Tracheostomy Care: Stoma Care :: Nationwide Children's Hospital

Helping Hand Logo

 

Tracheostomy Care: Stoma Care

A stoma is the opening in your child’s neck. The trach tube goes into the trachea at this opening. It is important to keep the area around the stoma clean and dry. Mucus can dry and form a crust around the trach tube. If left for even a short time, it will have a foul smell. Also, if the stoma is infected, germs can get into the lungs and cause a lung infection. It is important to clean the stoma at least 2 times a day.
 

Cleaning the Stoma

Image of cleaning stoma

Picture 1: Clean from the edge if the stoma
outward. Place the swab at the numbers as
on the clock.

Image of cleaning outside of stoma

Picture 2: Clean from the edge if the stoma
outward. Place the swab at the numbers as
on the clock.

  1. Gather all the items you will need:
    1. Several cotton-tipped swabs, such as Q-tips®,
    2. Half-strength hydrogen peroxide (mix 1 tablespoon of hydrogen peroxide and 1 tablespoon water),
    3. Two small, clean containers
  2. Wash your hands with soap and water. Rinse and dry with a clean towel
  3. Dip a Q-tip into the half-strength hydrogen peroxide liquid.
  4. Gently wash the skin around the stoma with the swab. Start at the inner part of the stoma and work outward. Place a swab near the stoma and roll it away from the stoma about an inch (Picture 1). Throw away the used swab. Using a clean swab, move around the stoma where the 2, 4, 6, 8, 10 and 12 are on the face of a clock.
  5. Use clean swabs and rinse the stoma with plain water. Rinse in the same pattern, rolling away from the opening. Pat the skin dry with tissue or a soft cloth.
  6. Clean the outside of the trach tube and the trach flanges with swabs and the half-strength hydrogen peroxide (Picture 2). Be sure to clean both the outside and under the flanges.
  7. Do not use powder or ointment near the trach stoma so they do not get into the lungs. If medicine such as Nystatin powder is ordered, apply it around the stoma using the cotton swabs. Do not shake the powder near the stoma. To apply Nystatin to the trach tie:
    1. Hold the trach tie away from the stoma.
    2. Put the powder on the trach tie.
    3. Fasten the trach tie on your child.
  8. Store hydrogen peroxide in a cupboard away from light and out of the reach of children.
  9. Once your child’s stoma has healed, use mild soap and water to clean your child’s neck and stoma. You will only need to use the hydrogen peroxide to remove thick or crusty mucus. Discuss this with your child’s doctor or nurse practitioner.
  10. Check your child’s skin under the trach tie at least two times a day. Be sure it is clean and free of any crusty mucus or irritation. If there is a rash or any skin problem, call your child’s doctor or the ENT department for a follow-up trach care appointment.

 

 
 
 
 
HH-II-199 5/12, Reviewed 4/15 Copyright 2012, Nationwide Children's Hospital
Nationwide Children's Hospital
700 Children's Drive Columbus, Ohio 43205 614.722.2000