Tracheostomy Care Guide | Head & Neck Cancer | HN Oncology

Patient Care Guide

Tracheostomy Care Guide

Step-by-step instructions for caring for your tracheostomy at home — cleaning, suctioning, humidification, emergencies, and what to expect as you progress toward decannulation.

What is a tracheostomy? A tracheostomy is a surgically created opening (stoma) in the front of the neck into the trachea (windpipe). A plastic tube is placed through this opening to keep it open and allow breathing. In head and neck cancer surgery, a tracheostomy is usually temporary — placed to protect the airway during recovery from a major operation and removed (decannulated) once swelling reduces and swallowing is safe. The tube does not affect your ability to breathe — in fact it makes breathing easier during the healing period.

Your tracheostomy tube has two parts: the outer tube (stays in place, changed weekly by the nursing team) and the inner tube (removable cannula that you clean every 4–6 hours). Always keep a spare inner tube within reach. The inner tube is your responsibility at home.

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Your Tube Type

Know which tube you have — care differs slightly

Check with your nurse: Look at your discharge paperwork or ask your ward nurse — note your tube brand, size, and whether it is cuffed or cuffless. Write it in the space below and keep it accessible.

My tube brand & size

Inner tube size

Cuffed tube

Has an inflatable balloon around the outer tube. Inflated to protect the airway (prevent aspiration) in the early period. Cuff is deflated as swallowing improves — this is a sign of progress.

Cuffless tube

No balloon — used when airway protection is no longer needed. Air passes around the tube allowing some speech. Usually used in later decannulation stages.

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What to Expect Week by Week

The typical recovery timeline for a temporary surgical tracheostomy

Days 1–3 (in hospital): Tube newly placed. Cuff usually inflated. Heavy secretions are normal — the trachea reacts to the tube initially. Suction performed by nurses. You will begin learning the routine.

Days 4–7: Secretions begin to reduce and thin. Nurses begin teaching you inner tube cleaning. Wound site care begins. Cuff may begin deflation trials if swallowing is assessed as safe.

Week 2–3: Discharge home typically occurs when you can independently manage the tube, family member is trained, and secretions are manageable. You will be given a full equipment kit and emergency card.

Weeks 3–6: Outpatient reviews. Tube may be downsized. Speaking valve trials may begin. Continued cuff deflation. Swallowing assessment guides progression.

Month 2–3: Most temporary tracheostomies are decannulated (tube removed) within 6–12 weeks of surgery. Decannulation follows a structured plan — see the Decannulation tab.

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Home Equipment Checklist

Everything you must have at home before discharge — tick each one

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Inner Tube Cleaning

Prevents mucus build-up and tube blockage — most important daily procedure

🕐 Every 4–6 hours — more often if heavy secretions

Never leave the outer tube without an inner tube for more than 2 minutes. Always have your spare clean inner tube ready before removing the soiled one. Tube blockage is a medical emergency.

Wash hands thoroughly with soap and water for 20 seconds. Prepare your clean spare inner tube and a bowl of clean water with a tracheostomy cleaning brush.

Twist the inner tube anti-clockwise and gently pull it straight out. Some tubes have a click-lock — press the release tabs simultaneously while pulling. Do not tug or yank.

Immediately insert the clean spare inner tube — align with the outer tube, push gently inward, and twist clockwise until it clicks or locks in place. Confirm it is secure.

Clean the soiled inner tube: Hold under running water. Use the cleaning brush to scrub the inside of the tube — work back and forth through the length of the tube 10 times. Check the lumen (inside) is completely clear against a light source.

Rinse thoroughly under clean running water — all soap residue must be removed. Shake to remove excess water. Do not dry with cotton wool or tissue — fibres enter the airway. Pat outer surface only with clean gauze.

Store the clean tube in the provided case — ready for the next cleaning. Boil the inner tube weekly (as directed by your nurse) for deep sterilisation. Replace inner tubes every 3–6 months or when damaged.

Cleaning schedule timer

Next clean due in

4:00:00

Set to 4 hours — tap start after each clean

Cleans today

target: 4–6

Signs the inner tube needs immediate cleaning: Noisy or wet breathing sounds · Increased breathing effort · You can see or hear secretions in the tube · SpO₂ reading dropping (if you have a home monitor) · Patient appears distressed or is using neck muscles to breathe.

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Stoma Site Care

Keeping the skin around the tube clean and healthy

🕐 Twice daily — morning and evening

Wash hands. Prepare: saline-soaked gauze, dry gauze, prescribed barrier cream (if any), clean tracheostomy ties if needed.

