FAQ Tracheostomy | Based on experience with my mother

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The following FAQs are based on my experience in caring for my mother who had a tracheostomy done in October 2023. Disclaimer: Always consult your healthcare provider for guidance and advice as each person’s situation and symptoms may vary.

Note: The page would be updated from time to time.

 

FAQ Listing:

I have published a short video in YouTube on some of the FAQs below:

ANSWERS IN MY OWN WORDS BASED ON MY CAREGIVING EXPERIENCE

Q: Why did your mother have the tracheostomy procedure done?

A: In October 2023, my mom was rushed to ER and subsequently admitted to ICU where she was placed on a ventilator due to severe pneunomia and a collasped left lung. Around the third day, the ICU doctor discussed with me about having a tracheostomy done as she noticed my mom have been in and out of hospital over these few years due to phlegm issue and lung infection. I have shared in detailed in this blog post.

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Q: What are the common reasons for those who opt NOT to have the tracheostomy done (as told to me by the ICU doctor)?

A: When the ICU doctor spoke to me about the tracheostomy, she also mentioned that some family members had opted not to have the tracheostomy done. She shared with me the common reasons such as:

  • there is no one in the family able to care for the patient at home once a tracheostomy is done
  • due to old fashioned behinds that there is some kind of taboo in puncturing a hole in the throat of a person
  • the patient had given an advanced directive not to have any life extending procedures done

Usually ICU would be the unit that is performing the tracheostomy and they have a different outlook as they have seen first hand how tracheostomy can help a patient breathe better and remove phlegm. From my experience, it was very different than the ER doctor who at first strongly discourage us from sending my mom to ICU as he felt it would make her suffer and likely she would not make it.

Note: The ER doctor was taken aback when he saw my mother a few months later still alive…. and looking relaxed now that we could easily do phlegm suction out.

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Q: Would tracheostomy affect the person’s ability to speak?

A: After my mom had the trach done, no sounds is produced from the vocal chords. The nurse told me is because my mom’s trach is open hence no sound could be generated by the vocal chords  and hence the person will no longer to be able to speak. In the case of my mom, it did not really make a difference because she had not been speaking much as her Alzheimers have been in advanced stage for the past few years.

However, some trach tube is not connected to an oxygen trach mask and closed up- for those cases, you would need to check wit the doctor if it would affect the ability to speak.

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Q: Was having the tracheostomy done worth it? What difference did it made for your mother?

A: YES, IT IS WORTH IT. My biggest regret is not to have done it earlier- it would have saved my mom from more than 2 years of suffering. Actually my mom’s primary care doctor had suggested it when my mother first started to have pneumonia due to excessive phlegm that could not be suctioned out via oral suctioning. However when I asked opinion of my mom’s friends, they had advised against it since this is usually not a common procedure done for old people who can no longer swallow who have excessive phlegm and kept getting recurring pneunomia.

I should have followed the advice my mom’s primary care doctor and had the procedure done. After the procedure is done, we were able to easily suction out phlegm when my mom cough it out and she no longer suffer the danger of oxygen deprivation due to hardened mucus that blocked her breathing passage. Due to the tracheostomy which is an opening to her throat, when she cough, the phlegm and mucus if excessive can be pushed out.

My mom also have an oxygen tube connected via a trach mask which help in her recovery. Her hands and feet which were usually quite cold, are now warm as she now have sufficient oxygen circulating her body.

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Q: Was it difficult caring for your mom after her tracheostomy?

A: At first, it took time to adjust. I remember the first time when I tried to do suction or wound dressing for my mom, my hands literally shook as I was so afraid I would do it wrongly and hurt her.

But like all caregiving and nursing duties, we become familiar through directly doing it again and again. The most obvious difference with a trach tube are:

  • need to perform daily dressing change at the trach tube area
  • the inner cannula needs to be removed and washed at least once a day
  • learning how to do suction via the trach tube
  • being careful not to wet the area, hence no more showers and wet baths. It is bed bath.

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Q: How did you learn to care for your mother after the tracheostomy such as wound dressing and tracheostomy?

A: This is something I really wish to share for you to be on the alert. After my mom had the tracheostomy done, she was still on the ventilator. Originally ICU had expected to move her to semi ICU to slowly weane her off the ventilator after the tracheostomy. However my mom had shown quick progress and they were able to weane her off the ventilator, ie she was able to breathe on her own (with assisted oxygen delivered via the trach mask) within the same day. Hence, ICU team moved my mom to the common ward.

