Manage secretions with a tracheostomy

Humidification

When people do not have a tracheostomy tube, their nose and mouth warm and humidify (moisten) the air they breathe. When you have a tracheostomy tube, the air no longer goes through your nose or mouth. This means the air you breathe is not moistened. You will need to add extra moisture to your airway so your secretions can be removed by suctioning or coughing.

Get moisture by:

• Using humidifiers.
• Drinking plenty of fluids.

You will need more humidity when:

• It is winter and your home is dry.
• Your secretions are thick, dry, or crusty.
• Your secretions are pink or have a little bit of blood in them.

Put an ultrasonic nebulizer or cool-mist humidifier where you sleep. This helps keep the air moist.

Heat moisture exchanger (HME)

Some people do well with a heat moisture exchanger device. This fits over the tracheostomy tube and helps trap moisture.

Humidifier care: each day

1. Empty and clean the humidifier tub with hot, soapy water.
2. Rinse well.
3. Fill with fresh tap water.
   o Never add water to the humidifier without cleaning the tub.

Humidifier care: each week

1. Empty the humidifier tub and rinse well.
2. Fill the humidifier tub with equal parts vinegar and water (such as 1 cup vinegar and 1 cup water, 2 cups vinegar and 2 cups water).
3. Turn the humidifier on for 1 hour.
   o Place the humidifier in an empty room. The vinegar has a strong smell.
4. Empty the humidifier tub and wash all the parts with hot, soapy water.
5. Rinse well.
6. Fill the humidifier tub with clean water and turn it on for 1 more hour.
7. Empty the humidifier tub and let it air dry.
8. Fill the humidifier tub with fresh tap water when you are ready to use.

Other ways to keep secretions thin and loose

• Fill your bathtub with hot water. Sit in the steam-filled bathroom for 20 minutes.
• Stand in the shower with water pointed away from your tracheostomy tube.
• Fill a spray bottle with new saline solution. Spray the saline solution into your tracheostomy tube a few times each day.

Using saline solution

Saline solution is made with salt and water.

Get a container ready to store the saline solution:

1. Wash the container and cap in hot, soapy water.
   or
   Place the open container and cap in the dishwasher on the hottest and longest running cycle.
2. Fill the container with boiling water.
3. Let it sit for 5 minutes.
   o Do not touch the inside of the container or cap.
4. Dump the water out.
5. Fill it with the saline solution.
   
   Make saline solution:
6. Boil a quart (4 cups) of water for 5 minutes.
7. Add 1 ½ teaspoons (tsp) of non-iodized salt to the water.
8. Pour the mixture into the clean container and cover with the cap.
9. Let the saline solution cool to room temperature before using.

Throw away the saline solution after 24 hours because germs may grow.

Putting saline solution into your tracheostomy tube will make you cough up secretions. This will help you breathe better.

You need these supplies

• Saline solution
• Syringe
• Clean cup
• Strong paper towel or gauze sponge
  o Do not use facial tissues.

Putting saline solution into your tracheostomy tube:

1. Pour 2 to 3 tablespoons (Tbs) of the saline solution into a clean cup.
2. Draw up 2 to 3 milliliters (mL) of saline solution into a syringe.
3. While taking a deep breath, put the saline solution into your tracheostomy tube.
4. Cough while you cover your tracheostomy tube with a strong paper towel or gauze sponge.
5. Do this again until your airway is clear and your breathing is not gurgling.
   o You may need to use suction if you cannot cough out your secretions.

Wash the cup and syringe with hot, soapy water each day. Rinse them well and let them air dry.

Use the saline solution more often when your secretions are thick and dry.