laryngectomee Stoma Care
- Stoma Care - Basics
- Stoma Care - Do's & Don'ts
- Stoma Care - Equipment
- HME (Heat/Moisture Exchange)
- Stoma Covers and Patterns
- After Care - Mucus Problems
stoma care - equipment
YOU NEED TO SEE WHAT YOU ARE DOING
A wall mirror over a sink with a flashlight just doesn't work. One of the most essential things to have is a lighted 3X magnifying mirror. This is necessary to do a thorough cleaning job of the stoma and prosthesis.
A WELL LIT MIRROR
Since all of us with stomas spend considerable time caring for and cleaning them, a well-lit magnifying mirror makes a difference. A makeup mirror with lights on the sides helps. So will a small lamp that aims a spot of bright light. Look in the catalogs with laryngectomee supplies.
Lighted mirrors are available or you can use a small hand held flashlight. Hand held flashlights allow greater control of the light so you get the light directed into the deeper area of the stoma. LED light works well because they produce a bright light and little battery power.
Lamp and Mirror
Tom Warborg made this lamp for his wife Carol, for her stoma care.
The lamp is from Seattle Lighting, it is called LED's by Zeppelin, Product No 422465, and costs about $55.
The mirror is Coghlan's Featherweight from REI, costs $3.25.
The rubber washer and spacer are from the local hardware store. Cheap.
The beauty of the thing is it gives a very bright light, which can be shined right at the stoma, while the mirror above reflects the illuminated stoma, not the viewer, and mostly the hands and instruments are not in the way. Better than anything we have tried.
STOMA CARE - PERSONAL EQUIPMENT
A GOOD PAIR OF TWEEZERS
Following a laryngectomy, you will quickly pick up another little task to add to your morning routine of whisker removal, hair brushing, and dental hygiene. Yes – You'll also have to remove that pesky, overnight, accumulation of mucus from the margin of your stoma and/or from your prosthesis. Get a good pair of tweezers. Instead of the drugstore, you need to check out the hardware store. There you'll find a pair cross-bent electronic tweezers. They were intended as soldering aids, but you would think they were designed with us in mind. These are hefty, stainless steel guys over six inches long with straight and bent blades (I prefer the 45° angle), but the really neat thing is that they operate on negative pressure. In other words, you open them and when you release, they clamp down. This will allow you to concentrate all your effort in that gentle, strategic pulling necessary to effectively remove any hardened mucus. They will last you forever and the cost is a very nominal $2-$5.00. (Marvin Whitley)
MY CHOICE OF TWEEZERS
A good pair of tweezers is an essential tool for a lary. While I have a pair of the ones with the angled tips which I like, my favorite is the medical "hemostat" (or clamp). They look similar to a pair of scissors, but the ends are blunt and pinch together. They can also lock closed in a powerful grip via an overlapping set of metal teeth adjacent to where your thumb and forefinger go. You can order this from several laryngectomee suppliers, or can often find them in hobby, military surplus, or medical supply stores.
SUPPLIES KIT TO CARRY WITH YOU
1. I use a small camera case to hold a supplies kit. I use one that is zippered and fits into my pants pocket or jacket when I am going out of the house. I carry my spare HME filters, EL batteries, tweezers, HME base plate adhesive, etc. It is all in a small maintenance kit, along with a small package of paper tissues, has everything I need during my day. Ron Mattoon
STOMA CARE - APPLIANCE OR MEDICAL EQUIPMENT
1. I had my surgery in February and was told to keep humidity high in the house. I was running 3 portable humidifiers, 24-7. The windows were soaked and the paint peeling off the walls under the windows. Result, I just spent a fortune to have damage repaired and the house painted. This year, I bought a small unit to measure humidity for $6 and keeping humidity to 50%. Seems to be working. I live in cold Canada, where it's about 5 Fahrenheit this morning.
Joe S. - Ontario
2. A hygrometer will keep track of the humidity. You should try to maintain it in the 40% to 50% range, although a little less may not be a problem IF it doesn't cause excess mucus and coughing. I have a Vicks that cost about $35 or $40 and, on low, I can hardly hear it with it placed within six feet of me.
