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Having a tracheostomy can change many parts of your life. You will need to learn how to take care of it and adapt other parts of your life, such as learning how to communicate, what to wear, and how to be intimate with a partner.

When you first get a tracheostomy, you will likely be in the hospital for several days and your health care team will take care of it. But if you’ll be going home with a tracheostomy, your health care team will teach you and your caregiver how to  care for it. They’ll also make sure you have the supplies you need.

Once you get home,  home health care nurses will probably come to your house to help get you settled. Taking good care of your tracheostomy will help prevent infection, plugs or blockages, and breathing problems.

Keeping your tracheostomy or laryngectomy tube in place

At first, you will likely need to keep a tracheostomy or laryngectomy tube in your stoma at all times. These tubes help keep your stoma and airway open. Your health care team will let you know which type of tube you need.

If you need a tube in your tracheostomy, you will need to secure it so it doesn’t accidentally come out (dislodge). If your tube comes out, your tracheostomy can close up.

There is a greater chance of your tracheostomy closing up in the first week or two after it’s placed because your stoma is still healing. If the tube comes out, you won’t be able to breathe well or at all if your stoma closes off completely.

To keep your tracheostomy or laryngectomy tube in place, secure it with a dressing, and tape ties or a soft holder. There are special holders  to secure your tracheostomy or laryngectomy tube.

Laryngectomy tubes may or may not need to be kept in place after your stoma heals. This may take a few weeks to months. Ask your doctor or someone on the health care team if you will need to keep your tube in place after you heal.

Suctioning the tracheostomy

You will need regular suctioning of your tracheostomy  to keep your tube and stoma free from extra mucus that can block it.  You might be able to clear these secretions by coughing, but sometimes you might need to suction your tube or stoma.

If your tracheostomy needs to be suctioned, a clear tube called a suction catheter is put into your tracheostomy and hooked up to a suction machine. This can be uncomfortable but may be needed to keep your airway clear.

If your mucus is very thick or hard to suction easily, you might want to have a humidifier in your room or at your bedside. A humidifier will help warm, moisten, and filter mucus so it’s easier to clear and remove. You might also be taught how to use small amounts of a solution to help loosen the mucus when you suction.

How often you need to suction your tracheostomy will depend on many factors. Newer tracheostomies often need to be suctioned more frequently. The number of times a tracheostomy is suctioned a day will usually go down over time as you learn to clear the mucus by coughing, and no other problems develop. But the amount of mucus your airway makes can change from time to time, so suctioning needs will vary.

Cleaning your tracheostomy or laryngectomy tube

If your tracheostomy has an inner cannula (a liner inside the outer tube), it needs to be cleaned regularly to keep it from getting plugged with mucus. Some inner cannulas can be reused after being cleaned. Others are disposable and meant to be replaced each time they are removed.

Even if your inner cannula is reusable, it should be replaced with a new cannula if it gets damaged or if a blockage cannot be cleared. You should also keep an extra inner cannula at your bedside in case the one being used can’t be cleared or comes out.

If you have a laryngectomy tube, it should be removed and cleaned regularly, as well.

Your surgical or health care team will teach you how to care for the kind of tube you have before you leave the hospital.

Caring for the skin around your stoma

Your health care team will teach you how to clean the skin around your stoma before you go home.  Be sure to ask what you should use to clean your skin and what type of dressing they suggest putting around your stoma.

When you’re caring for your tracheostomy at home, let your health care team know if you notice any reddened, swollen areas or more than small spots of blood around your stoma. This can be a sign of infection or other problems.

Preventing infection

When you have a tracheostomy, you are at higher risk of infection such as pneumonia and infection in the skin around your stoma. You can lower your risk of infection by:

• Washing your hands before and after you touch your tracheostomy, go to the bathroom, or at any time your hands might be dirty. 
• Clean your tracheostomy or laryngectomy as instructed by your health care team.
• Avoid being around people who are sick, especially if they are coughing or sneezing.
• Wear a cover over your tracheostomy or laryngectomy stoma when you are outside or around a lot of people to help keep debris and pathogens out of your airway.

Bathing

When taking a bath or shower,  avoid getting water into the tracheostomy. Water that gets in can go into your lungs.

You can put on tracheostomy shower shields that prevent water from getting into your stoma or tube. There are different models, so you might want to talk to your health care team before choosing one.

What to wear when you have a tracheostomy

You do not need special clothes for everyday wear. But you’ll want to avoid clothing that’s too snug or that blocks the your tracheostomy or laryngectomy tube so your airway stays clear.

Wearing a protective cover or stoma guard to keep dirt and other debris out of your stoma might be helpful. If you are concerned about how other people might react to your tracheostomy, you can cover it with a scarf, necklace, ascot tie, or turtleneck.

Communicating with a tracheostomy

With a tracheostomy, your windpipe (trachea) is separated from your throat, so you can no longer send air from your lungs out through your mouth to speak. But there are ways you can learn to talk:

Tracheo-esophageal puncture (TEP)

A TEP connects your windpipe and esophagus (swallowing tube). A small hole is made next to your tracheostomy, and a small one-way valve is placed so you can force air from your lungs into your mouth.

With TEP, you can cover your stoma with your finger to force air out of your mouth, producing speech. (With some newer “hands-free” models you don't have to cover the stoma to speak.) It takes practice, but you can work closely with a speech therapist to learn how to do this.

Electrolarynx

An electrolarynx is a battery-operated device that you place at the corner of your mouth or against the skin of your neck. When you press a button on the device, it makes a vibrating sound. By moving your mouth and tongue, you can form words. A speech therapist can teach you  to use it .

Esophageal speech

With training, some people learn to swallow air into their esophagus (the tube that connects your mouth to your stomach) and force it out through their mouth. As the air passes through your throat it causes vibrations which can be turned into speech. This method is used less often because newer devices and techniques are chosen instead.

Learning to speak again will take time and effort, and your voice will not sound the same. You will need to see a speech therapist who is trained in helping people who have had a laryngectomy. The speech therapist will play a major role in helping you to learn to talk.

Changes in your sense of smell and swallowing

When you get a tracheostomy, you may notice changes in how you swallow and how things smell to you.  This happens because you don’t have air going through your nose and mouth anymore. Changes in how things smell and how you swallow can make it harder to eat and drink.

If you have trouble swallowing, your surgeon or cancer care team might have you work with a speech pathologist. Many speech pathologists have advanced training to help people with swallowing problems. They can help you improve the way you swallow to avoid choking and gagging.

If you have lost your sense of smell, or are smelling odors that aren't really there, olfactory rehabilitation might help. This kind of rehabilitation can help you learn how to increase nasal airflow and to help you recover your sense of smell. Ask your surgeon or cancer care team how you could access this care.

You might need to adjust what you eat during and after treatment. You might need to eat different foods or use nutritional supplements. If you are having trouble getting enough to eat, ask to speak with a dietitian to come up with a plan so that you can get the nutrients you need.