How to clean, dry and store the inner cannula (and why it sometimes stink)

The inner cannula in a tracheostomy tube is a small removable small cannula that can be taken out from the trach tube to be cleaned and washed. In a tracheostomy kit which is a box that comes during each trach change, there would be 2 inner cannula and a trach brush that are provided.

How often do we need to clean the inner cannula:

At least once a day, to be done after daily trach dressing (change the gauze around the trach tube). Sometimes there is a smell that comes out when we remove the inner cannula. I’ve asked the ENT doctor if that happens, then clean the inner cannula twice a day instead of just once.

Why the inner cannula sometimes smell bad when taken out

My mom’s trach tube has to be changed once every 3 months by the ENT doctor. Usually I noticed when the 3 month mark is coming up, there would be a little stinky smell when I remove the inner cannula but the smell goes off after the entire trach tube is changed.

Once my mom had infection inside her trach tube.We did not know it was infection at first but there was a little bleeding around her trach tube which I took her to the hospital and later the ENT doctor through the camera inserted in her trach tube was able to see she had inflammation. It smell kinda bad each time I remove the inner cannula. The doctor suspected it was due to the trach tube had loosen and it was rubbing against her throat tissues, creating friction and subsequently inflammation, coupled with the fact my mom naturally have a lot of phlegm. After she prescribed a course of antibiotics, and some medicated drops to be administered into the trach tube (they are actually medicated eye drops) the smell disappeared.

Hence in my experience, if the smell is horrible, ie a strong stench that kinda fill up the room, then it would likely be a sign of infection. But if the smell is mild and it is closer to the 3 month mark, and the person did NOT have fever, change in phlegm colour and volume, nor look distressed, then it may be because the smell comes from the accumulation of fluid in the plastic confines of the trach tube. During trach tube change, usually the ENT doctor would run a camera in to check and would be able to detect if there is inflammation or infection inside the trach tube.

How to clean the inner cannula

Note: I have two soap containers….. one that is use to place the washed inner cannula to air dry it on a desk in my room. The other is used to store away the dry inner cannula to be used again the next day when I wash the other inner cannula inside the trach tube.

This is not based on any YouTube video but based on what the ward and ENT nurses had taught me directly on how to do it. A clean pair of gloves is worn during the inner cannula change.

1. After completing the trach tube dressing, I would lay a piece of clean tissue next to my mom’s pillow to put the inner cannula that I am about to remove from my mom’s trach tube. I also have the clean cannula stand by which I placed in a soap dish (that comes with a strainer).

2. Once everything is readily placed, I would remove the inner cannula and place on the tissue. Before putting in the other clean cannula, I would use a small sterile cotton swab, wet a little (just wet the tip but make sure it is not dripping because any droplets that get into the throat would cause coughing) with saline water (NSS water). Then I would use it to clean the inner trach tube (the area that juts out from the throat) before putting in the other clean cannula.

3. The inner cannula that I have removed would be washed in running tap water with the cannula brush (that came with the trach tube box).  After it is clean (I would raise it against the light to see closely if there is any solidified mucus stuck in the inner cannula), I would soak the cannula in a glass of boiled water. The nurse told me it should be water at room temperature or warm water but NOT boiling water (because the cannula is made of plastic and may break from the hot temperature). Once every few days or once a week, the cannula can be soaked in saline water (NSS water) in the cup.

4. Usually betweeen 15 to 30 minutes, the cannula can be removed (with a clean gloves) or using a clean pair of forceps) and placed on a strainer of a soap container to air dry. I dry it in the room and not outside to make sure there are no insects, flies or dust that get on it.

 

The ENT nurse told me that when we are storing away the washed inner cannula, it needs to be dry. Because if there are droplets of water that still remained inside the cannula, when we insert back into the trach tube, the droplet of water may go into the throat and causes a cough reflex. I also think that if it is dry, it would prevent bacteria growth.

That is how we can clean and store inner cannula. Hope this would help those who are caring for someone with a trach tube.

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