Dave R. - FL 0807
If you are having breathing problems, you might look at different types of breathing help. There are many companies that supply oxygen concentrators and equipment. This site will help you understand what equipment is available.:
Rotech's education section will help answer other questions.
It explains how weather, humidity, barometric pressure, temperature and elevation affect your breathing.
We have a section under Possible Problems, Being on Oxygen with some items of interest.
HUMIDIFIERS - EXPLANATION
There are basically two types of humidifiers that we use as laryngectomy patients. Of course, cleanliness is always a concern on both types of humidifiers to eliminate the growth of mold and bacteria.
1. The household appliance type is used to increases humidity (moisture) in a single room or in the entire house. There are point-of-use humidifiers, which can be small enough to only humidity a single room or your immediate area. or can be large enough to humidity a whole-house by connecting to the furnace.
The most common humidifier, an "evaporative", "cool mist", or "wick humidifier", consists of just a few basic parts: a reservoir, wick and fan. The other types of household humidifiers are the vaporizer, impeller, and ultrasonic humidifiers.
Unnecessary or overuse of a humidifier can raise the relative humidity to high levels, promoting the growth of dust mites and mold. A relative humidity of 30% to 50% is recommended for most homes.
More information and photos of household humidifiers can be found at: http://en.wikipedia.org/wiki/Humidifier
2. The personal medical humidifier is used with a mask to directly humidify the air that we breathe. This can be a small portable device or a larger one that is supplied by a medical equipment company. Humidification is provided to keep secretions thin and to avoid mucus plugs
Attach a mist collar (trach mask) with aerosol tubing over the trach with the other end of tubing attached to the nebulizer bottle and air compressor. Sterile water goes into the nebulizer bottle (do not overfill, note line guide). The trach mask should always be above the collection bag and the hose routed so condensing moisture in the hose flows back into the bag and not into the airway. A gurgling sound indicates moisture is collecting in the hose and should be cleared. Oxygen can also be delivered via the mist collar if needed. Proper care and use should be followed per the instructions of your doctor or respiratory therapist.
HUMIDIFIERS - RECOMMENDATIONS
1] Wal-Mart has a good ultra-sonic that holds about a gallon and a half. The output is adjustable so you can add more or less as you need. Radio Shack has a Digital Thermo-Hygro gauge that tells you the temp and Humidity on the same face. It's battery powered and the batteries last a long time. I can't remember what I paid for the humidifier or the gauge but both were less than $50 together. I have had mine about 2 years and both work great.
Joe W. - FL
2] I recently purchased a Venta air washer and humidifier. We got the 360 sq. ft. model LW24 to run in the bedroom. It works great and it also cleans the air. We don't have an instrument to measure the amount of humidity in the room, but my husband has no problems with excess mucus or crusting. We live in Florida where the humidity is generally pretty high except in winter. We have no problems with humidity/moisture build up in the room. PLUS it is very quiet. You won't notice it is even on. The nice thing about the Venta is you don't have any filters to replace and it is also almost maintenance free. Every 10-14 days, rinse off the barrel and add some cleaning solution (sold by Venta) that keeps everything clean and mold/mildew free. We add about 1/2 to 1 gallon of water every day (depending on how long we run it). They are not cheap. I think we paid about $300. We are now considering purchasing the larger model that will wash and humidify up to 760 sq. ft. to put in our living/kitchen area. Their website is http://www.venta-airwasher.com/. I purchased mine from Bed Bath and Beyond.
Debbie W. - FL 0207
3] I am 3 yrs. out of surgery, and I have always had a problem with my stoma bleeding during the winter months when I have to use my central heat, and summer months when I use my air conditioner. The culprit, I have found, is humidity, or the lack of it. It is my experience that trying to humidify an entire house is really a chore, not to mention expensive. Instead, I use a personal heat and humidity system. I have the DeVilbiss 8650D aerosol compressor with a trach mask that I sleep with directly over my stoma. The drawback to this setup is the noise the compressor makes. It's not as noisy as a large compressor, but it does put out a pretty good hummmmmm. But then, you don't have to use it at night. You can use it during the day while you are relaxing, watching TV, or whatever. Being an old Vietnam Vet, I can sleep through a nuclear attack if I choose to, so the noise doesn't bother me at all.
