How to Reduce Tracheostomy Secretions

How to Reduce Tracheostomy Secretions

Reducing secretions can be aided by humidification, suction, and coughing. One of the most crucial aspects of tracheostomy management is preventing secretion accumulation.

Individuals who have a tracheostomy frequently develop mucus secretions in the trachea, which is the windpipe.

A natural response to the treatment, secretions may raise the possibility of consequences like infection, respiratory problems, and a clogged tracheostomy tube.

Controlling and minimising secretion accumulation is a crucial aspect of tracheostomy management. Coughing, saline fluid, humidification, and suctioning are all effective techniques.

This article will address the causes of tracheostomy secretions, strategies for reducing secretions, and remedies for persistent coughing.

What is a tracheostomy secretion?

A mucus accumulation in the trachea following a tracheostomy procedure is known as a tracheostomy secretion.

Secretions typically have a thin consistency. The need for more fluids, humidification, or other therapies to break up or loosen the mucus may be indicated by thick discharges.

Secretions usually have a clear or white appearance. Secretions that are yellow, brown, or green could indicate an infection. Blood traces could be an indication of inflammation or edoema.

Each patient has different secretions in terms of thickness and volume.

Mucus discharges in excess might build up in the tracheotomy tube and airway. In the absence of efficient management, this accumulation may raise the possibility of issues like:

• breathing in the secretions, which could be polluted (aspiration)
• difficulty breathing
• blockage of the tracheostomy tube
• infection, such as pneumonia

Why do trach patients have so much mucus?

A natural response to modifications in the airway following a tracheostomy procedure is mucus discharge.

Normally, as air travels through your nose and throat, the upper airway moistens, warms, and purifies it.

Bypassing this process with a tracheostomy tube makes the air you breathe less pure, drier, and colder. The body creates more mucus as a result.

Mucus production can also be attributed to several different circumstances.

This includes:

• airway irritation following surgery
• the tracheostomy tube's existence within the trachea
• the incapacity to cough normally because the larynx is bypassed

As a result, many people have increased secretions in the initial days following surgery.

Additionally, heavier secretions may result from dry indoor air. This may result in tracheostomy tube blockage.

How do you stop or reduce tracheal secretion?

There are several methods to lessen and remove tracheal secretions, such as self-care, suctioning, and humidifiers.

Self-care

You might be able to clear your airway without the need for suction by using the following actions:

• Lean forward and clear your throat. Instead of collecting mucus from the mouth or nose, gather it from the tube.
• To fill the tracheostomy tube, squirt sterile saline solution. Next, try coughing one more.
• Make sure to avoid getting any water in the tube when taking a hot bath or shower.
• Over the tube, place a heated piece of gauze.

Try suctioning if you are having trouble breathing. If breathing becomes difficult after suctioning, contact your local emergency number for immediate medical attention.

Suctioning

Using a suction machine to remove mucus from the tracheostomy tube is known as suctioning.

Clinical practice guidelines state that suctioning is advised if you:

• detect or hear mucus in the airway or tube
• experience difficulty breathing
• feel like you're coughing more
• suspect an obstruction in their airway
• must deflate the cuff or replace the tube.

In the days after the surgery, you could require suctioning more frequently; however, this might lessen with time.

As needed, your healthcare team can suction while you're in the hospital recovering from a tracheostomy. A nurse or other medical expert can demonstrate suctioning at home before you leave the hospital.

It's crucial to remember that regular suctioning can increase the amount of secretions that accumulate. When done correctly, suctioning is usually safe, but problems like pain or infection can happen.

Humidification

Your breathing becomes more hydrated when you are humidified, which can thin and release secretions. Moreover, it can aid in preventing the production of dense, crusty mucus.

There are two types of humidifiers available for tracheostomy patients: passive and active. Active humidifiers get their heat and humidity from an external source.

Options include:

• passover humidifiers
• bubble humidifiers
• counter-flow humidifiers

A person's body temperature and level of hydration are used by passive humidifiers to create humidity. Generally speaking, they are simple-to-use, compact devices.

Options include:

• Artificial noses, or heat moisture exchangers (HMEs),
• stoma filters or bibs

Consuming these gadgets in addition to drinking enough water is crucial.

Inner cannula cleaning or replacement

You might be able to take out and clean the inner tube inside the main outer tube, or you could replace it completely if secretions clog the tracheostomy tube. The inner cannula is the term for the inner tube.

A medical specialist may replace or clean the equipment in a hospital setting. To ensure that the inner cannula is properly replaced or cleaned at home, follow your doctor's recommendations.

Respiratory muscle rehabilitation

The goal of respiratory muscle rehabilitation is to make the diaphragm, abdominal muscles, and rib cage muscles stronger.

Using a pressure threshold or resistive device, breathing exercises are part of the training. According to research, this kind of exercise helps strengthen cough reflexes and enhance swallowing, both of which can lessen secretions from tracheostomies.

Medications that reduce trach secretions

Prescription drugs called mucolytics can aid in the thinning of secretions. These medications may facilitate clearing secretions from the respiratory tract. Additionally, it can keep mucus from clogging the tube.

Mucolytics are often supplied as a liquid that is used in a nebulizer. The drug is available for inhalation as a mist thanks to the machine.

Medications that are mucolytics include:

• N-acetyl cysteine (NAC)
• carbocysteine
• erdosteine
• fudosteine
• dornase alfa
• thymosin beta-4

Other drugs that could be used to treat excessive secretions from the airways include:

• expectorants
• bronchodilators
• nasal decongestants

According to a clinical case report published in 2020, "there is limited high-quality literature assessing the efficacy of mucolytic agents in critically ill patients beyond small studies suggesting some benefit."

The researchers found that only nine smaller studies, involving a total of 379 participants, particularly addressed the topic in their examination of papers published between 1970 and 2014. Overall, they found no advantage, and those trials didn't always reveal negative side effects.

To fully understand how individuals react to specific therapies and what potential advantages or disadvantages there may be from employing mucoactive drugs, more research is required.

Treating excessive coughing with a tracheostomy?

Breathing dry air through the tube during tracheostomy might cause excessive coughing.

Treatments like humidification and hydration can lessen coughing. If possible, try taking a warm bath or shower or using a humidifier.

Drink a lot of water to keep yourself hydrated. Some tracheostomy patients may have difficulty swallowing and require intravenous or subcutaneous hydration.

If your severe coughing doesn't go away, ask your doctor about other possibilities.

Takeaway

There are numerous ways to successfully lower tracheostomy secretions. Saline solution, medicine, humidification, and suctioning are a few examples of this.

Drinking plenty of water, having a warm shower, and coughing when necessary to clear secretions from the tube are easy ways to help minimise secretions.

In the days immediately after a tracheostomy procedure, a lot of people have larger secretions, which progressively decrease with time.

Discuss alternative treatment choices with your doctor if secretions are still a concern.