Cleaning tracheostomy tube supplies and maintaining the emergency tracheostomy equipment and supplies

At the end of this chapter, you will be able to: 

• demonstrate when to clean your child’s tracheostomy tube.
• demonstrate how to clean your child’s tracheostomy tube.
• identify the items needed to be restocked in the emergency tracheostomy kit (or go kit) and other necessary equipment and supplies.

How often must I clean my child's tracheostomy equipment?

Tracheostomy tubes and obturators: 

Tracheostomy tubes (outer cannula), obturators and inner cannula, if they have one, should be cleaned immediately after you change your child’s tracheostomy tube. This makes sure that they are ready to use whenever your child needs them. Routine tracheostomy tube changes are recommended weekly or as prescribed by your child’s health-care team.

Wash the tubes as often as recommended by your child’s health-care team.

• PVC tubes are usually washed weekly but they can also be washed every other week or less frequently depending on what has been prescribed for your child. PVC tubes are replaced monthly.
• Silicone neonatal and paediatric tubes are washed weekly (or less frequently depending on what’s been prescribed for your child) and replaced after 5 washes.

How often you replace the tracheostomy tube after cleaning depends on the type of tube your child has. Before each cleaning and each use, tracheostomy tubes should be inspected. Discard and replace the tube if:

• the tube is bent or cracked
• the plastic appears discoloured or unusually stiff (both signs of old plastic)
• you cannot read the writing on the flange
• the obturator is bent or hard to insert

Reusable inner cannulas

Clean two to three times a day or more often if dirty or if there is a lot of mucus.

Before you start

Gather your supplies:

• plastic container or basin for soaking solutions. The container must be large enough to easily accommodate the cannula without bending or forcing it to fit.
• 3% hydrogen peroxide
• sterile, distilled water
• clean container with a lid for storage or a clean plastic bag
• disposable gloves (optional)
• clean towel
• tracheostomy tube brush
• new disposable inner cannula or clean reusable inner cannula
• inner cannula to be cleaned

Steps:

1. Wash your hands.
2. Prepare a basin with equal parts of half hydrogen peroxide and sterile water.
3. While holding the neck flange steady with one hand, carefully remove the inner cannula as per the instructions for the brand of tracheostomy tube being used.
4. Pull out the inner cannula.
5. Replace it with a spare, clean inner cannula.
6. Place the dirty inner cannula in the basin of prepared solution.
7. Using a tracheostomy brush, gently remove any mucous.
8. Rinse thoroughly with sterile water or sterile saline to ensure all the hydrogen peroxide is removed.
9. Gently shake off any excess water.
10. Allow to air dry on a clean towel and store in a safe place.

Disposable inner cannulas

Change twice daily with routine care and/or if it is partially or fully blocked. Disposable inner cannulas are less cost effective than reusable.

Corks/caps

Clean daily with mild soap and water. Replace if the cap becomes loose, or leaks.

Heat and moisture exchanger (HME)

Replace daily. Most HME’s cannot be washed and must be thrown away at the end of the day. There are a few brands that allow you to wash the HME housing and replace the filter only. Discuss which HME will be most suitable for your child with their health-care team.

Heated high flow (e.g., Airvo) tracheostomy connector/adaptor

These can be used for up to 30 days.

Proper cleaning of tracheostomy equipment helps prevent lung infections. Most children use plastic or silicone tracheostomy tubes. If your child uses a metal or silver tracheostomy tube, your child's health-care team will explain how to clean it.

Below are recommendations for cleaning the different material tracheostomy tubes. Always read and follow the manufacturer’s recommendations for other details and alternate ways to clean.

How do I clean plastic (PVC) uncuffed tracheostomy tubes (e.g., Shiley tube)?

You can clean and re-sterilize reusable tracheostomy tubes (outer cannula), reusable inner cannulas (if your child uses one) and obturators for up to one month. After one month, you should discard them.

NOTE: Cuffed Shiley/plastic tracheostomy tubes cannot be cleaned and must be replaced after each tube change.

Before you start

Gather your supplies

• tracheostomy cleaning brush
• 3% hydrogen peroxide
• sterile, distilled water
• a clean container with a lid or a clean plastic bag for storage
• disposable gloves
• clean towel
• clean tweezers
• tracheostomy tube and obturator to be cleaned
• reusable inner cannula to replace dirty one, if needed
• cap/cork, if needed
• two large plastic containers or basins for soaking solutions
• containers must be large enough to easily accommodate the tracheostomy tube and supplies without bending or forcing them to fit
• to avoid mixing up clean and dirty items, label the container for dirty equipment #1 and the container for clean equipment #2

