A stoma is an opening that connects a
portion of the body cavity to the outside environment. A stoma is
created after a laryngectomy to generate a new opening for the trachea in the neck, thus connecting the lungs to the outside. Caring for the stoma to insure its patency and health is crucial.
General care
It is very important to cover the stoma at all times in order to prevent dirt, dust, smoke,
bugs, etc., 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. Over times this duration is gradually reduced. It is often left overnight until there is no more shrinking.
Stoma care when using a base plate or adhesive housing: The skin around the stoma can become irritated 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.
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:
Provox (Atos Medical) ShowerAid
InHealth Stoma Shower Devices
Preventing aspiration into the stoma
One of the major causes of respiratory emergency in a neck breather is the aspiration of tissue or paper towels into the trachea. This can be very dangerous and cause asphyxiation. It usually happens after covering the stoma with a paper towel when coughing out sputum. Following the cough there is a very deep inspiration of air that can suck the paper back into the lungs. The way to prevent this is to use a cloth towel or a strong paper towel that does not break easily, even when moist. Thin tissues should be avoided.
Another way to prevent aspiration of paper tissues is to hold one's breath until one has completely finished wiping off the sputum and removed the paper tissue or paper towel from the stoma area.
Aspiration of other foreign material should also be prevented by covering the stoma at all times by an HME, foam cover, or stoma cover.
Aspiration of water into the stoma while taking a shower can be prevented by wearing a device that covers the stoma (see above). One can keep the HME on while showering and/or avoid breathing in when water is directed at the stoma’s site.
Taking a bath in a tub can be done safely as long as the water level does not reach the stoma. The areas above the stoma should be washed with a soapy washcloth. It is important to prevent soapy water from entering the stoma.
General care
It is very important to cover the stoma at all times in order to prevent dirt, dust, smoke,
bugs, etc., 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. Over times this duration is gradually reduced. It is often left overnight until there is no more shrinking.
Stoma care when using a base plate or adhesive housing: The skin around the stoma can become irritated 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.
It is generally not recommended to leave the housing on for
more than 48 hours. Some individuals, however, keep the housing much longer,
and replace it when it becomes loose or dirty. In some people the removal of
the adhesive is more irritating than the adhesives. In the event the skin is
irritated, it is better to leave the housing on only for 24 hours. If the skin
is irritated, it may be advisable to give the skin a rest for a day or until
the area heals and cover the stoma only with a rigid base without any glue or
with a foam cover. There are special hydrocolloid adhesives that allow use on
sensitive skin.
It is important to use liquid film-forming skin protecting dressing (i.e. Skin PrepTM Smith & Nephew, Inc. Largo Fl 33773) before placing the glue.
Stoma care when using tracheostomy tube: The buildup of mucus and the rubbing of the tracheostomy tube can irritate the skin around the stoma. The skin around the stoma should be cleaned at least twice a day to prevent odor, irritation and infection. Using
a hydrocolloid adhesive is often a good solution for patients with sensitive
skin. 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.
Stoma
Skin irritation around the stoma
If the skin around the stoma becomes irritated and red, it is best to leave it uncovered and not expose it to any solvents for 1-2 days so that it can heal. Sometimes individuals can develop an irritation to some of the solvents used to prepare and glue an HME base plate (housing). Avoiding these solvents and finding others that do not cause irritation is helpful.
If signs of infection such as open ulcers and redness, are evident topical antibiotics can be useful, Seeking advice from one’s physician is helpful especially if the lesion does not heal. The physician can obtain a bacterial culture of the affected area that can guide the choice of antimicrobial therapy.
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:
- Covering the stoma with the palm and not inhaling air when water is directed at the vicinity of the stoma.
- Wearing a bib with the plastic side out.
- Using a commercial device that covers the stoma.
InHealth Stoma Shower Devices
- Wearing one's stoma cover, he base plate or HME housing while showering may be sufficient especially if water flow is directed away from the stoma. Pausing air inhalation for a few seconds while washing the area close to the stoma is also helpful. Taking a shower at the end of the day just before removing the HME and its housing is a way to use the housing for water protection. This simple method can make taking a shower easier.
- When washing the hair lowering the chin below the stoma by bending over.
Water and pneumonia
Laryngectomees are at risk of inhaling (aspirating) water that may not be free of bacteria. Tap water contains bacteria; the number of bacteria varies, depending on the cleaning efficacy of the water treatment facilities and their source (e.g., well, lake river etc.). Pool water contains chloride that reduces, but never sterilize the water. Sea water contains numerous bacteria; their nature and concentrations varies.
When unclean water gets into the lungs it can sometimes cause pneumonia. Developing aspiration pneumonia depends on how much water is inhaled and how much is coughed out , as well as on the individuals' immune system.
When unclean water gets into the lungs it can sometimes cause pneumonia. Developing aspiration pneumonia depends on how much water is inhaled and how much is coughed out , as well as on the individuals' immune system.
Radiography of aspiration pneumonia
Preventing aspiration into the stoma
One of the major causes of respiratory emergency in a neck breather is the aspiration of tissue or paper towels into the trachea. This can be very dangerous and cause asphyxiation. It usually happens after covering the stoma with a paper towel when coughing out sputum. Following the cough there is a very deep inspiration of air that can suck the paper back into the lungs. The way to prevent this is to use a cloth towel or a strong paper towel that does not break easily, even when moist. Thin tissues should be avoided.
Another way to prevent aspiration of paper tissues is to hold one's breath until one has completely finished wiping off the sputum and removed the paper tissue or paper towel from the stoma area.
Aspiration of other foreign material should also be prevented by covering the stoma at all times by an HME, foam cover, or stoma cover.
Aspiration of water into the stoma while taking a shower can be prevented by wearing a device that covers the stoma (see above). One can keep the HME on while showering and/or avoid breathing in when water is directed at the stoma’s site.
Taking a bath in a tub can be done safely as long as the water level does not reach the stoma. The areas above the stoma should be washed with a soapy washcloth. It is important to prevent soapy water from entering the stoma.
