How To Clean A Tracheostomy Tube And Stoma?

Cleaning a tracheostomy tube and stoma is a daily routine that keeps the airway open and lowers the risk of infection. You clean the stoma and the skin around it at least once a day, and more often if there is mucus buildup or irritation. The inner cannula, if your tube has one, is usually removed and cleaned several times a day, while the outer tube is changed on a schedule your care team sets. Always wash your hands first and use the supplies and method your doctor or respiratory therapist taught you.

How To Clean A Tracheostomy Tube And Stoma

There are two separate jobs here, and people often blur them together. One is cleaning the stoma and the skin around it. The other is cleaning the tube itself. They use different steps and different timing.

For the stoma and surrounding skin:

• Wash your hands with soap and water, or use an alcohol-based hand rub, before and after care.
• Put on clean medical gloves if you have them.
• Remove the old dressing and any soiled gauze.
• Clean the skin around the stoma gently with a mild soap and water or the solution your care team recommended. Some clinicians use a diluted hydrogen peroxide mix, but this is not right for everyone, so follow your own instructions.
• Clean in a circular motion, moving outward from the stoma. This helps move debris away from the opening rather than toward it.
• Rinse gently and pat the skin dry. Moisture under a dressing can irritate skin and encourage germs.
• Check the skin for redness, swelling, drainage, or a bad smell. Report changes to your care team.
• Place a clean split gauze dressing under the tube flanges, unless your team told you to leave the stoma open to air.
• Secure the tube ties so the tube stays in place but is not tight against the neck. You should be able to fit about one finger under the ties.

The inner cannula is a removable liner inside some tracheostomy tubes. It collects mucus so the main tube stays clear. Many people clean or replace it several times a day, often every few hours, depending on how much mucus they produce. A blocked inner cannula can make breathing hard, so it is never left dirty for long.

Clean the inner cannula by removing it, soaking and rinsing it as your care team instructed, letting it dry, and putting it back or swapping in a clean one. Some cannulas are disposable and are simply replaced.

The outer tube is not cleaned in place the way the inner cannula is. It is changed on a schedule — often weekly for some tubes, or longer for others — and the change is usually done by a trained clinician or a caregiver who has been taught the procedure. A tube that comes out can close off the airway within minutes, so this is not a step to improvise.

What Supplies Do You Need?

Gather everything before you start. Stopping mid-clean to search for gauze is when mistakes happen.

• Clean gloves
• Mild soap and water or the cleaning solution your team specified
• Cotton swabs or soft gauze
• Split gauze dressings
• Tracheostomy ties or a holder
• Suction equipment if you use it
• A mirror, if you are doing this yourself
• A clean towel or pad to work over

Keep a spare tube, ties, and emergency supplies within reach at all times. A spare tube of the same size and type is standard practice.

How Often Should You Clean Your Tracheostomy?

Stoma care happens at least once a day. Many people do it twice, morning and evening, and again any time the dressing gets wet or soiled.

Inner cannula care is more frequent. Some people clean it every four hours, others less often, depending on mucus volume and the type of tube. Your care team will tell you what fits your situation.

Outer tube changes follow a set schedule. The timing depends on the tube material and your needs. Silicone tubes may be changed less often than some other types. Do not change the schedule on your own.

If you have a new tracheostomy, you may need more frequent care in the first weeks while the stoma heals and you get used to the routine.

How Do You Prevent Infection Around a Tracheostomy?

Hand hygiene is the single most effective step. Most infections around a stoma come from germs on hands, not from the tube itself.

Other steps that help:

• Keep the skin dry. Trapped moisture breaks down skin and gives bacteria a place to grow.
• Change soiled dressings promptly.
• Use clean or sterile supplies as your team directs.
• Suction only when needed — frequent, unnecessary suctioning irritates the airway.
• Keep the area free of powders, creams, and lotions unless your team approved them.
• Avoid pools, hot tubs, and standing water, which can carry bacteria.

Signs of infection to watch for include increasing redness, swelling, warmth, yellow or green drainage, a foul smell, fever, or new pain. These need medical attention, not just more cleaning.

What Are the Risks of Poor Tracheostomy Care?

A blocked tube is the most urgent risk. Mucus can harden inside a tube that is not cleaned, and a plugged airway is a medical emergency.

Skin breakdown is common when the stoma stays wet or the ties rub. Over time this can lead to a wound that is harder to manage.

Infection can spread from the skin into deeper tissue. In severe cases it can affect the airway or the bloodstream.

Granulation tissue — extra tissue that grows around the stoma — can form with ongoing irritation. It may bleed or make the tube fit poorly.

These problems are largely manageable when the routine is followed. They become serious when care is skipped or done inconsistently.

When Should You Call Your Care Team?

Call right away if you have trouble breathing, if the tube seems blocked, if the tube comes out, or if you cannot pass a suction catheter. These are emergencies.

Also call if you see:

• Heavy bleeding from the stoma
• Green, yellow, or foul-smelling drainage
• Fever
• New or worsening pain
• Redness or swelling that is spreading
• A change in the amount or thickness of mucus

Do not wait to see if things improve on their own. Early treatment is easier than a late complication.

Can You Clean a Tracheostomy in the Shower?

Some people are told they can shower with a tracheostomy, using a shower shield or by keeping the stoma covered. Others are told to avoid getting water directly into the stoma.

Guidance varies because it depends on your tube, your stoma, and how healed the site is. Ask your care team what is safe for you before you try it. Water that enters the airway can cause coughing, and in some cases infection.

What Makes Tracheostomy Care Different at Home?

In a hospital, staff handle the routine. At home, you or a family member does. That shift is where most problems start.

Two things matter most. First, know your own tube — the type, the size, and whether it has an inner cannula. Second, keep supplies stocked and within reach. Running out of clean gauze at 2 a.m. is a real problem.

Training matters too. A caregiver who has been taught the steps by a clinician is far less likely to make errors than someone following a video. If you have not had hands-on training, ask for it.