Caring for your tracheostomy stoma after decannulation

Who is this leaflet for?

This leaflet contains information about what happens with the stoma (hole) where your tracheostomy tube was removed (decannulation). It will help you and your family to understand the normal healing process and to be aware of things that could delay healing.

What is a tracheostomy stoma?

When a person requires a tracheostomy tube to be inserted, a stoma is made in their neck through to the trachea (windpipe). Once the tracheostomy tube has been removed the stoma remains. During the healing process of the stoma, you may experience secretions and air escaping when you cough or talk. This is normal. A dressing will be placed over the stoma to stop anything from going into the stoma.

The healing process

• We expect the stoma to close within 7 to 14 days, however for some patients this may take longer.
• The stoma will naturally heal from the inside of the body (windpipe) to the outside. This means the part you can see on your neck will heal last.
• As healing takes place you should notice less air and secretions coming out of the stoma.
• To protect the stoma during the healing process from infection or foreign bodies, we recommend regular dressing changes.
• To help the healing process, when the patient coughs or talks, we recommend placing a hand over the dressing where the stoma is. This prevents the dressing from expanding and pulling away from the skin.

Who will look after the stoma?

Whilst you are in hospital, the nursing team will monitor your stoma and carry out all dressing changes. Sometimes the tracheostomy nursing service will review you if necessary. If you go home whilst the stoma is still healing, the community nurses can continue to monitor, until the stoma is fully healed and closed. This will be arranged by your ward nurses prior to discharge.

The nurses will clean the stoma using sterile packs to prevent infection. A dressing will then be placed to cover the stoma and protect it.

There are many dressings that can be used and if you are allergic to any specific types of dressings it is important to mention. The dressing will need to be changed daily and more frequently if it becomes wet or loose.

Alternatively, you or your family may wish to take care of your stoma. If this is the case, your nursing team will teach you how to do this before going home.

How will I know that my stoma is fully healed?

Your nurses and doctors will be able to guide you as to when the stoma is fully healed. A good indication is when you can no longer see a visible hole or secretions and you cannot feel air escaping.

Are there any possible complications?

Sometimes there can be complications with the stoma healing; these can include the following:

• infection
• overgranulation tissue
• delayed healing

What is over granulation tissue?

Overgranulation tissue is when the body tries to heal itself too much. This can cause varying sizes of extra tissue to be grown around the stoma. This can look like small bobble like growths. This does happen sometimes and is nothing to be alarmed by.

Overgranulation tissue can be identified and treated easily by the tracheostomy nurses, community nurses or GP. If you think there is some overgranulation tissue around your stoma raise this with your healthcare team.

What happens if the stoma does not fully close?

It is rare that we see patients where their tracheostomy stoma does not close completely. If this does happen, your hospital doctor, tracheostomy nurse or GP will refer you to the ENT doctors. They will be able to review your stoma and provide advice about closing it.

What will the stoma look like once it has closed?

Most people will be left with a small scar on their neck that will usually fade over time. Every person who has needed a tracheostomy and had it removed will have a different scar. If you are unhappy with your scar, you might like to discuss this with your GP, in the first instance. They may refer you to a specialist for a surgical opinion. Alternatively you may wish to use other remedies such as massage oil or unscented creams when the stoma is fully healed.

Is there anything else I should consider?

Until the stoma is fully closed, while it is healing it is important to bear in mind that your windpipe is still open.

Avoid swimming or submerging into a bath/water until the tract is fully closed. If water enters the stoma there is a very high risk it will go into the trachea (windpipe) and could then go into your lungs which could lead to a chest infection.

• avoid placing foreign objects into the stoma
• use a water shield for extra protection in the shower
• avoid spraying aerosols or perfume near the stoma
• ensure the stoma is covered whilst shaving or having haircuts
• keep the stoma covered when pets are around

To cover the stoma you can use specialist bibs which can easily be obtained from the Addenbrooke’s tracheostomy nursing service or wards that care for patients with a tracheostomy. Alternatively, scarves and neckties can be used to provide some protection.

Raising concerns

You should seek urgent medical assistance by calling 999 if you experience any of the following:

• Difficulty in breathing
• Noisy breathing
• Substantial bleeding from stoma / mouth

Who can I contact for further information?

The tracheostomy nursing service, your hospital doctor, GP (including out-of-hours GP) or nurses can provide further information or answer any questions you may have.

Tracheostomy nursing service - Addenbrookes Hospital

Tel: 01223 348679

(Monday – Friday 08:00 – 17:00), non-urgent queries.