When is a tracheotomy performed?
A tracheotomy may be necessary if your breathing is obstructed. This may be the result of:
- Swelling of the airway after radiation, surgery, accident or infection
- Tumor growth in and around the larynx, mouth and/or in the pharynx
- Insufficient functioning of the vocal cords
- Stagnation of the vocal cords after thyroid surgery
- Long-term ventilation
In most cases, a tracheotomy will be temporary. Once the cause is remedied, the tracheotomy can be lifted. Sometimes this is not possible and the tracheotomy persists longer.
What is a cannula?
A cannula is a plastic or metal tube that is placed directly into the trachea through an opening in the neck. Breathing takes place through this tube after the operation.
The cannula consists of an inner and an outer cannula. The outer cannula remains in the trachea. You can take out the inner cannula to clean.
The cannula with a cuff has a small balloon that can be filled with air. The cuff sits on the lower part of the outer cannula and is located in the trachea. A cannula with cuff is inserted during surgery. Because the swallowing function is temporarily disturbed after the operation, there is a risk that fluid will end up directly in the lungs. That can cause pneumonia. The cuff prevents that.
A cannula strap is around the neck and ensures that you do not accidentally cough out the cannula. There are all kinds of cannula straps. It is important that the strap is not too loose, because the cannula can then be accidentally coughed out.
Filter
It is important to use a filter on the cannula. This improves the humidity in the lungs and ensures that your lung function remains as good as possible.
Shower protector
You can use these while showering. The shower protector ensures that you breathe in as little moisture as possible.
Trachea cannula care
Dripping/spraying
Is the mucus thin and clear and can you easily rinse the inner cannula? Then coughing up the mucus and cleaning the cannula is enough.
When the mucus is thicker and you cannot rinse it out of the cannula with water, it may be necessary to drip or spray with NaCl 0.9%. Here’s how to do that.
Cleaning inside cannula
Remove the inner cannula. Hold the shield and rinse it clean. If necessary, do this with the help of tweezers and a 5×5 gauze. You should never remove the outer cannula; the tracheotomy opening can then close. Place the inner cannula back in the outer cannula. Place the filter on the cannula.
Skin care
If you wish, apply a split mesh under the cannula to protect the skin. If the skin is irritated, you can protect it with a barrier cream.
What problems may you encounter?
- My mucus is tough and I can hardly cough it up. It remains in the lungs or trachea.
- I cough up a lot of clear and thin mucus
- I cough up traces of blood and crusts
- I cough up yellow/green mucus
- The skin around my cannula is red
- I sometimes have stuffy and the feeling that I can hardly breathe
- When coughing up, there is drink and traces of food in the mucus
Cause may be
- Dry air
- Irritation of the trachea
- Smoking or having smoked a lot in the past
- Do not use a filter
Advice
- Drip or spray 1 to 2 extra times a day with NaCl 0.9%, if necessary more often
- Always use the filter
- Increase the humidity in the house
Cause may be
- Colds
- Drip too much with NaCl 0.9%
- Use of mucus thinner
Advice
- In consultation with doctor stop taking mucus thinner
- Reduce the amount of NaCl 0.9% with dripping or drop less often
Cause may be
- The trachea is too dry, causing crusting. By constantly coughing up these scabs, the trachea becomes irritated / damaged
- The cannula presses against the trachea, this irritates the trachea
- The cannula strap is too loose, making the tube too mobile. That irritates and excites the trachea
- Inflammation of the trachea
Advice
- Moisten the trachea more often with NaCl 0.9%
- Place a filter in front
- Check that the cannula strap is not too loose or too tight
- Check that the cannula.
- Learn a good couching technique. If necessary, ask for help from a nurse at the outpatient clinic
- In case of permanent blood loss, talk to your doctor
Cause may be
- A respiratory infection
Advice
- Consult (family) doctor
- If necessary, drip 1 to 2 times a day extra with NaCl 0.9%
Cause may be
- The mucus irritates the skin.
- The cannula irritates the skin.
Advice
- If the skin is very sensitive and delicate, it can be protected with a skin-protecting liquid.
- Use a split mesh. If necessary, ask for advice at the outpatient clinic.
Cause may be
- Mucus plug or crust in the cannula
Advice
- Remove and clean the inner cannula
- Drip well to cough out the plug.
- If the shortness of breath persists, contact the ENT clinic or ENT doctor on duty.
Cause may be
- Choking
Advice
- Consult ENT doctor