Common wards are busy wards with lots of beds and patients. Usually such wards at government hospitals are short staffed due to many patients, usually in full occupancy. The moment my mom was moved to the common ward, the doctor told me my mom can be discharged the next day after she completed her antibiotics.

I looked at my mom’s hands and legs swollen due to the IV antibiotics, and she looked weak as she just had the trach surgery done. And worse still, I have no idea how to care for my mom and also the nurse told me my mother would require continous oxygen delivered 24/7 via the trach tube. I told the nurse I had no idea how to care for my mom. she said no issue she would give me a ‘crash course’ to learn once and I can be on my way.

It was then I INSISTED to be moved to private room as we need time to prepare for the oxygen machines and procure the oxygen tanks. I could see clearly my mom was not fit to be discharged but understandly the ward had continous shortage of beds hence if I wish to have my mom stay longer, I would need to pay much more for single private rooms.

Turned out to be the right decision as after my mom was moved to private room, she received more personalized care. And the nurses there had time to explain and teach me how to do the daily wound dressing and trach tube suction. They even showed me how I could do bed bath and wash my mom’s hair on the bed (as she can no longer take wet baths in the bathroom due to avoid water getting into the lungs via the trach tube).

Later I heard from a lady that she knew of someone who had a trach tube who had passed away shortly after being discharged from hospital. Please note a session of ‘crash course’ is NOT SUFFICIENT unless the caregiver had prior experience or is a qualified nurse. It took me about 2 weeks to observe and later being allowed to do on my own with the nurses watching, teaching and guiding me.

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Q: Could a person have a wet bath/ shower after having the tracheostomy done?

A: As far as I know, nope. Some tracheostomy tubes can be closed but in the case of my mom, it is opened as there is a trach mask that covers her trach tube opening where it is connected to an oxygen concentrator where oxygen is being administered to her.

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Q: What are the caregiving procedures required for tracheostomy??

A: The main additional things are we have to change the dressing around the trach tube at least once a day, remove the inner cannula to wash it daily and learn to do phlegm suction via the trach tube.

Care also need to be taken if the person is bedridden and needed to be lifted from the bed, and need to learn how to wash their hair or give them a bed bath without wetting the area around the neck, especially the trach tube.

It is VERY IMPORTANT to ensure sterility, hence best to use disposable and change after each use for example hand gloves, suction catherer (tubes), etc. Any carelessness could lead to internal infection and hospitalization.

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Q: Does the trach tube needs to be changed? If yes, how often and who does the change??

A: Yes it does. For my mom it is once every 3 months. In the hospital that I am in, my mom’s tracheostomy tube was surgicially placed by an ENT doctor. The same ENT doctor is also appointed to help my mom change her trach tube.

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Q: I noticed the trach tube seemed a little loose. Should I be alarmed?

A: If the trach tube is lose, it may dislodge from the position or move around within the throat causing injuries, internal bleeding due the trach tube constantly rubbing against the throat tissue. In this case please arrange to go to hospital to have it checked.

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Q: The skin around the trach tube is very reddish. What can I do?

A: The ENT doctor told me that the reddish skin around the trach tube is caused by excesive phlegm. I had thought that it was due to the daily dressing which is done using NSS water that contains salt. Regardless, the doctor had prescrbed eye oilment to use a sterile cotton bud to apply the oilment over the area.

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Q: How often do the tracheostomy wound dressing and inner cannula change need to be done?

A: The wound dressing, ie changing the gauze dressing needs to be done at least once a day. If phlegm had ben sneezed out and the phlegm had spilled over to the gauzes, then fresh dressing would need to be change.

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Q: What items are required when doing the wound dressing?

A: For dressing, I use the following items:

  • clean disposable gloves
  • disposible dressing kit that comes with the following
  • NSS water to wet the cotton buds
  • Cotton swab sizes M and S
  • Semi transparent tape used specifically for dressing

 

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Q: Should I be alarmed if there is bleeding around the opening of the trach tube?

A: In the beginning right after the tracheostomy, there was a little bleeding as after all, the doctor had literally punctured an opening at my mom’s throat.  There was also clots of blood which the nurses at the private room helped me to remove.

