Scientific Foundation for Chronic Tracheostomy Care Outside of the Hospital
Much like many other parts of the home care environment, there are essentially no controlled studies or significant peer-reviewed research papers to guide the care of tracheostomy patients in the home. As a result, many of the home tracheostomy care standards are based on some form of extrapolation of the tracheostomy care performed in local hospitals. Other factors might include local physician prescribing standards, anecdotal clinical data, and, of course, insurance payment rules.

In the area of pediatrics, the consensus statement prepared by the American Thoracic Society (ATS) entitled "Care of the Child with a Chronic Tracheostomy" is a very complete set of recommendations derived from a review of the available and relevant published data, along with the consensus of a panel of experts.¹ 

A more specific and procedure-focused consensus guideline is the American Association for Respiratory Care (AARC) Clinical Practice Guideline (CPG) governing suctioning of the patient in the home.2 The current AARC-CPG, although well referenced, is specific to suctioning only and provides little additional guidance regarding the overall and long-term management of tracheostomy patients in the home.

The April 2006 issue of Respiratory Care includes a comprehensive series of New Horizon Symposium papers on tracheostomy care.3 One of these is a review of literature and practice surrounding long-term care of the tracheostomy patient in the home or alternate site.4 

Components of Tracheostomy Care in the Home
As technology-dependent patients transition from the comfort and protection of the controlled institutional setting to the home, there are a number of important factors that must be evaluated and controlled. Even with the recent growth and improvement of home medical and respiratory technologies, creating a subacute or intensive care-like environment in the home can be difficult. The home is not piped with an unlimited supply of high-flow oxygen, suction is not available on the wall next to the bed, and experienced clinicians are not often immediately accessible. In many cases, the home medical equipment (HME) provider has to work hard to piece together various devices to create an environment appropriate for the safe and effective management of a patient with a tracheostomy in the home. These include oxygen devices, high-pressure/flow air compressors, AC and DC powered suction machines, heated humidification devices, tracheostomy tubes, suction catheters, tracheostomy care supplies, gloves, etc. The list can become quite comprehensive and somewhat expensive. To help narrow the focus, the following is a list of the key elements of any home tracheostomy management program:

Patient and Caregiver Training
Training should begin as early as possible to allow the patient and caregiver adequate time to understand the information and practice techniques with the equipment. The more complex the case, the earlier the training should begin. The details of appropriate patient training extend well beyond the scope of this article but at a minimum should include basic airway anatomy, medical justification for the tracheostomy, tube description and operation, signs and symptoms of respiratory and upper airway distress, signs and symptoms of aspiration, suctioning technique, tracheostomy tube cleaning and maintenance, stoma site assessment and cleaning, cardiopulmonary resuscitation, emergency decannulation and reinsertion procedures, tube change procedure, equipment and supply use and ordering procedures, and a scheduled follow-up plan with the attending physician. Suction Catheters, Single Catheter, Medi-Vac Yankauer Suction Handles, Retractor Style Yankauer, Kendall,  Suction Cath Kit