If you've never seen this setup, it's a small air compressor with a heated nebulizer bottle attached that you fill with distilled water. Attached to this is a 4 or 5 ft.. length of corrugated tubing with a trach mask on the end. The trach mask goes directly over your stoma with an elastic strap around your neck to hold it in place, and the compressor blows a very light stream of moist, heated air which you breathe. You can do this for any length of time you choose. I personally use mine at night for 7 or 8 hours. When I make my run to the bathroom I refill my water bottle This has completely eliminated my stoma bleeding problem. Sometimes I go days without using it, when I notice a little blood in my mucous I know it's time to spend a couple nights on my humidifier.
I don't have a clue to the price of this humidifier, being that it is supplied by the VA. The best I could come up with is an address for the manufacturer:
100 DeVilbiss Dr.
Somerset, Pa. 15501-2125
Of course you will want to see your ENT doctor first to make sure your bleeding isn't being caused by something else.
Robert P. - GA 0106
4] I have been told the "wicking" type is the most effective and have several of them. They have a large filter in them which the water is pumped over the top and down a sort of channel that causes a waterfall over the top of the filter keeping it constantly wet and the fan blows through the filter evaporating the water. The brand I use is Lasco as it is common in my area and filters and such are readily available. It has a 3 speed fan and a humidistat adjustment on it so you can set it to go on and off when you reach a satisfactory level of humidity and it will maintain this degree of humidity automatically. Mine is a Lasco model 1128 9 gallon recirculating humidifier. It holds about 4 gallons of water and is rated at 9 gallon discharge per 24 hours. I think the cost on this was about $60.00, and I use just this one unit in a very large 9 room old farm house built in 1864. I change my filter yearly unless I have a lot of mineral deposits that don't clean off then maybe twice a year. I live in the country with my own well and, even with a water conditioner, we have a lot of minerals in our water. But rather than used distilled water I just use a humidifier water conditioner. It cost about $2.00 per quart and mixes @ 1 tablespoon per 1 and 1/2 gallon of water for my situation anyway. I take my filter out usually every two weeks and soak it in warm water then rinse it several times and this removes all the mineral deposits. The most important thing I have found is to make sure you have a humidistat gauge before you start messing with the humidity in your home. If you don't know what the current humidity is, it will be impossible to adjust it so you are comfortable. You can purchase these for anywhere from $7.00 to $15.00 in my area anyway. Wal-Mart carries them around here and I keep one on each level of my house, one in both my offices and one in my vehicle when I travel on trips as the A/C removes humidity and by shutting it off for several minutes you can bring the level back up again. I have found that every year since my lary operation I tolerate a little less humidity then I did the previous year. I think our bodies tend to adjust to some of our adverse conditions over time.
Wild Bill from MN 1206
5. QUIET AIR COMPRESSOR/HUMIDIFIER I am 5 years post surgery and I have found MY solution to the humidifier vs noisy machine of the usual nebulizer. I was using a monster that seemed like it weighed 25 or 30 lbs and sounded like a jack hammer. I tried connecting a long hose and would leave it sitting in the hall outside my bedroom. The major problem is the long hose would sag and moisture would condense and accumulate as water in the lowest point of the hose. Then with water accumulating in the hose it would start "gurgling". My wife travels quite a bit on her job and, since I'm retired, I like to accompany her as often as I can. Also, we both like to travel internationally as often as possible. Travel was a real problem with the overweight, noisy monster, so I started looking for an alternative. There was a person discussing this very topic on this Web Site about 3 years ago. When I checked this persons recommendation out, I found it worked for me. This person recommended purchasing a CPAP Model 200 which is a humidifier producing low humidity and very low noise and weighs about 14lbs. It produces air and humidity through a hose with the stoma mask. The noise level is similar to what a fan will make with no machine noise and only air movement noise. There may be two drawbacks to purchasing one of these units and those are the price which is about $450 to $500 and, secondly, the unit produces a very low humidity output, which may not be enough for everyone. On the up-side, because of the light weight, it can be transported easily and it is small enough to fit in a carry-on bag for airline use. Another plus is that cleaning is simple with no fear of mold or other contamination. The water is contained in a canister, which is removable from the unit and can be emptied and air-dried daily. I place the hose, with the stoma mask attached, in the dishwasher every few days for cleaning and sterilizing. The water from the canister never enters the unit, so there is no