It is important to take note that the trach tube dressing is not too tight, nor have loosen up. If it is loosen up, the trach tube would move and it would cause friction with the skin and tissue which may cause bleeding. Bring the person to the hospital to have the doctor to take a look.

However one day when I was doing dressing, I observed there is bleeding on my cotton swab. When I use a new cotton swab, there is new blood out. It got me a little worried so I called the ambulans to take my mom to hospital (my mom need to travel with an ambulans as she require supplemental oxygen 24/7). The ambulans driver came with 2 nurses from ER to take a look at my mom and they too felt it is better to take my mom to hospital as they were concerned there is internal bleeding.

It was at night, we went to hospital and the ER doctor took a look and determined that it seemed like a superficial wound and not life threathening, ie it can wait. The ER doctor set me up with an appointment with the ENT specialist who had performed the tracheostomy the next morning as he said they would need to check by putting in a small camera which ER do not have but ENT department has.

The next day, the ENT doctor checked and found there was inflammation inside my mom’s throat tissues around the trach tube. Causes may be due to my mom having a lot of phlegm and/or friction caused by the looseened trach tube rubbing against her throat. She prescribed antibiotics for 10 days and fixed another follow up appointment 14 days later. She also prescribed special eye/ear drops with antibiotics for me to drop in twice a day via the trach tube opening to help with the inflammation.

In the follow up checkup after my mom completed the course of antibiotics, the inflammation had reduced substantialy and the doctor said she no longer require additional oral antibiotics but to continue the drops for another 7 days.

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Q: When I perform phlegm suction via the trach tube, there were little traces of blood. Is it dangerous?

A: When my mom first had the tracheostomy done, there would be little traces of blood observed during suction via the trach tube. The nurse told me if there is a little bit of blood it is okay but if the blood is like bleeding and continous then would need to go to ER.

When doing suction, need to bear in mind that when the suction catherer is inserted into the trach opening, press to disable suction first. Only enable the suction to work when we slowly pull up the catherer. If the suction is enabled with the catherer just stationary inside the throat, it may suction the tissue causing injury and bleeding.

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Q: How often should phlegm suction be performed?

A: The rule of thumb is each time before meal and safely 2 hours after the last meal. My mom is on tube feeding and have a feeding schedule 4 days per day hence I would do suction each time before I feed her. However, there are times where suddenly she coughed out a lot of phlegm and it obstructs her airway. Her face would grow red from struggling and I would immediately do suction, and usually would be able to get a lot of phlegm out.

Suction cannot be done during or immediately after meal because it may trigger coughing which may cause the food from the stomach to reflux upwards and go into the lungs. This brings the risk of aspiration pneunomia. Nurses generally would refuse to do phlegm suction during or immediately after meal unless it is emergency (example patient is choking due to hardened mucus obstructing breathing).

 

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Q:With the trach tube, do we perform anymore oral suction (ie insert suction tube via the mouth)?

A: Yes, we still need to perform oral suction, ie insert the catherer via the mouth into the trachea. IMPORTANT: CANNOT reuse the suction catherer – ie after put into the throat, please NEVER put into the trach tube as it may result in infection. The nurses taught me to first do oral suction as this would usually trigger the cough reflex which would cause more phlegm to be coughed out from the lungs upwards.

After that, change into a different set of disposable gloves and a NEW suction caterer to do suction on the trach tube. Usually if I am doing oral suction, I would do it right before the next meal where my mom’s stomach is empty (for tube feeding, we use a syringe to check the stomach contents before giving each feed), ie I wait longer after the last meal time. This is because oral suction would trigger a coughing effect and if the person is having a full stomach, they may end up vomitting or for the stomach contents to reflux upwards into the lungs which could result in aspiration pneunomia which is life threathening.

 

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Q: How do I know if there is an infection in the trach tube?

A: The doctors told me to look out for the following signs:

  • the person behaviour is not like usual, ie very lethargic and not really responsive when they are usually alert
  • having fever (but at times my mom may not have fever when she is having pneunomia so be alert of other signs)
  • phlegm volume more than usual
  • phlegm colour changed like yellowish or greenish
  • food digestion is no good

Note: My mom always have phlegm that are yellowish and solidify. The doctor said if all along through the years she had this, then it may be the type of phlegm she is producing.

 

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