Looking after your stoma

A stoma is a hole (opening) made in the skin in front of your neck to allow you to breathe. It is at the base of your neck. Through this hole, air enters and leaves your windpipe (trachea) and lungs.

You can see when and how you might have a breathing stoma in our surgery section. 

Your stoma is now your airway. You breathe and cough through it. It is very important that you know how to look after it.

Protecting your stoma

Before your surgery, the air reaching your lungs was warmed, moistened and cleaned as it passed through your nose and upper airways. When you breathe in through your stoma, the air is drier and colder than your lungs are used to. It may also contain particles of dust. All this can irritate your lungs.

The dry air can make your airways produce mucus. The mucus can collect around your stoma and get crusty. To protect your stoma and your airways, try to avoid:

• extreme temperatures

• fumes from traffic or the place where you work

• smoke

• dust

This can be hard to manage if you live in a town or city. But there are other ways to protect your lungs after a tracheostomy or laryngectomy. 

Keeping your airway moist

The air you breathe through the stoma goes directly into your lungs through the laryngectomy or tracheostomy tube. It is no longer moistened as it passes through your mouth and nose.

This means the moisture must be replaced. If it isn't, the mucus your airways naturally produce becomes thick. This can make it difficult for you to breathe.

If your mucus becomes so thick that you can’t cough, this can be very serious. It can potentially block your stoma. It can also make you more likely to get chest infections.

There are things you can do to help to avoid these problems:

• wear a cover over your stoma. There are different types of cover. Your speech and language therapist can show you what is available and what is best for you

• drink plenty of fluids to keep hydrated. This helps keep the mucus in your airways thin. Speak to your nurse or doctor about how much you should be drinking

• your tube will need cleaning, your nurse can show you how and when to do this

• use a filtering and moistening system

• use humidifiers in your home

Filtering and moistening systems

Your stoma needs to be protected with a filter or cover. This helps to keep out dust, pollen, and other objects. This helps to keep your stoma clean, with less crusting. It also reduces the risk of infections.

Filtering and moistening systems are commonly used. Some manufacturers call these systems HMEs. It stands for heat and moisture exchangers. They warm and filter the air as you breathe and are available on prescription.

There are also laryngectomy foams with ties that go around your neck. These are sometimes called stoma bibs. They come in a variety of styles and cover your stoma.

Your speech and language therapist or nurse can tell you about the different types of filtering and moistening systems.

Using a nebuliser

A nebuliser is a machine that makes a mist out of fluid, which you then breathe in using a special mask that fits around your stoma. You doctor might suggest you have a saline (salt water) nebuliser if your mucus is thick. The mist helps to thin down the mucous making it easier to remove.

Humidifiers

A few people may need to use humidifiers at home. You might need one if the air in your home is dry. The humidifier helps to reduce the secretion from crusting. Your speech and language therapist may be able to offer advice on what you can use at home.

Skin care around your stoma

You need to clean your stoma often while it is healing. When you are in hospital, your nurse will help you do this.

The liquid recommended for cleaning stomas and tubes varies between hospitals and specialists. You should follow the instructions given by your nurse or speech and language therapist. 

Your stoma might need cleaning 4 or 5 times a day until it has completely healed. Keeping your stoma clean can help to stop scar tissue from forming. Scar tissue can make the stoma narrower.

When the skin has healed, you can usually use soap and water to clean around the stoma. Be careful not to get soap into the stoma as it might irritate the skin. Your healthcare team will explain how to do this. Remember always to dry your skin thoroughly. 

All the tubes and speech valves need regular cleaning. Your speech valve might come with specially designed brushes or sprays to help you clean it. Because the valve connects your windpipe with your food pipe, food can lodge around it. If you don't remove this, they can block the valve or cause an infection.

Before you leave hospital, your nurse will show you how to look after the valve. They show you how to take out the valve, clean it, and put it back. Your stoma nurse might also help you at home. As your confidence grows, you will manage this yourself.

Cleaning and changing your tube

Many people learn to clean and change their own tubes. You will not be expected to do this until you have practiced with your nurses, and you feel confident. 

How you clean the tubes varies, depending on the type of tube you have. Your nurse shows you how to do it. You might need to clean your tube every day or only once a week. Some people might need to clean their tubes more often. You can practice on the ward, with your nurse watching you and providing support.

To change and clean your tube at home, you might need:

• brushes

• swabs to clean around your stoma

• a mirror so you can see what you are doing

At first, taking out your tube can be worrying. But your stoma will heal so that it's permanently open. Once you are confident, you will find it easier to do.

Suctioning your stoma

While you are recovering from your surgery, your nurse helps you clear out your airways with gentle suction through a soft plastic tube. In time, you should be able to clear your airways yourself, just by coughing.

After surgery to remove the voice box (laryngectomy), you might need to suction your stoma at home, particularly if you have a cold. It’s important that you and someone close to you, preferably someone you live with, learn how to do this. Your nurse can teach you and your family and friends how to do this before you go home.

Coping with a breathing stoma

Getting used to having a permanent breathing stoma can be difficult. It can take time to get used to the changes you need to make. Feeling sad and very low in mood is part of the recovery for many people but there is help available.

Contact your healthcare team or specialist nurse to let them know how you feel. They can help you and explain what support is available in your area.