdoors.

Signs of Infection and When to Call the Doctor

Call the treating doctor straight away if the person has:

• Fever or chills
• Redness, swelling, warmth or pain around the stoma that is getting worse, or pus
• Bleeding or discharge from the stoma
• Mucus that is hard to suction or cough up, or changes colour, or breathlessness even after suctioning
• Noisy breathing, problems swallowing, or coughing after eating or drinking
• A tube that has moved or slipped out of position
• Any new or unusual symptom

Emergencies: When to Call 112

Call 112 straight away and follow the emergency plan the hospital team taught you if:

• The person has severe difficulty breathing
• The tube is blocked and you cannot clear it as you were trained
• The tube comes out and you cannot put it back as you were trained

In the first days after the operation, only a trained healthcare professional should put a tube back in. Keep the spare tube and emergency numbers ready at all times. See what to do in a medical emergency at home.

How OSVI Healthcare Helps with Tracheostomy Care

With nursing care at home from OSVI Healthcare, trained nurses provide tracheostomy care at home, as the treating doctor advises, in hourly visits or 12-hour or 24-hour shifts. For patients on a ventilator, we provide ICU nurses (see ICU at home).

• Equipment: suction machines, oxygen and ventilators to rent or buy through medical equipment at home, set up by trained staff.
• Doctor visits: a doctor visit at home, day or night, with follow-up.
• One point of contact: a care manager coordinates the care, and the care plan is supervised by a qualified doctor.
• 24×7 support: our care team is available day and night.

Frequently Asked Questions

Is a tracheostomy permanent?

Not for most people. When the person can breathe well without it, the team may remove the tube, and the hole usually closes on its own, leaving a small scar. Some people need it long-term or for life.

Can a person with a tracheostomy speak?

Many can, if the voice box is not injured. This may need the cuff (a small balloon on some tubes) to be let down first. Ask the medical team.

Who changes the tracheostomy tube?

The first change is usually done in hospital by a healthcare professional. How often the tube is changed, and by whom, depends on the type of tube and the team’s advice. Some family carers are trained to change it at home.

This article is provided for general information and does not constitute medical advice, diagnosis or treatment. Every patient’s situation is different, so please consult a qualified doctor for guidance specific to you. In a medical emergency, call 112.