Expertise with the tracheostoma
If patients require a tracheostoma, i.e. an opening in the neck for breathing, there is a wide range of very different causes. For example, various neurological diseases or tumours in the neck may require a tracheostoma.2 The objective is always to ensure the ability to breathe.
However, individual forms of restoration must be selected depending on the cause. Selection of the tracheal cannula plays the major role here.3 This involves many changes in everyday life for patients and their families. They may need to learn new daily routines or change their normal routines to fit the change in circumstances.
Care services manage the specific tasks in consultation with the doctor depending on the care situation and also assist the family with help and tips. The equipment supplier also manages important tasks such as advice, instruction and training. For example, the brochure "Recommendations for the care of tracheotomy patients", published by the Bundesverband für Medizintechnologie e. V. (German association for medical technology) (BVMed) contains information that can be useful.2 In this article we would like to provide some basic information for everyday life with tracheostoma care based on common questions by users.
Why does breathing through a tracheostoma suddenly feel easier?
In short: because of the shorter respiratory path. Tracheostoma patients breathe exclusively through the opening in the neck, no longer through mouth and nose. This shortens the respiratory path. This is why patients feels a significant reduction in the breathing resistance; breathing initially feels easier. Although this initially feels positive, it is counterproductive for physiological reasons, because breathing resistance is important for maintaining lung volume and function.
Why does the lung produce mucous so quickly?
Cold, dry and unfiltered air enters the lungs directly through the unprotected tracheostoma, bypassing the important functions of the nose. The shorter respiratory path may also make it easier for pathogens to enter. The protective mechanisms of the trachea that prevent the penetration of pathogens and particles into the lower respiratory paths are not optimal with cold and dry air.4 The unprotected tracheostoma without continuous humidification and warming promotes increased formation of mucous. Tracheostoma protection is therefore extremely important. Various options are available, such as special cloths or compresses up to so-called artificial noses, also referred to as HME (Heat and Moisture Exchangers). The most important factor is to use these aids consistently for 24 hours a day to ensure the complete range of functions.
![[Translate to English:] Mann mit Zeichnung einer Tracheotomie](/fileadmin/_processed_/4/0/csm_Tracheotomie_a40390f101.jpg)
What exactly in an artificial nose?
This is the colloquial term for a HME (Heat and Moisture Exchanger). The small filters replicate the functions of the nose and with consistent use they re-humidify and warm the breathing air and they are also important for filtering the incoming air. They also generate a required breathing resistance which enables complete ventilation of the pulmonary regions. It is essential to replace the filters every 24 hours or when they are dirty to prevention colonisation by germs. They are listed as single-use articles and must not be cleaned.
What is important for the hygiene and care of the tracheostoma?
The skin in the region of the tracheostoma is exposed to many unfavourable factors. Leaking secretion, i.e. mucous, irritates the skin and mechanical action, such as from plasters or compresses may cause skin damage. Daily inspection and cleaning where necessary should become routine. A range of different cleaning and care products is available, such as special cleaning cloths and also special skin protection preparations. The objective is care for the skin in the region of the tracheostoma, keep it dry and prevent infections.
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What does it mean to "change tracheostomy tubes"?
The tracheostomy tube should be optimally adjusted to the requirements of the patient at all times. For example, the tracheostomy tube immediately after the operation should be from that at discharge. In some cases, different features are required for speaking from those required for swallowing malfunctions. A customised tracheostomy tube fitted to the patient's requirements is essential for well-being and the result of the rehabilitation.
How do you clean the tracheostomy tube?
Correct cleaning of the tracheostomy tube is important to prevent infection and to maintain the quality of the product. If a tracheostomy tube has internal cannulas, they can be removed for cleaning while the outer cannula generally remains in the tracheostoma. All components should be rinsed under running water and then placed in a lukewarm cleaning solution. After the cleaning bath, it is important to thoroughly remove all detergent residues. Always observe the cleaning instructions of the manufacturer.
Must a tracheostomy tube be changed?
Yes, it must be changed regularly as required by the patient. The tracheostomy tube should be changed in accordance with maximum service life specified by the manufacturer and national regulations. Changing the tracheostomy tube is a medical procedure, which can generally be done by supervised medical staff, except in special cases where a doctor will be required to change it. Changing the tube is stressful for the patient and requires careful planning and a professional procedure. See the Andreas Fahl Medizintechnik-GmbH YouTube channel for two videos on this topic. See also the BVMed brochure for assistance.
![[Translate to English:] Laptop auf einem Holztisch zeigt YouTube Kanal von FAHL](/fileadmin/_processed_/9/5/csm_50__Image_-_4_3_Laptop_FAHL_YouTube_c5dd2a0180.jpg)
Videos on YouTube
Cleaning the tracheostomy tube:
How do I clean a tracheal cannula? | Animation | Fahl Medizintechnik-Vertrieb GmbH
Changing of the tracheostomy tube:
- Tracheal cannula change for patients | Animation | Fahl Medizintechnik-Vertrieb GmbH
- Tracheal cannula change for nursing staff | Animation | Fahl Medizintechnik-Vertrieb GmbH
Endotracheal suction:
Endotracheal suctioning (ETS) for nursing staff | Animation | Fahl Medizintechnik-Vertrieb GmbH
What must be considered with suction?
Endotracheal suction, i.e. suction of secretion with a suction catheter through the cannula, is an essential procedure for restoring a clear respiratory path. The frequency of suctioning should be closely based on when it is actually required. The slogan "as often as necessary and as rarely as possible" generally applies, because in many cases this procedure is also stressful for the patient.
Why should you inhale?
A good inside climate with sufficient relative humidity is important, particularly in winter, to reduce the viscosity of the secretion, i.e. to ensure that it does not become too viscous. Inhalation also helps to make mucous more liquid so it can more easily be removed.5 And also in some cases medication supplements can be applied directly to the position where they are effective. Inhalation has been proven particularly effective for tracheostoma patients with infections of the upper respiratory tract or during holiday trips in arid climatic regions. The manufacturer's recommendations for cleaning the devices should be observed to prevent the danger of infection.
What is the purpose of a speaking valve?
Speaking valves allow tracheotomy patients to speak without using their fingers. The different functions of the valve move the air as it is exhaled from the tracheostoma to the upper respiratory tract where the voice is generated. The resulting air circulation in the upper respiratory tract also has some additional advantages, e.g. that the sensitivity in this region is increased.6 Speech therapists use a speaking valve, e.g. training with swallowing. The use of a speaking valve is always decided in consultation with the doctor and must be decided depending on the situation, and must also be supervised until daily use is possible.
Please note: speaking valves must only be used on an unblocked tracheostomy tube.
Sources:
1 Baumann HJ. etal. Die Tracheotomie auf der Intensivstation…Pneumologie 2010; 64:769–776
2 https://www.bvmed.de/verband/publikationen/fachbroschueren/empfehlung-tracheotomieversorgung-2017?sh=Empfehlung+tracheotomierter, abgerufen am 16.01.2025
3 Klemm, E. (2012). Kompendium der Tracheotomie (pp. 36-37). A. Nowak (Ed.). Berlin Heidelberg: Springer.
4 https://flexikon.doccheck.com/de/Zilie/Pathophysiologie, abgerufen am 20.01.2025
5 Prävention der nosokomialen beatmungsassoziierten Pneumonie. Bundesgesundheitsbl. 56, 1578–1590 (2013)
6 Niers, N. (2014). Tracheotomie: ein Ratgeber für Betroffene, Angehörige, Pflegekräfte, Therapeuten und Ärzte. Schulz-Kirchner Verlag GmbH.
