Cleaning Tracheostomy Stoma

<< RESPIRATORY

*THIS PROCEDURE IS TYPICALLY PERFORMED BY A REGISTERED NURSE

The use of this procedure guideline assumes that the registered nurse has the nursing education and skills to perform this task. This procedure guideline does not replace nursing clinical judgment.

Considerations:

  • When caring for a student who has a tracheostomy, the nurse should always know the reason for the tracheostomy, the child’s underlying health conditions and whether the child needs the tracheostomy to breathe
  • The frequency of stoma care and the care of the surrounding skin is based on the individual student’s current skin condition and associated factors, such as the amount of secretions and the degree of skin folds around the neck
  • Attempt to provide the student with as much privacy as possible, given the urgency of the situation
  • There should always be a “GO BAG” (Emergency Travel Bag) accessible when completing any tracheostomy procedure
  • If the student’s “GO BAG” contains a battery charged suction machine, the school nurse should check the battery charge level daily to ensure that it is fully charged
  • The school nurses should establish a schedule to periodically check the “GO BAG” to ensure all necessary supplies are available, not expired, and are in working condition

Supplies:

“GO BAG” (Emergency Travel Bag) Equipment:
The essential equipment to be kept with the student at all times is as follows:

  • gloves
  • portable oxygen (if ordered) with appropriate sized Ambu-bag
  • appropriate size Ambu-bag facemask (for emergencies when unable to reinsert a new tracheostomy tube
  • portable suction machine that can operate with battery or electricity
    • Battery should be fully charged
  • sterile suction catheters
  • sterile saline vials
  • water-based lubricant
  • distilled or sterile water
  • 4×4 gauze
  • split gauze dressing (if student uses)
  • unscented and dye free soap
  • syringe, if needed for tracheostomy tube cuff
  • sterile water for cuffed trach filled with water
  • two spare tracheostomy tubes — one the size the student currently uses and one that is a size smaller in the event that the tube needs to be changed and there is difficulty passing it through the stoma
  • obturator, if applicable
  • spare tracheostomy ties
  • blunt scissors
  • emergency phone numbers
  • pulse oximeter — may be optional if student is not on oxygen or mechanical ventilation

Additional Needed Supplies:

  • Student’s Individualized Health Plan (IHP) and healthcare provider’s order
  • Parent/guardian authorization form
  • Gauze
  • Sterile cotton tip applicators
  • Mild soap or student specific cleaning solution
  • Water
  • Saline
  • Medicine cup
  • Prepackaged sterile tracheostomy dressing, if ordered
  • Stethoscope
  • Personal protective equipment
    • gloves
    • goggles
    • mask
Procedure Download
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Procedure:

  1. Gather supplies
  2. Clean the work station with soap and water or disinfecting wipe
  3. Review Individualized Health Plan and healthcare provider’s orders
  4. Ensure proper documentation of parent/guardian authorization to perform the procedure
  5. Position student providing as much privacy as possible
  6. Explain the procedure to the student at his/her level of understanding
  7. Wash hands
  8. Put on gloves
  9. Ensure that tracheostomy ties are secure
  10. Remove dressing if applicable, dispose of per school policy
  11. Observe stoma for
    •increased secretions or change in consistency,
    •color or odor of secretions,
    •redness or crusting,
    •bleeding or
    •pain to stoma site
  12. Clean the neck using gauze sponges and/or cotton-tipped swabs and cleaning solution (such as mild soap) per Individualized Health Care Plan (IHCP) and health care provider’s orders
  13. Allow the skin to dry
  14. Dip cotton dip applicator in saline/water mixed with cleaning solution (i.e. mild soap) ordered by the health care provider
  15. Support the tracheostomy tube with your finger during cleaning
  16. Use cotton tip applicator to clean outer portion of tracheostomy tube and surrounding skin
    1. Start as close as possible to the tracheostomy tube then work away from it
    2. Do not put the swab into the stoma
    3. Make only one sweep with each cotton tip applicator before discarding
  17. Repeat the process until debris and/or mucus is removed
    1. Minimize direct moisture to the tracheostomy ties
  18. Using cotton tip applicator to clean the outer portion of the tracheostomy and surrounding skin using just water
    • Start as close as possible to the tracheostomy tube then work away from it
    • Do not put the swab into the stoma
    • Make only one sweep with each cotton tip applicator before discarding
  19. Use a dry cotton tip applicator to dry skin surrounding stoma starting at inner most part and moving outward
    • Drying the skin is vital to maintaining skin integrity
  20. Place dressing on tracheostomy site, if ordered by healthcare provider
  21. Dispose of used supplies per school policy
  22. Assess student’s respiratory status, as needed
  23. Remove gloves
  24. Wash hands
  25. Document assessment, intervention and outcomes in student’s health care record
  26. Follow up with parent/guardian and health care provider, as needed

References:

Children’s Wisconsin. (n.d.) Tracheostomy care and suctioning the trach tube. Retrieved June 7, 2023, from https://childrenswi.org/medical-care/tracheostomy-home-ventilator/educational-resources

Children’s Hospital St. Louis. (n.d.) Tracheostomy home care. Retrieved June 7, 2023, from https://media.bjc.org/sitelinks/tracheostomy/a001_introduction_welcome.html

Children’s Mercy Kansas City. (2018). Office of evidence based practice (EBP) – Critically appraised topic: Tracheostomy emergency supplies. Retrieved June 8, 2023 from https://www.childrensmercy.org/contentassets/878a471901cd4e858cc27ae0d82f441e/trach-go-bag-cat.pdf 

Children’s Mercy Kansas City. (n.d.) Tracheostomy stoma and neck care. . Retrieved June 7, 2023, from https://youtu.be/ZR3TRrc8Yxc 

Children’s Mercy Kansas City. (n.d.). Tracheostomy tube. Retrieved June 7, 2023, from https://www.childrensmercy.org/siteassets/media/departments-and-clinics/otolaryngology/tracheostomy-care-parent-card.pdf

Lawrence, P. R., Chambers, R., Faulkner, M. S., & Spratling, R. (2021). Evidence-based care of children with tracheostomies: Hospitalization to home care. Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses, 46(2), 83–86. https://doi.org/10.1097/RNJ.0000000000000254

Lynn, P. (2019). Providing care of a tracheostomy tube. In Skill checklists for Taylor’s clinical nursing skills. A nursing process approach. (5th ed.) (pp. 331-333).

Pediatric Home Services. (2017). Trach stoma care (Cuidado del estoma). Retrieved June 7, 2023, from https://www.pediatrichomeservice.com/tips-how-tos/trach-stoma-care/?play=1

Toothaker, R., & Cook, P. (2018). A review of four health procedures that school nurses may encounter. NASN school nurse (Print), 33(1), 19–22. https://doi.org/10.1177/1942602X17725885

Page last updated: February 28, 2025
Page last reviewed: February 28, 2025

The information and materials presented in this Website are intended for informational purposes only and are not designed to diagnose or treat a health problem or disease, or assist in diagnosis or treatment of the same.  The information is not intended to substitute for, supplement or replace clinical judgment.  If there are any concerns or questions about or relating to a nursing or medical procedure, contact the individual’s healthcare provider.  The information provided on this Website is not intended to be a substitute for medical orders and persons without the proper education, training, supervision and/or licensure should not perform the procedures.