Cleaning a tracheostomy tube involves removing the inner cannula, soaking and scrubbing it to clear mucus buildup, caring for the skin around the stoma, and replacing the ties that hold the tube in place. The entire process should be done at least once a day, though your care team may recommend more frequent cleaning depending on how much mucus you produce.
Gather Your Supplies First
Having everything within arm’s reach before you start makes the process safer and faster. You’ll need:
- Tracheostomy care kit (includes pipe cleaners or a small brush and sterile gloves)
- Hydrogen peroxide (for reusable cannulas, unless your care team says otherwise)
- Distilled or plain water for rinsing
- Cotton-tipped swabs for cleaning the skin around the stoma
- Pre-cut trach gauze (split gauze designed to fit around the tube)
- Clean trach ties or a Velcro holder
- Water-based lubricant
- Non-sterile procedure gloves
Some of these items, including hydrogen peroxide, cotton swabs, and lubricant, may not be covered by insurance, so keep extras stocked at home.
Suction Before You Start
Before touching the tube for cleaning, check whether suctioning is needed. Signs include a moist cough, visible mucus or bubbles at the trach opening, rattling sounds, whistling from the tube, fast breathing, or a bluish color around the mouth. Even without obvious signs, routine suctioning twice a day (morning and evening) is standard practice. Suctioning first clears the airway so you can clean safely without mucus interfering.
Disposable vs. Reusable Inner Cannulas
Before you begin cleaning, check which type of inner cannula you have, because the process is completely different for each.
Disposable inner cannulas are not meant to be cleaned. You stabilize the outer neck plate with one hand, unsnap and remove the soiled cannula, throw it away, and snap a new sterile one into place. Replace it whenever secretions build up. Never wash a disposable cannula for reuse.
Reusable inner cannulas (common brands include Bivona and Portex) need to be scrubbed, rinsed, and reinserted. The steps below apply to reusable cannulas.
How to Clean a Reusable Inner Cannula
Hold the outer neck plate steady with one hand. With your other hand, unlock and gently slide out the inner cannula. If it won’t come out easily, don’t force it. Some care teams recommend inserting a spare clean cannula right away so you can breathe comfortably while you clean the dirty one.
Place the removed cannula in a small tray or basin. Gently wash the inside and outside using a pipe cleaner or soft-bristled brush with mild detergent and distilled water. Be careful not to scrub too hard, scrape, or stretch the tube, as this can damage the material. Rinse thoroughly with distilled water and set it in a clean tray to dry. Clean the obturator (the piece used during tube changes) the same way.
One important note on cleaning solutions: Bivona and Portex tubes should not be cleaned with vinegar or hydrogen peroxide, as these can degrade the material. Other reusable tubes may use a hydrogen peroxide solution. Always follow the specific instructions your care team provided for your tube brand.
Cleaning the Skin Around the Stoma
While the inner cannula is out (or your spare is in place), clean the skin around the stoma opening. Dip cotton-tipped swabs in saline or distilled water and gently wipe in a circular motion around the stoma site, removing any crusted secretions or mucus. Use each swab only once, then discard it.
As you clean, look closely at the skin. Healthy stoma skin should look similar to the surrounding area. Watch for redness that’s spreading, swelling, warmth, unusual tenderness, or any discharge that’s thick, discolored, or foul-smelling. Some degree of local irritation is common with tracheostomies, but worsening redness, green or yellow secretions, or a bad odor can signal infection. Bloody secretions, persistent cough, or discomfort behind the breastbone are also worth reporting to your care team promptly.
Pat the skin dry with clean gauze before placing a fresh pre-cut trach gauze dressing around the tube. Never cut standard gauze to fit, as loose fibers can enter the airway.
Replacing Trach Ties Safely
Dirty or damp ties should be replaced during your daily cleaning routine. This is the step where the tube is most at risk of accidentally coming out, so having a second person help is strongly recommended. One person holds the tracheostomy tube firmly against the neck while the other removes the old ties and threads new ones through the openings on the neck plate.
If you’re alone, put the clean ties on first before removing the old ones. This way the tube is always secured. Whether you use fabric ties or a Velcro holder, adjust the fit so one finger slides comfortably between the strap and your neck. Too loose and the tube can shift or fall out; too tight and it will dig into your skin.
How Often to Clean
At minimum, clean the inner cannula and the stoma site once a day. Many people need to do it more often, especially in the early weeks after the tracheostomy is placed or during respiratory infections when mucus production increases. If you notice secretions building up inside the cannula between scheduled cleanings, clean it (or swap in a fresh disposable cannula) right away rather than waiting. A clogged inner cannula restricts airflow and makes breathing harder than it needs to be.
Reusable cannulas that have been cleaned should be stored in a clean, dry container until their next use. Keep at least one spare cannula ready at all times so you’re never without a clean one.