Gently clean around the stoma using saline-soaked gauze — wipe from the centre of the stoma outward in a single stroke. Use a fresh piece of gauze for each wipe. Never reuse a gauze piece on the stoma.

Inspect the stoma: Look for redness, swelling, crusting, discharge, or skin breakdown under the flange. A small amount of dried secretion around the stoma is normal. Yellow-green discharge, bleeding, or skin breakdown requires medical review.

Pat dry with dry gauze. Apply barrier cream if prescribed — particularly under the tube flange where pressure sores can develop. Place a clean tracheostomy dressing (split gauze) under the flange if instructed.

Check tube ties (tapes/Velcro): You should be able to fit two fingers under the ties — snug but not tight. Loose ties allow the tube to move and irritate the stoma. Check daily.

Suction only when necessary. Unnecessary suctioning irritates the tracheal lining and stimulates more secretion production. Suction when secretions are visible or audible — not on a fixed schedule.

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Suctioning Technique

Removing secretions from the tracheostomy safely

When needed — not on a fixed schedule

When to suction

Suction NOW if:

Gurgling or wet breathing sounds
SpO₂ dropping on pulse oximeter
Visible secretions at tube opening
Increased work of breathing
Patient is distressed or anxious

Do NOT suction if:

Breathing is quiet and unlaboured
No visible or audible secretions
Less than 1 hour since last suction
Patient is eating or just finished eating

Prepare equipment: Wash hands. Connect suction catheter to suction machine. Set suction pressure to 80–120 mmHg (as instructed by nurse). Put on clean gloves.

Ask the patient to take 3 deep breaths (or give 3 assisted breaths if they cannot). This pre-oxygenates before the procedure.

Insert the catheter WITHOUT suction — keep the suction port open (not occluded). Insert smoothly and gently to the length of the tracheostomy tube — do not push deeper. Never force if resistance is felt.

Apply suction only as you WITHDRAW the catheter — occlude the suction port with your thumb and slowly rotate the catheter as you pull it out. The entire suction pass must take no more than 10–15 seconds.

Allow 30–60 seconds rest between passes. Ask the patient to breathe, cough if able, or give assisted breaths. Maximum 3 suction passes per episode. If secretions persist after 3 passes — rest for 10 minutes then try again.

Flush the catheter with clean water between passes. After suctioning, give 3 deep breaths. Dispose of catheter — single use only. Wash hands.

Suction pass timer

Max seconds per pass

Stop and withdraw when timer reaches zero. Do not exceed 15 seconds.

Complications requiring immediate action: Sustained SpO₂ below 90% · Significant bleeding from tube · Patient loses consciousness · Blue colour (cyanosis) to lips or fingertips · Inability to insert catheter (tube may be blocked or displaced) → CALL EMERGENCY SERVICES (112).

Secretion colour guide

Clear / White

Normal. Well hydrated. Good humidification.

Yellow

Possible early infection. Increase fluids. Monitor — call team if persists.

Green

Likely infection. Call the clinical team — antibiotic review needed.

Blood-stained

Small streaks — often normal after suction. Frank blood or large clots → Emergency.

Brown / Black

Dried old blood or environmental debris. Call team for assessment.

Very thick/sticky

Inadequate humidification. Increase fluids and HME use. Try saline nebuliser.

The nose and upper airway normally warm, filter and humidify every breath you take. A tracheostomy bypasses this — cold, dry, unfiltered air enters directly. Without adequate humidification, secretions thicken, crusts form, and tube blockage becomes a real risk. Humidification is not optional — it is a core part of tracheostomy safety.

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HME (Heat and Moisture Exchanger)

The most important humidification device — worn 24 hours a day

🕐 Worn continuously — changed daily

The HME is a foam filter that fits directly over the tracheostomy tube opening. It traps heat and moisture from exhaled air and returns it on the next inhale — mimicking the nose's function.

Wear the HME at all times — day and night, indoors and outdoors. Remove only during nebuliser treatments or inner tube cleaning. Replace with a new HME immediately after.

Change the HME filter daily — or more often if it becomes wet or discoloured. Never wash and reuse the foam insert.

In cold or dry weather — additional humidification is needed. Use a saline nebuliser morning and evening (as prescribed). In air-conditioned rooms, secretions thicken faster — monitor closely.

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Saline Nebuliser Treatment

Prescribed for thick secretions or after radiation to the neck

🕐 As prescribed — typically 2–3 × daily

Wash hands. Use prescribed saline (0.9% sodium chloride — single-use vials). Do not use tap water.

Remove HME. Attach nebuliser mask or tracheostomy nebuliser collar over the tube opening.