concern about having to clean the unit out. There is an air filter on the unit, so that all air being breathed is filtered. Filters are cheap and may be cleaned from time to time. I neglected to mention that the unit has a heating element, which heats the base of the canister, so that air passing over the water surface humidifies the air as it enters the hose and to the stoma mask. The air at the stoma mask is cool-humidified air. This is not a solution for a person requiring a higher humidity level, but for me it is just right. The noisy-monster, provided by my insurance company, even though the humidity output was adjustable, it was unsatisfactory even at a low humidity setting and still produced more than I needed. Here is another idea. There is a small portable humidifier which uses a regular drinking water bottle for the water source. Simply empty the drinking water from the bottle and fill with distilled water. The unit is a KAZ Model PH5700 which is a very nice, clean humidifier and, with a little work, the output can be modified to attach a hose and stoma mask. I have modified mine and carry it as a backup to my CPAP. The only modification required is to cut off the strap attachment on a stoma mask enough so the mask can be completely fitted over the KAZ output. When this is done, then using silicon cement, attach the modified stoma mask over the output vents of the KAZ. Now the hose can be attached to the KAZ and, when turned on, there will be cool steam at the stoma mask. I can not regularly use this because the output is too much for me. I believe the KAZ is sold through Bruce Medical or Luminaud and possibly other supply houses and is probably in the $50-$60 price range. Don W. - CA 0107
1. I have been reading all the postings about humidity and the white dust. I worked in the water industry for 22 years, so this may help. City treated water contains lime, salt or calcium to help soften the water. Home softeners also condition with salt or calcium. When the water is atomized and dries the dust is either lime, salt, or calcium. The use of distilled water (while expensive) will stop the white dust.
George C. - NJ
It is preferred if you can cough up the mucus or an obstruction. Irrigation with saline solution helps to cough and often eliminates the need for using a suction catheter . Suctioning should only be done by the advice and instruction of the doctor, nurse, or respiratory therapist.
There are many types of suction machines from portable battery units to home based units. It is not practical to cover the machines here. We can however give the basics.
Clearing the airway is important to prevent a mucus plug from blocking the airway and stopping the patient's breathing. Suctioning should be considered if the airway can not be cleared by coughing. There is always the possibility of damage to the tissues of the airways when a catheter is inserted, so care must be taken. The use of saline solution or the pink water bullets can help loosen and soften mucus, allowing it to be removed easier. If the patient feels or hears mucus rattling in the airway, try irrigation to get it up and coughed out. This is most often needed in the morning when the patient first wakes up. When there is an increased respiratory rate (working hard to breathe), you might need to clear the airways, but if there is a wheezing sound, it is more likely to be needed immediately.
Secretions should be white or clear. If they start to change color, (e.g.dark yellow, brown or green) this may be a sign of infection and you should talk with your doctor.
Clean your equipment, tubing and suction catheter before putting away and before using and be sure your Suction Machine is in working order. Wash your hands before and after handling:
1. Turn on the suction machine and connect the suction connection tubing to the machine.
2. Use a clean suction catheter when suctioning. Whenever the suction catheter is to be reused, it can be cleaned by placing the catheter in a container of distilled/sterile water and apply suction for approximately 30 seconds to clear secretions from the inside. Next, rinse the catheter with running water for a few minutes then soak in a solution of one part vinegar and one part distilled/sterile water for 15 minutes. Stir the solution frequently. Rinse the catheters in cool water and air-dry. Allow the catheters to dry in a clear container. Do not reuse catheters if they become stiff or cracked.
3. Connect the catheter to the suction connection tubing.
4. Suction a small amount of distilled/sterile water with the suction catheter to clear any residual debris/secretions. The collection cup should also be cleaned regularly to prevent bacteria growth and odors.
We will not give you instructions for the actual suctioning because, done improperly, it can cause damage. Your medical personnel should advise you on this.
For additional reading:
For Suctioning Patient in Home:
For Those With Tracheostomies
Detailed Care information
Do not be confused between Tracheostomy and Laryngectomy. While the hints for cleaning are excellent, Total Laryngectomees use different equipment to insert and are total "neck breathers". For more information about that and other subjects, you may learn more in our educational videos at::
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