Ward 35 – ENT (Ear, Nose and Throat)
You will have been shown on the ward how to clean and care for your tracheostomy, including what to do in any emergency situations. This leaflet is designed to remind you of the basics.
Your tube
Your tracheostomy tube is made up of an ‘outer’ tube which remains in your neck at all times. It is changed at the hospital by the ENT nurses every 4 to 8 weeks.
Your phone number has been passed to the ambulance service if you are unable to make your own way to the hospital. They know you breathe through your neck and will send an ambulance urgently to your home address if you dial 999.
Your tube also has 2 inner tubes which are colour coded and need to be removed regularly for cleaning:
- White for night (non-fenestrated)
- Blue for day (fenestrated)
You will have been advised to alternate these and wear the white tube at night to prevent granulation (overgrowth of tissue which could block the tube if not noticed and acted upon).
Cleaning
There are no ‘set’ times where you should clean your inner tube. You should always clean it when you wake up and before you go to bed. During the day you should regularly check the tube. Sometimes you will also be able to hear the secretions in your tube when you are breathing. This will prompt you that it needs cleaning.
To clean the tube, twist the outer end (or small white or blue square if you have a longer tube) anti-clockwise until you hear a click then slide the tube out. Before you clean this one, you MUST put your spare tube in.
Place it the same way and turn it clockwise until you hear a click and it is flush to the outer tube. It should not come out if you were to cough.
To clean the tube, use the swabs provided and sterile water (or cooled boiled water) to thoroughly clean the middle and outer tube removing all secretions. Allow to air dry and set aside for when you need to change the tube again.
Dressings
The tracheostomy tubes are usually made of hard plastic. Unfortunately, this can make the skin on your neck sore. You may have been given dressings on the ward to help prevent the tracheostomy tube rubbing or pressing on your skin.
The lyofoam dressing can also absorb extra secretions to stop your neck getting sore due to excess moisture. This should be changed daily, or when it is saturated.
Ensuring olive oil is placed around the neck regularly can also help with the prevention of skin irritation and pressure sores. Always check for signs of infection, for example, pain, unusual smell, discharge, secretions which are green, yellow or brown and escalate these to your ENT nurses.
N.B. olive oil should not be used if you are undergoing radiotherapy – use the skin creams provided by the radiotherapy department and speak to the team if your skin starts to get sore.
The neck tapes only need to be changed when they are dirty. This requires 2 people as you need to make sure the tube is securely held in place whilst the tapes are unfastened.
You should be able to fit 1 finger under your neck tapes, but they should not be any looser as the tube is then not secure. This is your main airway.
Humidification
Breathing through this tube bypasses your nose or mouth meaning that the air is no longer warmed and filtered by the small hairs in your nose. To keep your chest healthy, we recommend wearing a bib or a ‘heat moisture exchange’ (HME) device. These devices warm, filter and moisturise the air you are breathing to keep your airway moist. If it becomes too dry this can make you cough and you may notice some bleeding.
If you have a lot of secretions this can be removed for short periods until it starts to dry up a little bit. You should wear a wet bib if you are coughing a lot so that the air is still being filtered.
The bibs can be handwashed. The HME devices are single use and should not be washed; if they are saturated, they need to be thrown out and replaced. You will have been given these on the ward; some examples are pictured below:
You may have been given a speaking valve, which clips on to the HME. It is important you only wear this with the ‘blue’ tube during the day. At night, when you are sleeping, you should just wear your HME or bib.
It is also recommended that you purchase a nebuliser to keep your airway moist. You will need a prescription for 0.9% saline which you should use as recommended by your clinical team. This is usually between 2 to 6 times per day.
The frequency of nebulisers may need to be increased due to hot weather in the summer and, or the use of central heating in the winter. You should also increase your fluid intake, either orally if it is safe for you to swallow liquids or via your feeding tube, to maintain your hydration.
Supplies
You will need to order additional supplies from a company called ‘Fittleworth’. You have been registered with the company by the nurses on the ward.
You may be able to order directly with the company, or your GP may prefer to make this order for you. If you are unsure, phone your GP surgery or Fittleworth who can both advise you on this.
Website: https://www.fittleworth.com/
Telephone: 0800 378 846
Email: [email protected]
Showering
You will have been given a waterproof bib on the ward. Always ensure you wear this shower bib to protect water from going into your lungs via your tracheostomy tube.
Emergencies
- Difficulties breathing
Take your HME or speaking valve off. Remove your inner tube and replace with a clean one. Use your nebuliser to clear any dried secretions within your airway. If you are still struggling to breathe you should call 999. - Bleeding
If there are any signs of bleeding from around the outside of your tube, through the inner tube or in your secretions you should call the ENT department to arrange a review. - Tube displacement
Call 999 immediately and inform them your breathing tube has come out. The paramedics should ask for the ENT on-call doctors to see you once you arrive at A&E.
If you experience a large bleed call 999 immediately. If you live alone, don’t panic the ambulance service know you have a tracheostomy and will know that you require urgent help, even if you cannot state this over the phone.
Contact us
If you require further information please contact Ward 35 on:
Telephone 01642 854535
Email: [email protected]
Patient experience
South Tees Hospitals NHS Foundation Trust would like your feedback. If you wish to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Department who will advise you on how best to do this.
This service is based at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services.
To ensure we meet your communication needs please inform the Patient Experience Department of any special requirements, for example; braille or large print.
T: 01642 835964
E: [email protected]