When a tube first appears in their neck, many people say they are afraid to look in the mirror. After breathing only through the nose and mouth all their life, from one day on, air comes and goes through a small hole in the middle of the neck. Yet after a few days, the body adapts first. The breathing sound that felt awkward at first, and the sound of air passing through the tube, at some point just become part of your own breathing. A tracheostomy tube is a passage that sends air straight to the airway without going through the nose and throat. So there is one thing to be clear about: the jobs our nose normally does - warming the air, moistening it, filtering out dust - are now things you have to take care of in its place.
The first of those is humidification. If dry air that has skipped the nose goes straight into the airway, mucus dries and crusts and easily blocks it. That is the most dangerous thing. So many people keep the room humidity moderate and fit an artificial nose (HME filter) at the tube opening to recapture the moisture from their own breath. Drinking a little more water than usual also makes the mucus much thinner. If your mucus keeps turning yellow and sticky, or the rattling sound when you breathe grows louder, that is a signal from your body. Do not force yourself to endure it; start by checking the humidification.
Caring for the skin around the tube becomes a daily routine too. Once or twice a day, with clean hands, gently wipe around where the tube goes in, and change the gauze (dressing) tucked between if it is wet. This is because pooled secretions easily macerate the skin or cause an odor. If, while cleaning, you find a spot that is red and swollen, oozing, or painful to press, do not let it pass; it is best to tell your care team. Tighten the strap that holds the tube so that only one or two fingers fit underneath. Too loose and the tube comes out; too tight and the neck gets chafed. This feel comes to your hands after a few days.
Suctioning out the mucus is something everyone is afraid of at first. You insert a thin tube and suck out the mucus, and honestly, it makes you cough and your eyes water. But once you get the knack, it becomes much easier. Not inserting too deep or too long, not sucking in one long pull but in short breaks, and giving yourself a moment to catch your breath afterward - just keeping to these makes it far more comfortable. Washing your hands thoroughly before and after suctioning goes without saying. Using a new sterile tube each time is the rule, which feels cumbersome at first, but it is the surest way to prevent infection.
The matter of voice cannot be left out either. Depending on the type of tube, you may not be able to speak, or you may make sounds again with an aid such as a speaking valve. When you cannot speak for a while, it is frustrating and even heartbreaking. At such times, agreeing in advance with your family on things like a phone memo app, a whiteboard, or hand gestures makes everyday conversation surprisingly workable. And when bathing, be especially careful not to let water get into the tube. Keep the showerhead below the neck or use a protective cover. Swimming is absolutely out.
The most important thing is that, even though all of this looks like a mountain at first, it does in the end become second nature. Keep a spare tube and a suction device always close by in case of emergency, and practicing once with your family in advance what to do if the tube gets blocked or comes out brings a lot of peace of mind. If you suddenly have trouble breathing, your lips turn blue, or you see blood from the tube, do not hesitate; get emergency help right away. What is written here is general guidance only, so be sure to tailor the specific methods to suit your own tube type and condition together with your care team.