Often patients who have been treated for cancer are discharged from the hospital still requiring some sort of respiratory care. For some patients this is more invasive, involving a tracheostomy, and for others it involves chest physical therapy to promote airway clearance or the use of supplemental oxygen.

Tracheostomy

Patients healing from surgery or who may be undergoing cancer treatment may need a tracheostomy (trach, for short; pronounced trake) to assist with breathing. “This is a surgical opening, also called a stoma, made in the trachea, or windpipe, and in the front of the neck to allow the person to breathe more comfortably,” says Kimberly A. Stump-Sutliff, MSN, RN, AOCNS, associate medical editor with the American Cancer Society in Atlanta.

“This surgery creates a new way for the patient to breathe when the normal passage through the nose and mouth is altered by disease or surgery,” Stump-Sutliff says, such as when cancer is blocking the throat and is too large to be removed completely.Furthermore, if a lot of swelling is expected after the tumor is removed, the doctor may want to do a temporary tracheotomy to allow the patient to breathe more easily until the swelling goes down, she says.

How a Trach Works

It is vital to understand that having a stoma instead of a larynx means that the air breathed in and out will not pass through your nose or mouth. As air passes through your nose or mouth, it is humidified, warmed, and filtered (dust and other particles are removed). With a tracheostomy, the air reaching the lungs will be drier and cooler, says Stump-Sutliff. This may irritate the lining of the breathing tubes and cause thick or crusty mucus to accumulate. Because of this, you need to learn how to take care of the stoma using periodic suctioning, cleaning, and a humidifier. A doctor, nurse, or other health care professional will teach you how to care for and protect their stoma, which includes precautions to keep water or small particles from falling into the windpipe, Stump-Sutliff adds.The tracheostomy tube should be cleaned at least once a day as instructed by your nurse or doctor.

To clear the way of airway secretions, portable suction machines may be used. These machines are small and compact devices that include a suction canister, tubing, and the mechanical unit, which creates the suction. It is important that you keep the tubing sanitary and to lean and empty the suction canister.

Susan Childress, RN, MSN, OCN, director of nursing at Huntsman Cancer Institute at the University of Utah in Salt Lake City, emphasizes that following the directions set by a doctor or nurse is very important. 

Communications may be affected by a tracheostomy. “If unable to speak, be sure to set up alternative methods for communication, such as small white boards with markers, paper and pen, and charts with common words that can be pointed to,” Childress says.

Skill and Knowledge Are Key

It is important that all of the necessary information and directions are explained to both the caregiver and patient so they understand it and grasp the necessary skills before they are discharged from a facility, advises Cristina C. Hendrix, DNS, GNP-BC, FNP, associate professor with Duke University School of Nursing in Durham, North Carolina. “Patients can be comfortably at home with a tracheostomy, provided that the patient and caregiver have the knowledge and skills needed in maintaining the integrity of the tracheostomy, suctioning when needed, and watching for complications,” Hendrix says.  

Hendrix also says that if the tracheostomy is dislodged, you need to go to the emergency room. Other situations that may require a visit to the emergency room are: (1) excessive secretions, fever, or chills that may suggest infection; (2) respiratory difficulty or difficulty in suctioning that may suggest that the tube may be clogged; and (3) excessive redness or bleeding around the tracheostomy site.

According to Hendrix, patients that are ventilator-dependent are generally cared for in a facility where with licensed providers trained to care for the patients’ special needs. “Ventilators are maintained by clinicians with special expertise, such as a respiratory therapist,” Hendrix adds.

Oxygen Therapy

Many patients require supplemental oxygen therapy when they return home. This oxygen is a medical treatment, and must be prescribed by your doctor. It is important for you to get printed instructions with how many liters of oxygen you need; how often it is used (e.g., night or just on exertion, or all the time); how it will be delivered – via mask or nasal cannula; and what company will provide the oxygen, as well as the company’s contact information. Your health care provider will prescribe a setting or flow rate, and may prescribe different settings according to activity, such as during exercise, sleep, and rest. It will be important for you to follow the directions carefully and use the proper settings appropriately so as not to either deprive yourself of oxygen or administer too much.

Furthermore, Childress advises that patients make sure to get the provider’s “on call” phone number for questions or concerns that may arise on weekends, after hours, and holidays. There are safety measures to be aware of when using oxygen, and your doctor will discuss these with you. Most importantly, you should NEVER smoke during oxygen treatment.