Stoma site cares are done between sponge removal and replacement. The stoma is a wound that should be cared for with gentle cleaning. Observation of the skin at the stoma site and record your findings in the electronic medical record.
To clean the stoma it is advised to use cotton tipped applicators dipped in sterile water. Gently dab away any retained or dried sputum and clean around the stoma. A dry cotton tipped applicator may be used to dry the stoma area after cleaning.
Skin breakdown around the stoma is a risk in the long term placement of a tracheostomy tube. Attention should also be given to the skin under the tracheostomy tube securing device. Inspection of these areas should occur at least daily and soiled or damp dressings and securing devices should be replaced.
Note the appearance of the skin around the stoma and record the description. This information is important to avoid the start of any skin breakdown.
By the time a patient arrives to a long-term care facility the stoma has typically had enough time to develop a mature tract. (usually about one week) It is important to note that the stoma will not close immediately if the tracheostomy tube should be removed for routine tracheostomy changes or accidental decannulation.
Once the tracheostomy tube has been removed it will literally take a few days for the stoma to fully close. In the first days of decannulation the patient may forget that air is escaping from the trachea at the stoma site. Patients may cover the stoma with a finger to occlude airflow out of the stoma to allow for speech.
Routine cleaning of the stoma site is important to keep pathogens away from entering the body via the stoma. Dry gauze and bio-occlusive tape is used to create a seal. The surrounding skin may need preparation with skin protection.
Nearly all tracheostomy tube patients develop granulation tissue but only 3 – 12% require intervention to resolve significant narrowing. Nonetheless any granulation tissue that impairs stoma closure should have a consult by wound and ostomy specialists.