Cleaning metal tracheostomy tubes

At the end of this chapter, you will be able to:

• demonstrate when to clean your child’s metal tracheostomy tube.
• demonstrate how to clean your child’s metal tracheostomy tube.

Metal tracheostomy tubes

Metal tubes such as stainless steel or silver tracheostomy tubes are not used very often anymore, but some children need them for specific reasons. The ear, nose and throat (ENT) surgeon will decide if your child requires this type of tube.

When do I need to replace my child’s silver tracheostomy tube?

• if they need a different tube, as per your child’s ENT doctor
• if dented
• if broken

Advantages of metal tracheostomy tubes

• They can be reused over several years if the size does not need to be changed.
• Metal tracheostomy tubes can be easily cleaned and sterilized.
• Less infection risk - The surface of a metal tracheostomy is less porous (permeable or absorbent) than a plastic tracheostomy and less likely to grow germs.
• Thin wall - The wall of the tube is thinner compared to the plastic tracheostomy tubes, allowing for greater airflow through the airway.
• The material used for silver cannulas is quite rigid, they do not need to be very thick.

Disadvantages of metal tracheostomy tubes

• Silver tubes do not bend, and because they are quite sharp, they often damage the windpipe and the skin of the neck. Even if the cannulas are adapted perfectly, these injuries cannot always be avoided and may be dangerous.
• Metal tracheostomy tubes can become cold during cold weather. This can cause irritation in the airway and lead to more secretions.
• Patients rarely use silver cannulas in combination with an HME filter because they may not be able to fit generic HME sizes.
• Metal tracheostomy tubes are more expensive so the initial cost of the tube will be higher.
• Metal tracheostomy tubes are custom made so they take a longer time to receive than plastic or silicone tubes.

Before you start cleaning, follow the manufacturer's recommendations for cleaning your child’s metal tracheostomy tube

Gather the following equipment and supplies:

• tracheostomy cleaning brush or pipe cleaners (slightly longer than the tracheostomy tube)
• sterile distilled water
• mild soap
• clean towel
• clean dry empty container with a lid (for clean tracheostomy tubes), labelled with the child's name and date
• clean tracheostomy ties
• metal tracheostomy tube to be cleaned

Cleaning a metal tracheostomy tube

1. Wash your hands.
2. Rinse the metal tracheostomy tube and obturator with a strong stream of cold water. Cold water loosens the secretions and makes them easier to remove.
3. Scrub the metal tracheostomy pieces with a cleaning brush, toothbrush or sponge to remove any tarnish. Some metal tracheostomy tubes are made with a high level of silver metal; brisk scrubbing helps to clean the tube and prevent metal tarnish.
4. Insert a pipe cleaner or tracheostomy brush into the metal tracheostomy tube, firmly rotating it throughout the length of the tracheostomy tube to remove any residue. Confirm that the tube is clean by holding it up to a light source.
5. Repeat step 4 as needed. Discard the pipe cleaner(s)/brush after use. If you use a reusable tracheostomy brush, make sure it is thoroughly rinsed, disinfected and allowed to air dry in a clean area.
6. Inspect the tube. If there are any dents or any signs of damage, discard and replace the tube. Metal tubes dent easily, and dented tubes can compromise your child’s airway.
7. Clean the tube in mild soap and sterile distilled water. Rinse and air dry.
8. Attach the new tracheostomy tube ties.
9. Store the clean tracheostomy tube, cannula and obturator in a container covered with a lid. Make sure all parts are completely dry before sealing the container.