Post decannulation

This information is aimed at those who have had a tracheostomy tube removed (it may also be useful for those caring for someone who has had a tracheostomy tube removed). Although the information has been collected and agreed by many specialists it is in addition to, and not a replacement for specialist advice received from the St Georges Hospital team.

We have chosen to provide this information because recovery following tracheostomy frequently continues after patients leave hospital. This information should offer you practical help and advice on how to help recovery and who to contact if you have any concerns.

Why is this information important?

Patients who have tracheostomies frequently experience changes in their lifestyle (such as: swallowing; eating; drinking; talking; and coughing). Some of these changes may continue after the tracheostomy tube is removed – although frequently do get better.

Additionally, many patients who have had tracheostomy tubes will not yet have fully recovered from the illness or operation which caused them to need a tracheostomy tube. Therefore, knowing what to expect will help patients understand when they need to approach the hospital for a review of their condition.

What do patients need to be aware of?

Most importantly, if a patient develop noisy (often squeaky sounding) breathing at any time following tracheostomy tube removal they should call for help immediately (a nurse if they are in hospital or GP if they are at home). If the patient is feeling breathless, uncomfortable or panicky at the same time, they must dial 999 and ask for an ambulance.

What else do patients need to be aware of?

The following information is designed to help speed up recovery and let patients know when to contact the hospital:

1. Healing of the tracheostomy wound: when the tracheostomy tube is removed the wound left should heal over within 1-2 weeks. Specific information will be given regarding this by the Hospital team but is it also important that:
2. • The dressing covering it is changed if it becomes wet, or begins to leak or lift away from the skin;
   • The patient provides support for the wound by placing a finger on top of the dressing when talking or coughing;
   • Patients advise their nurse (in hospital) or GP (when home) if:
   • • They are having to change dressings more often than before
     • If fluid on the dressing becomes more of a problem or changes colour (to green or red)
     • If the wound has not healed over or stopped leaking after two weeks following tracheostomy tube removal
     • If the scar which forms once the wound has healed is raised or very noticeable
3. Pain or discomfort: Patients occasionally experience pain or discomfort in the area where the tracheostomy tube was, especially when speaking, swallowing or coughing. Occasionally some discomfort may be experienced when the head is moved (up or down or from left to right). Before a patient leaves hospital, they should receive advice on this matter (and this may include what medications should be taken to reduce any pain or discomfort). The following information may be of benefit:
4. • Continue taking any pain killers which have been given until such a time as they are no longer needed (i.e. have little or no pain, or until a doctor, pharmacist or nurse advises not to take them);
   • Unless advised by a doctor, pharmacist or nurse, do not suddenly stop taking pain killers. Aim to reduce the amount taken over a few days before finally stopping
   • If new pains develop in the neck (particularly when swallowing), contact the hospital
   • Talking: Speech will be assessed prior to leaving hospital and patients may have received advice form the hospital’s Speech And Language Therapy Team (SALT). If the voice has altered this should be discussed with the hospital team before they go home. Additionally, be aware:
   • That changes in the voice are common during the first few weeks following tracheostomy tube removal. If this change is likely to be permanent, patients should be advised of this before they go home
   • If the voice changes (e.g. hoarseness, weakness, or whispering quality), patients should contact the hospital
5. Eating and drinking: It is important that patients are capable of taking sufficient food and fluids when they return home. If this is likely to be a problem, they should discuss this with the nurse whilst in hospital. Patients may also be seen by the SALT team and/or a dietician for advice which should be followed for as long as they recommend. The hospital should be contacted if the patient experiences changes in their ability to eat or drink, specifically:
6. • Difficulty swallowing
   • Vomiting shortly after eating/drinking
   • Coughing or difficulty breathing during or shortly after eating or drinking

Contacting St George’s University Hospitals NHS Foundation Trust

Patients should call for an ambulance (dial 999) if:

• Their breathing becomes difficult or noisy whilst at rest

Patients should contact the hospital if they have:

• Difficulty swallowing
• Vomiting shortly after eating/drinking
• Coughing or difficulty breathing during or shortly after eating or drinking
• Noisy breathing during the day or night (this includes snoring in those patients who didn’t snore before they had a tracheostomy tube) – this may often be noticed by family or friends
• A tracheostomy scar which is raised or uncomfortable one month or more after the tube has been removed
• New pain or discomfort (particularly when swallowing)
• A hoarse, weak, or whispering quality to your voice of more than one weeks duration