How to Clean the Tracheostomy (Trach) Site

Cleaning the tracheostomy site daily helps prevent infection and irritated skin.

A tracheostomy (trach) is a small opening through the skin into the windpipe (trachea). This opening is called a stoma. A small plastic tube called a trach tube is placed through the stoma to help your child breathe.

Trach ties are used to secure the trach tube in place. They should be changed every day at the same time you clean the trach site. Trach ties should also be changed anytime they are wet or soiled.

Always use 2 caregivers to clean the trach site. One caregiver will clean the site and change the ties. A second caregiver will hold the trach in place and assist as needed.

Supplies for cleaning the trach site

• 2 caregivers
• Suction kit
• Suction machine
• Towel roll
• 6 cotton swabs (you might need more if the site is heavily soiled)
• Liquid antibacterial soap or baby shampoo
• 3 washcloths
• 2 cups
• Water
• Pre-cut trach ties
• Emergency supplies (Always keep emergency supplies with your child and within reach.)

Prepare to clean the trach site

• Clean your work area with disinfecting wipes.
• Gather supplies.
• Both caregivers should wash hands with soap and water or use an alcohol-based hand sanitizer.
• Pour clean water in one cup.
• Put a few drops of the soap in the bottom of the second cup and add clean water.
• Place 3 cotton swabs in each cup.
• Wet one washcloth with clean water and set aside.
• Wet a second washcloth. Then add some liquid soap. Work the washcloth together in your hands to create suds. Set aside.
• Position your child safely lying down where both caregivers can view and reach the trach and neck area. Place a towel roll under the shoulders to make it easier to see the trach site.
• Before you start cleaning, your child may need suctioning to help prevent coughing. 

Clean around the stoma using cotton swabs

• The primary caregiver will take one soapy cotton swab and place it under a flange close to the trach hub. Wipe outward away from the stoma. Discard swab.
• Repeat the previous step with the second soapy cotton swab under the other flange.
• Use the third soapy cotton swab to clean the top of the flanges. Be sure to wipe away from the stoma. Then discard the swab.
• Repeat the first 3 steps using the clean, wet cotton swabs. This will help remove the remaining soap.

Clean the neck using washcloths

• The secondary caregiver will use a pointer finger and middle finger on the flanges to hold the trach in place.
• The primary caregiver will undo the trach tie on one side and push it under the neck, until it comes out the other side.
• The primary caregiver will use the soapy washcloth to clean the neck area. Start close to the stoma site and wipe away from it.
• The primary caregiver will repeat the previous step with the clean wet cloth. During this step, check the skin. Look for skin irritation or break down. Report skin problems to your child’s doctor when you finish cleaning the site.
• The primary caregiver will use the dry washcloth to gently pat the skin dry. Do not rub the skin with a dry washcloth.

Change the trach ties

• The primary caregiver will take one of the new trach ties and run the Velcro end through the flange hole on the clean side of the neck. Then, secure the Velcro to itself.
• The primary caregiver will remove the dirty trach ties from the other side of the trach.
• The primary caregiver will repeat the previous cleaning steps using soapy, wet, and dry washcloths to clean the other side of the neck. Always wipe away from the stoma.
• Once the neck is dry, the primary caregiver will attach the second new trach tie to the second flange.
• While keeping control of the trach and the child’s head, the secondary caregiver will lift the head and neck. The primary caregiver will secure the two trach ties together in the back.
• The secondary caregiver should not let go of the trach until they make sure the trach ties are not too tight or too loose. One finger should fit between the trach tie and the neck. If the ties are too tight, they can restrict blood flow, causing tissue damage.

After cleaning the trach site and changing ties, you can put a new dressing around the trach if needed.

If you have questions about cleaning the trach site, speak to your child’s care team.