Tracheostomy care for cancer patients and caregivers
Kellie Bramlet Blackburn
Living with a tracheostomy and learning proper tracheostomy care can take some adjustment for cancer patients who rely on them during cancer treatment. It may even be a little intimidating at first. But patients can lead healthier lives by taking the necessary steps to prepare for a tracheostomy procedure and care for a tracheostomy, also called a trach.
We spoke with Kate Schwarzlose, an advanced practice registered nurse in Head and Neck Surgery, about what cancer patients and their caregivers should know about tracheostomy care.
What is a tracheostomy?
A tracheostomy is an opening in the windpipe, or trachea, that allows air in so that patients can breathe better.
Why do cancer patients need tracheostomies?
Most often, our cancer patients may need a tracheostomy because a tumor is obstructing the airway or swelling or other problems from surgery or radiation are making it difficult to breathe. Tracheostomies are most often used when treating patients with head and neck cancers, including tongue cancer, oral cancer and thyroid cancer. A tracheostomy may also be done if a patient has been on a ventilator for an extended period of time.
How is a tracheostomy performed?
A surgeon performs a tracheostomy either surgically in an operating room or using a minimally invasive technique that allows them to use a tiny camera to see the inside the throat. Patients are sedated for both types of procedures.
How long do cancer patients typically have tracheotomies for?
A tracheostomy may be temporary or permanent. Typically:
Surgery patients may use a tracheostomy for one to two weeks or more.
Patients who experience vocal cord dysfunction may rely on a tracheostomy permanently.
How is breathing with a tracheostomy different?
Breathing with a tracheostomy feels different. Patients are breathing through a trach tube instead of their nose and mouth. The air they breathe will be drier because it hasn’t passed through a moist nose and throat before reaching the lungs.
Putting small amounts of saline into the tube, using a saline nebulizer or using a device called a heat and moisture exchanger can help add moisture to the air patients breathe when using a trach.
Can patients with tracheostomies talk?
The tracheostomy changes the way patients communicate because the air goes into their lung without passing through the voice box, nose and mouth. This makes it difficult to speak, and often patients choose to write instead.
As the swelling goes down, patients may be able to cover the end of the trach tube with a finger and redirect the air through the vocal cords, allowing them to speak.
At MD Anderson, patients meet with a speech pathologist who can help improve speech and can even show them how to use a hands-free speech tool, like a speaking valve.
What does tracheostomy care and cleaning involve?
Tracheostomy care is very important. Done properly, it helps keep patients healthy and free from infection. It may be helpful for patients to have a caregiver assist with trach care, but they can do it on their own, too.
Trach care needs to be performed up to three times each day. This includes:
Using a suction machine to clean the tube
Cleaning the skin around the opening
Cleaning the parts of the tube with a brush
Adding saline to the tube to moisten the air the patient breathes
Changing the trach ties that hold the tube in place every one to two days or as needed
When taking a shower or bath, patients need to avoid getting water into the tracheostomy so water doesn’t get in their lungs. Covering the tube with gauze can keep water out while still letting air in.
Patients with tracheostomies should avoid clothing that’s too snug or that blocks the tube.
What are some signs of infection patients and caregivers should be aware of?
An infection can be very serious. Patients should call their care teams if they experience:
a persistent cough with thick mucus,
an odor from the trach, and/or
redness, swelling or pain in the skin surrounding the trach tube.
Do patients with tracheostomies need feeding tubes?
A trach shouldn’t affect patients’ abilities to eat or swallow. That’s because the only impacted area is the trachea – the airway. A separate part of the body, the esophagus, allows food to enter the stomach when eating. But some patients do need both a tracheostomy and a feeding tube as they recover from surgery.
How is a tracheostomy removed?
If patients regain the ability to breathe on their own, the trach tube is ready to be removed. It’s removed in a bedside procedure and doesn’t require surgery or anesthesia. It’s generally not considered painful.
Following the removal, the incision closes naturally, similar to a piercing. It takes about one to two weeks for the incision to close and heal. Patients will need to cover the incision when they talk or cough to make sure too much air doesn’t escape and cause the incision to open. Some patients will have tracheostomies on a more permanent basis.
No matter the length of time a patient may have a tracheostomy, they may take some initial adjustment. With proper planning and care, they can help patients lead healthier lives.