Methods to Decrease Aspiration When Using a Trach Tube

A trachestomy is a medical procedure that creates an opening in the windpipe to facilitate breathing. A tracheostomy tube is inserted into the airway through a stoma (an opening cut into the throat), creating an opening for breathing which bypasses nose and mouth. A trach tube can be left in place for days or years, depending on the patient.

Aspiration occurs when the tube causes the patient to breathe mucous and other secretions into the lungs, leading to infection, pneumonia or more serious conditions and death. Several methods can decrease the risk of aspiration when using a trach tube.

Humidification

• The nose and mouth usually perform humidification, warming and moistening breathed air. Because a trach tube bypasses the nose and mouth, humidification needs to be provided by other means. Humidification helps keep secretions thin and can help prevent the formation of a mucous plug, both of which decrease the risk of aspiration. Patients with tracheostomies need an environment with 50% humidity or higher. This can be achieved through the use of basic room humidifiers or by fitting the patient with a heat moisture exchange mask, based on a physician's recommendations for that particular patient's situation.

Suctioning

• Because patients with tracheostomies tend to produce increased amounts of mucous due to the lack of humidification of the air they breathe, they are at risk of developing a mucous plug that can block the trach tube and cause aspiration. Signs that a patient needs to be suctioned include rattling sounds from the trach tube, fast breathing and mucous bubbles at the trach tube opening.

  Because suctioning can expose the patient to infection, it should be performed under controlled, sanitary conditions with clean (ideally sterile) gloves and catheters. The specific suctioning method can very based on each patient's individual situation, but the general steps are consistent in most cases. A suction catheter is attached to a suction machine and inserted into the trach tube at a depth appropriate for the patient. The suction catheter is moved carefully along the inside length of the trach tube until the tube has been cleared of mucous secretions.

Use of A Cuffed Trach Tube

• For patients with medical conditions that make them more likely to be at risk of aspiration, specially-designed trach tubes may be used. Called cuffed tubes, these tubes have a soft balloon, or cuff, around their far end which can be inflated with air or saline solution. Inflating the cuff helps to create a better seal for the tube in the airway, which can help keep patients from breathing in secretions and aspirating. Only a physician can decide when a cuffed tube is needed and how much it should be inflated for each particular patient.