Cleaning plastic (PVC) tracheostomy tubes

1. Wash your hands.
2. Mix half hydrogen peroxide and half sterile, distilled water into container #1, for dirty equipment.
3. Pour sterilized, distilled water into container #2, for cleaned supplies.
4. Remove the used Velcro ties from the tracheostomy tube. Hand wash the Velcro ties in mild soap and water. Rinse and allow to dry. Replace it if needed.
5. Rinse the tracheostomy tube, reusable inner cannula (if applicable) and obturator with a strong stream of cold tap water.
6. Clean the inside and outside of the tube by scrubbing gently with a tracheostomy cleaning brush. Make sure you remove visible dirt.
7. Place the tracheostomy tube and any adjuncts (inner cannula, obturator and cork caps) in container #1. Soak the tubes for 10 minutes. Discard the solution after use.
• If the hydrogen peroxide/water solution is bubbling vigorously on the tracheostomy tube (an indication of secretions or bodily fluid), repeat steps 6 and 7.
8. Wash your hands.
9. Put on clean gloves (recommended).
10. Remove the tubes from container #1 using your gloved hands or clean tweezers. Handle the tube by its neck flange and the obturator by its handle. Place the tubes on a clean dry towel and allow them to dry completely.
11. Rinse with sterile, distilled water and then place the tubes into container #2. Soak the tubes for 10 minutes.
12. Remove the tubes and any adjuncts from container #2 using your gloved hands or clean tweezers. Handle the tube by its neck flange and the obturator by its handle.
13. Do not rinse the tubes with tap water. Instead, place them on a clean dry towel. Allow them to dry. Tap the tracheostomy tube gently against the towel to remove any droplets of water from inside the cannula. Do not whip or shake the cannula. Ensure all parts are completely dry.
14. Once dry, attach the clean ties to the flange. Reinsert the obturator.
15. Place the tubes in a clean container or plastic bag and seal the container or bag. Store the tubes properly to prevent bending or strain.
16. Throw out all used and dirty supplies, including the liquid solutions in containers #1 and #2.
17. Wash all plastic containers with soap and water. Rinse well. You can wash the containers on the top shelf of the dishwasher.
18. Remove gloves, if used, and wash your hands.

How do I clean silicone tracheostomy tubes (e.g., Bivona brand)?

You can clean and re-sterilize silicone paediatric tracheostomy tubes up to five times before you discard them. Adult Bivona silicone tracheostomy tubes can be washed up to 10 times. Bivona tubes have a special Superslick coating that keeps mucus from sticking to them. Do not scrub tubes too hard or the coating will come off. It is important to track the number of times you’ve washed the tube.

Before you start

Gather your supplies:

• ​container for water
• tracheostomy cleaning brush
• mild liquid, fragrance-free soap
• clean container with a lid or a clean plastic bag for storage
• disposable gloves
• clean towel
• clean tweezers
• tracheostomy tube and obturator to be cleaned
• cork, if needed
• a pot to heat water that is designated for tracheostomy cleaning only

Cleaning silicone tracheostomy tubes

1. Wash your hands.
2. Put on clean gloves (recommended).
3. Prepare supplies.
4. Remove the used Velcro ties from the tracheostomy tube. Hand wash the ties in mild soap and water. Rinse with tap water and allow to dry.
5. Using hot water and a mild, fragrance-free detergent solution, gently wash the inside and outside of the tube, the reusable inner cannula and obturator with a gentle tracheostomy brush until all visible debris is removed. Too much scrubbing, scraping or stretching may damage the tube.
6. You can let the tracheostomy tube soak in soapy water for up to 60 mins as per Bivona manufacturer recommendations.
7. Rinse with tap water.
8. Discard the brush with the other used and dirty supplies when you are finished cleaning.
9. Place the tracheostomy tube and any adjuncts (inner cannula, obturator) in a rapidly boiling pot of clean water and then remove the pot from heat. Keep immersed for 20 minutes. For cuffed tubes, the pilot line can be submerged into the water (note, only for the Bivona brand, not the Shiley cuffed tubes).
• Another option is to sterilize the tracheostomy tubes in a bottle sterilizer. If you choose this method, make sure the bottle sterilizer is used only for tracheostomy sterilization.
10. Once the water has cooled use clean tweezers (or washed fingers) remove the tracheostomy tube from the water by its hub or flanges and place it on a clean dry towel.
11. Use the clean tweezers (or washed fingers) to remove the obturator by its handle from the water and place it on a clean dry towel. Allow the tubes to dry completely.
12. Place tubes in a clean container or plastic bag and seal the container or bag. Store the tubes properly to prevent bending or strain.
13. Discard the used water.
14. Remove gloves, if used, and wash your hands.

Note: You should check that cuffed tubes can inflate after cleaning, drying and before you store them. Inflate the cuff as if you are checking it (5 mLs of air or water depending on the type of cuff). Ensure no leaking and that the cuff reinflates evenly around the tube. If issues are noted, the tube should be replaced.

Bivona Trach Cleaning Steps from Seattle Children's Hospital

Cleaning other equipment and supplies

Reusable manual resuscitation bag

• Wash weekly, if used.
• Refer to the manufacturer’s instructions provided with the bag and consult with your respiratory vendor if you have any questions.

Disposable manual resuscitation bag

• Must be thrown away and replaced monthly if used.

Suction machine

• Wipe the surface of the suction machine clean daily with a damp, soapy cloth and then wipe it dry with a lint-free cloth.
• Empty and wash canister daily.
• Change tubing weekly or more often if secretions are sticking.

Oximeter

• Wipe the surface of the suction machine clean daily with a damp soapy cloth and then wipe it dry with a lint-free cloth.
• Wipe down probe and cable wires with a damp cloth.
• Replace disposable probes as needed (approximately once a week).

Container to store tracheostomy tube

If you choose to use a plastic container to store your child’s emergency tracheostomy kit supplies, be sure to clean it on a regular basis. Ideally, this should be done after tracheostomy tube changes when supplies are used and replaced.

Important: Restock the tracheostomy kit right away. (please see the page The emergency tracheostomy kit for items to stock in an emergency tracheostomy kit).

Bacteria growth in tracheostomy tubes

A bacterium called Pseudomonas aeruginosa can grow in tracheostomy tubes. This bacterium can become difficult to clear from the trachea and lungs even when new tracheostomy tubes are placed, because it is passed between the tube and the patient. Your child's health-care provider may prescribe a regimen to get rid of the Pseudomonas aeruginosa, especially if your child is scheduled for an upcoming open airway surgical procedure.