Secretion Management

Humidification is an essential component of tracheostomy care. Humidification can prevent tracheostomy tubes becoming blocked by secretions. This can have serious implications for patients and needs to be managed appropriately. There are a number of ways we can humidify a patient’s tracheostomy.

  • Stoma filters or bibs can be used for individuals with a tracheostomy that are breathing spontaneously and do not require oxygen. These devices contain a layer of foam that absorb moisture from the individual’s expired gases. An example is a ‘Buchannon’ bib which can be used by either an individual with tracheostomy or laryngectomy.

  • A Swedish nose or Heat and moisture exchangers (HME) are also known as artificial noses. HMEs consist of rolls of metal gauze, sponge/fiber or sheet/corrugated paper. An HME works by absorbing exhaled warmth and moisture and then delivers it to the next inhaled breath.

  • For patients that require oxygen via their tracheostomy, this should always be humidified. Oxygen can dry secretions further and should always be given by a humidified system.

  • Saline nebulisers can also be given to help loosen thick secretions from your patient’s tracheostomy.

    You can either give 0.9% saline nebulisers or for more stubborn secretions consider 3% saline nebulisers (hypertonic).

    Please watch the video that explains the benefits of giving a mucolytic (a medicine that makes your mucous less thick) to loosen secretions.

Subglottic suctioning

Some tracheostomy tubes have a subglottic port. These are used to help reduce the secretions that build up above the cuff.   When used as part of a bundle of care, these tubes can help reduce the incidence of ventilator-associated pneumonia. These tubes are recommended as the first tube that is inserted for a ventilator-dependent ICU patient. The subglottic port should be aspirated every few hours; more frequently if necessary. Document the volume and nature of secretions, as this can be useful in assessing whether any intervention is required to help manage upper airway secretions.

Aspirate subglottic secretions using a 10 ml syringe.