Patient education on care of the tracheostomy tube
and stoma is of utmost importance in preventing many
complications. The Joint Commission32 has identified the
safety implications of patient education. Patients and
caregivers should be taught how to perform basic care of
the tracheostomy, including the importance of changing
the tracheotomy tube as scheduled, cleaning or replacing
the inner cannula, cleansing the stoma, and replacing
the tracheostomy holder or ties.
The clinical consensus statements on tracheostomy
care2 recommend that when possible patient and family
education should begin before the tracheostomy is done.
Before discharge, patients and their caregivers should
receive a checklist of supplies that should be taken with
the patient at all times. Patients and caregivers should be
evaluated before discharge to assess their competency in
caring for the tracheostomy. They should know what to
do in an emergency. They should be informed of the
type, size, and length of the tracheostomy tube; how and
when to use suctioning; how to clean the stoma and the
tube itself; how to change the ties; indications of respiratory
distress; how to use all home equipment; and signs
and symptoms of infection and skin breakdown. Finally,
a home care instruction manual should be given to
patients and caregivers before the patient is discharged.2
Most manufacturers of tracheostomy tubes provide a
home care manual for their products. Otherwise, Northwest
Memorial Hospital in Chicago has published an
instruction manual33 that can be downloaded from the
Internet. Emergencies at home are an essential part of the
discharge discussion. Possible home emergencies should
be discussed before discharge, ideally allowing patients
and their family members to discuss and demonstrate
key skills such as suctioning, use of the manual resuscitat