Pour prescribed volume of saline into nebuliser cup. Connect tubing to compressor. Switch on — you will see a fine mist.

Breathe normally for 10–15 minutes until all solution is nebulised. After treatment, you may find secretions loosen — have suction ready if needed.

Replace HME after nebuliser is complete. Rinse nebuliser cup and tubing with clean water and leave to air dry.

Nebuliser session

15:00

15-minute treatment timer. Have suction ready for after.

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Speaking Valve (Passy-Muir)

Allows speech when the cuff is deflated — a significant milestone

The speaking valve is only used with the cuff fully deflated. NEVER place a speaking valve on an inflated cuffed tube — this completely blocks the airway and is a medical emergency. Your clinical team will confirm when you are ready for speaking valve trials.

Cuff must be completely deflated — confirmed by your nurse before first use.

The speaking valve is a one-way valve that opens to allow air in through the tube but closes on exhale — redirecting airflow upward through the vocal cords and out through the mouth and nose.

First trials: 5–15 minutes only, supervised. Remove if the patient appears to struggle, has increased secretions, or becomes distressed. Gradually increase duration over days to weeks.

Successful tolerance of the speaking valve for several hours is a key step toward decannulation — it shows the patient can breathe adequately around the tube.

Decannulation is the goal. For most head and neck cancer patients with a temporary tracheostomy, the tube will be removed within 6–12 weeks of surgery. The process is gradual and structured — each stage prepares the airway for the next. Your clinical team sets the pace based on your swallowing, secretion levels, and airway safety — not a fixed timeline.

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The Decannulation Journey

Tap a stage to mark it as complete

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What Happens at Decannulation

Removing the tube — what to expect

The decision is made by your clinical team — usually after you have tolerated capping for 24–48 hours with no breathing difficulty, oxygen saturations above 95%, and manageable secretions.

Deflate cuff (if cuffed tube). The nurse removes the securing ties. The tube is removed in one smooth pull. This takes 1–2 seconds and causes brief coughing.

A dressing is placed over the stoma immediately. The stoma will close on its own within 48–72 hours. You may notice some air escaping around the dressing when coughing — press gently with your hand over the dressing when coughing until the stoma closes.

You will be monitored for 4–6 hours after decannulation — oxygen saturation, breathing rate, and comfort are checked regularly. Mild hoarseness and a lump-in-throat sensation are common for a few days.

The stoma site heals over 1–2 weeks. Keep the area clean and dry. Avoid submerging the neck until fully healed. A small scar will remain — this fades over 6–12 months.

After decannulation: Your voice may be hoarse for days to weeks as the vocal cords readjust. Swallowing may feel temporarily strange — the tracheostomy tube subtly affects swallow dynamics. These symptoms improve rapidly in most patients. Continue swallowing exercises as directed by your SLT.

Print this page and keep a copy at home, in your bag, and in your car. In an emergency, family members need to know what to do immediately. Post the steps on the fridge.

🚨 BLOCKED TUBE — Cannot breathe

Stay calm. Call for help. Shout for someone nearby.

IMMEDIATELY remove the inner tube. Twist anti-clockwise and pull out. This alone often restores airflow if the blockage was in the inner tube.

If breathing improves — insert the spare clean inner tube. Call the hospital team to report the episode.

If breathing does NOT improve — attempt to suction through the outer tube. If still unable to breathe → CALL 112 IMMEDIATELY.

If the outer tube also needs emergency removal (trained caregivers only, as instructed by nurse): deflate cuff if present, remove tube, cover stoma loosely, call 112.

Emergency: 112 | Hospital Line: +91 9150000542

⚠️ TUBE HAS COME OUT (Accidental decannulation)

If the patient is breathing — cover the stoma loosely with a clean cloth to keep it open. Do not panic. Call the hospital immediately.

Do not attempt to reinsert the tube yourself unless you have been specifically trained to do so — forcing a displaced tube can cause serious injury.

If the patient is NOT breathing or turns blue — call 112. Tell the operator: "My patient has a tracheostomy — the tube has come out and they are not breathing. They breathe through their neck."

If you are trained in emergency tube reinsertion — perform it now using the spare tube at the bedside. Confirm position. Call the hospital immediately after.

When to call the team — Red flags

Daily Tracheostomy Care Schedule

Complete all tasks. Tick each one as done. Consistency prevents complications.

Pre-Sleep Safety Checklist

Complete every night before bed — non-negotiable

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Tracheostomy Team Support

Never hesitate to contact us with concerns about your tracheostomy — no question is too small. We would rather receive 10 calls about nothing than miss one real emergency.

WhatsApp +91 9150000542