It is very important to cover the stoma at all times in order to prevent foreign material (i.e., dirt, dust, smoke, bugs) from getting into the trachea and lungs.
There are various kinds of stoma covers. The most effective ones are called Heat/Moisture Exchangers (HME) because they create a tight seal around the stoma. In addition to filtering dirt, HMEs preserve some of the moisture and heat inside the respiratory tract and prevent the person from losing them. The HME therefore assist in restoring the temperature, moisture and cleanliness of the inhaled air to the condition before the laryngectomy.
The stoma often shrinks during the first weeks or months after it is created. To prevent it from closing completely, a tracheostomy or laryngectomy tube is initially left in the stoma 24 hours a day. A laryngectomy tube is a soft, silicone tube that fits into the stoma. Those with inadequate stoma (too small, too large or deformed) may benefit from surgical repair (stomaplasty).
Stoma care when using a base plate or adhesive housing: The skin around the stoma can become irritated (i.e., red, inflamed) because of repeated gluing and removal of the housing. The materials used to remove the old housing and prepare for the new one can irritate the skin. The removal of the old housing can also irritate the skin especially when it is glued.
An adhesive removal wipe containing liquid (e.g., Remove TM, Smith & Nephew, Inc. Largo Fl 33773) can assist in removing the base plate or housing. It is placed at the edge of the housing and helps the housing detach from the skin when it is lifted off. Wiping the area with Remove TM cleans the site from remnants of seal used to glue the housing. It is important to wipe off the leftover Remove TM with an alcohol wipe so that it will not irritate the skin. When a new housing is use, wiping off the Remove TM prevents it from interfering with placing glue again.
If the area appears red, tender or smells bad, stoma cleaning should be performed more frequently. Contacting one's physician is advisable if a rash, unusual odor, and/or yellowish-green drainage appear around the stoma. This may represent a bacterial infection.
Do and don't in stoma care:
- Keep the stoma clean: Keep the inside of the stoma clean, moist, and glistening. Saline "bullets" can help keeping it moist.
- Use a clean face cloth to clean the stoma.
- Avoid using cotton balls or paper tissues to clean the stoma: These may get sucked into your breathing tube or trachea and cause breathing problems.
- Keep the tracheostomy tube clean; If you wear a tube follow your physicians and nurses direction for its care.
- Cover stoma at all times: Use a heat and moisture exchanger, gauze, cotton, or crocheted covers.
- Do not use cotton or cotton-filled gauze to clean: The fibers may get sucked into your trachea.
- Exercise with moderation: Excessive whenever you can but without too much strain.
- Dress comfortably: Allow for circulation of air, coughing and protection of clothing from coughing and secretions.
- Cover stoma when coughing or sneezing: Use thick paper tissues or handkerchiefs to pick up any coughed mucus.
- Wear identification: Carry medical identification. It is available from the American Cancer Society, Medic Alert and or your physician.
- Have regular medical examinations: Have regular examinations with your primary and ear nose and throat physicians.
- Do not allow water to enter your stoma: Do not swim unless you use a Larchel snorkel, which helps protect your airway. Use care in bathing, shaving. Use a shower shield or a moist towel to cover your stoma.
- Do not inhale smoke, dirt, dust or irritating fumes: Avoid inhaling smoke, dust or irritating fumes and use stoma covers to protect you from inhaling insects or objects.
- The area around the stoma and inside the wall of the trachea should be regularly checked for accumulated mucus and crusts in the morning, before going to sleep, and a throughout the day. A good source of light (i.e., flashlight) and a mirror to view the stoma are essential.
- Gently wash the skin around the opening with a clean face cloth and mild soap and water and wipe it dry. Keeping the stoma and the skin around it clean and free from secretions, can prevent skin irritation.
- It is important to humidify the inhaled air. This prevent stoma crusting, eases breathing, and reduces coughing. Wearing a stoma cover (i.e., HME) helps keep your stoma clean, dust free, and retains moisture.
- If there is mucus in the stoma it can be coughed or suctioned (using suction machine) out. Using saline bullets, saline spray, inhaling water steam (i.e., humidifier), can help in expelling the mucus by making it less viscous.
- The inside of the stoma and the voice prosthesis (TEP) can be cleaned using cotton-tipped swabs and blunt tweezers. This should be done using good lighting and a mirror. Caution is needed to prevent injuring the trachea in the cleaning process.
Skin irritation around the stoma
Protecting the stoma from water when showering
It is important to prevent water from entering the stoma when taking a shower. A small amount of water in the trachea generally does not cause any harm and can be rapidly coughed out. However, inhalation of a large amount of water can be dangerous.
Methods to prevent water from entering the stoma are: