![](media/image1.jpeg){width="1.575in"
height="1.261111111111111in"}Patient Education Information Sheet

North Florida/South Georgia Veterans Health System (NF/SGVHS)

Surgical Service; ENT Section

**Laryngectomy Home Care**

**Introduction:**

Your larynx (voice box) is at the upper end of the trachea (windpipe).
This area of the neck is often called the "Adam's apple." The larynx
contains the vocal cords for speech (see picture below left). A total
laryngectomy is an operation that removes the larynx.

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**Before Surgery After Surgery**

**After surgery, you will ...**

-   Have an opening in your neck called a stoma (see picture above
    right). The stoma is made by attaching the upper end of the trachea
    (windpipe) to an opening in your neck. The stoma leads directly to
    your lungs. This permanent opening from the trachea to the neck is
    sometimes called a tracheostomy, but it is really a laryngeal stoma.

-   Breathe through your stoma, not through your nose and mouth.

-   Learn a new way to speak because your voice box has been removed.

**After your laryngectomy you ...**

-   Will notice a change in your sense of smell. You will not be able to
    inhale odors through your nose.

-   Will taste food differently as well. Taste is linked to odors and
    smell.

-   Will not be able to blow your nose. This is because you cannot
    exhale air through your nose.

-   Will not be able to hold your breath and bear down.

-   Will not be able to warm, moisten, or filter the air you inhale.

**Communication -- Speech**

A speech pathologist will talk to you about other methods of speaking.
You may need to write messages until you learn a different way to speak.

**Hand Washing/Clean Supplies**

Because your hands may spread germs, you must wash your hands before and
after caring for yourself. Always use clean supplies.

**Humidity**

The nose and mouth normally help to keep the air you breath filtered,
warmed, and wet. This will not happen with a stoma. You will need extra
humidity in your house. The amount of moisture needed will vary. Use an
ultrasonic nebulizer or a room-size or cool-mist humidifier in your
home. Drink plenty of fluids to keep your airway most. More humidity
will be needed during the winter months when your home is dry. More
moisture is needed whenever you have a discharge or oozing that is
thick, dry, or forms mucous plugs (dry, crusted secretions). Pink or
blood-tinged oozing may also indicate a lack of moisture. Putting a
saline (salt) solution into the trachea adds moisture. This causes a
cough that can help clear secretions from your airway.

**Cleaning the Humidifier**

Germs will grow in a humidifier. Clean the unit to lessen the chance of
lung infections. Check the humidifier package insert for cleaning
advice. Ideas for daily and weekly cleaning are listed below.

Daily ...

-   Empty and clean tub with hot, soapy water. Rinse well.

-   Fill with fresh tap water.

-   Never add water to the humidifier without emptying and rinsing the
    tub.

Weekly ...

-   Empty and rinse tub.

-   Fill the tub with equal parts of vinegar and water. Turn the
    humidifier on for 1 hour. The vinegar smell will be very strong so
    put the humidifier in an empty room.

-   Empty the humidifier and wash all parts with hot, soapy water. Rinse
    well.

-   Fill the tub with clean water. Turn on the humidifier for another
    hour.

-   Empty and air dry. Unit is ready for use.

**Making Saline Solution**

Saline solution is a salt solution that will help clear secretions.
First, boil 1 quart (4 cups) of water for 5 minutes. Then add 1 and ½
level teaspoons of non-iodized salt to the water. Cool to room
temperature before using. Because germs may grow in the solution, throw
away unused saline solution after 24 hours.

**Using Saline Solution**

Instilling (slowly adding) saline solution into your airway will help
you cough and this will help to clear secretions.

-   Pour a small amount of saline solution into a clean cup.

-   Draw up 2 to 3 cc into the syringe.

-   While taking a deep breath, instill the saline solution into your
    stoma.

-   Cough while covering your stoma with gauze or a soft paper towel.

-   Repeat until your airway is clear. If unable to clear your airway
    with saline solution, use suction.

-   Wash saline solution cups and syringes daily with hot soapy water.
    Rinse thoroughly. Air dry.

-   When secretions become thick and dry, saline solution may need to be
    instilled as often as every hour.

**Suction**

The purpose of suction is to remove secretions that you cannot remove by
coughing. Suction will clear your airway and help you breathe easier.

-   Connect suction catheter to tubing from suction machine.

-   Moisten catheter tip with saline solution.

-   Take 4 to 5 deep breaths.

-   Gently insert the catheter through the stoma. *Do not cover the
    suction control vent* while you insert the catheter. Pass the
    catheter as far as you can without force, then pull it out slightly
    before starting suction (see picture below).

![](media/image4.png){width="3.5in" height="4.114583333333333in"}

**Suctioning --- thumb is off the suction control vent**

-   To apply suction, cover the vent with your thumb (see picture
    below). Do not apply suction for more than 10 seconds. Release thumb
    from vent if you feel the catheter grab during suction. Gently
    rotate the catheter as it is withdrawn.

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height="4.086805555555555in"}

**Suctioning ---thumb is covering the suction control vent**

Suction saline solution to clean the catheter.

-   Do not insert the catheter more than 3 times during a suctioning
    period. Take a few deep breths between each time the suction
    catheter is inserted. If more suctioning is needed, allow yourself a
    5 to 10 minute rest.

-   Breathe deeply after you remove the catheter.

In most cases, the use of a saline solution and a humidifier keeps your
secretions thin enough to cough or suction out. If you have thick
secretions, mucous plugs, or a feeling that your airway is not clear,
these ideas may help:

-   Fill the bathtub with hot water. Sit in the steam-filled bathroom
    for 20 minutes.

-   Place a moist all-gauze square over your stoma. Keep the gauze damp.
    The gauze may be held in place by folding it over with twill tape or
    bias tape tied around your neck.

-   Stand in the shower with the water directed away from your stoma.

-   Fill a spray bottle with saline solution. Spray into your stoma
    several times a day.

**Cleaning Suction Catheters**

-   Place catheters under cool running tap water to rinse secretions.

-   Wash catheters well in hot, soapy water. Use mild liquid soap. Rinse
    with tap water. It may be helpful to attach the catheter to suction
    to remove any remaining soapy water.

-   Soak catheters in equal parts of white vinegar and tap water (1 cup
    vinegar to 1 cup water) for 1 hour. Rinse catheters with saline
    solution. Connect catheter to suction to rinse inside of each
    catheter.

-   Air dry catheters on a clean towel.

-   Store catheters in a clean, covered container.

**Suction Machine Care**

-   Empty suction bottle into the toilet.

-   Wash the suction bottle and tubing daily with hot, soapy water.

**Airway Care**

Cleaning ...

The skin around your stoma should be kept clean and dry. Cotton-tipped
applicators like Q-tips or a damp washcloth may be used to gently remove
secretions surrounding the stoma. You may want to apply a thin film of
petroleum jelly to the outer edges of your stoma to prevent crusting.

Covering ...

Cover your stoma to prevent dust, insects, or other foreign matter from
entering your stoma. This also helps to moisten and warm the air you
breathe in. The covering will also lower the sound of breathing from
your stoma. It will also reduce stoma odors. Cover your stoma with an
all-gauze square folded over with twill tape or bias tape tied around
your neck (see picture below). Many kinds of stoma shields and covers
are available. Ask your nurse or speech pathologist for more
information.

![](media/image6.png){width="4.1875in" height="3.920138888888889in"}

**Stoma covered with all-gauze square**

You may wish to use a different style of stoma cover. Women may like to
use a scarf, high-necked dress, or a turtleneck sweater. For men, a high
neck T-shirt, turtleneck, or dress shirt with an ascot (wide scarf) may
be worn.

Appliances ...

You may not need an appliance inserted into your stoma to keep it open.
Over a period of time, however, the stoma may slowly shrink in size.
This is called stoma stenosis. The stoma size may be kept the same by
routine or ongoing use of a stoma vent or a laryngectomy tube.

The stoma vent is a commonly used appliance (see pictures below). Some
people prefer to use the stoma vent all the time because it helps to
keep the stoma edges clean and free of secretions. The correct size
stoma vent will be selected for you.

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**Stoma stent shown in place Stoma stent**

**Stoma Stent**

-   Clean stoma.

-   To secure stent in stoma, insert ties into openings in outside rim
    of the stent.

-   Lubricate the stent with saline (salt) solution or a water soluble
    gel (K-Y Lubricant).

-   Insert the stent and secure ties around the neck.

-   Do not use petroleum jelly on the stoma while using a stoma stent.
    The ointment may destroy the stoma stent.

Clean the vent at least twice a day using a soft brush or pipe cleaner,
mild soap, and water. Rinse well under running tap water.

Do not use the stent if it is cracked, damaged, or if it does not fit
your stoma. Check with your nurse or doctor to be sure.

**Precautions**

-   When bathing or showering, keep water out of your stoma. Do not
    swim.

-   Avoid powders, aerosol sprays, dust, smoke, and lint from facial
    tissues. Do not smoke.

-   Do not use facial tissues to cover your stoma because they may
    shred.

-   Do not use over-the-counter antihistamines (cold medications). These
    can dry secretions and the airway.

**Emergency Information**

Talking on the telephone may be difficult. Plan a way to get help in
case of an emergency. Place emergency numbers near the phone, such as
the fire department, ambulance, visiting nurse, and doctor.

During cardiopulmonary resuscitation (CPR), breathing must be performed
mouth to stoma, not mouth to mouth.

Oxygen must be given through the stoma, not nose or mouth.

A medical alert bracelet/necklace (see picture below) should be worn.
These are available from drugstore pharmacies. Information can be etched
on the back of the bracelet/necklace to let others know that you breathe
through a stoma in your neck.

**A family member should contact the local police department** and tell
them that, if a 911 call comes from your home, an ambulance must be sent
right away. The police department will note that a person at that
address cannot speak on the telephone.

**Activity**

Unless there are other limiting conditions, you should be able to do
most of your usual activities except for those such as swimming or
boating. You may not need to change jobs unless the area in which you
work is very dusty or has extreme temperatures. Breathing in those
conditions can be very uncomfortable.

**Mouth Care**

Because you will not be able to taste and smell as well as before, you
will not be aware of mouth odors.

Floss and brush twice each day.

**Diet**

Unless you have had additional surgery or radiation therapy, you should
be able to eat and swallow as before. If you have problems swallowing or
eating, tell your doctor. Because you are unable to hold your breath and
bear down, constipation may be a problem. Include high-fiber foods
(fresh fruits and vegetables, bran, whole grain bread, and cereals) in
your daily diet to help keep normal bowel movements. Exercise and
drinking more liquids will also help. Use an over-the-counter laxative
if needed.

**Discharge Information**

Before you leave the hospital, a visiting nurse may be contacted to help
you with your home care and any supplies you may need. Supplies may be
purchased from a drug store or medical supply company. Arrangements for
a suction machine, if needed, will be completed before you leave the
hospital. Most patients rent the suction machine. The need to suction
may decrease over time. Return the suction machine when it is no longer
needed. Arrange to have a humidifier at home.

The International Association of Laryngectomees (IAL) is an organization
that can help provide support to you and your family. It is sponsored by
the American Cancer Society. It has many local chapters called "Lost
Chord Clubs." Their website is
[www.larynxlink.com](http://www.larynxlink.com/). This site has a link
to local Florida chapters. Another very helpful website is
[www.webwhispers.com](http://www.webwhispers.com/). This site provides a
great deal of information and resources for patients with larynx cancer.

**Home Supplies**

The following will be sent home with you:

-   Sterile saline solution

-   Gauze squares to use when coughing (soft paper towels may be used
    instead)

-   Suction catheters

-   Connecting tubing for suction machine (if not supplied by medical
    equipment company)

-   Suction machine

-   Home humidifier or aerosol machine to connect to stoma to keep
    humidified.

-   Stoma vent if ordered

-   Brush/pipe cleaners

**Warning Signs**

Please notify your doctor if you are having problems or if any of the
following occur:

-   Difficulty breathing or noisy breathing that sounds blocked

-   Dry, crusted secretions (mucous plugs) or blood-tinged secretions
    from stoma

-   Chest discomfort

-   Increased tracheal secretions

-   Thick, foul-smelling secretions

-   Fever

-   Decrease in stoma size or difficulty inserting stoma vent

-   Redness or skin breakdown around stoma

-   Problems swallowing or eating

-   Separation of the incision, drainage, or increased swelling

**Special Instructions for You ...**

**To Contact Your Doctor Call:**

ENT -- Head and Neck Surgery Section

800-324-8387 extension 6054

(Evenings and weekends: Dial "0" for the operator and ask for the ENT
resident physician on call.)

Information in this handout was used with permission from the website of
the University of Iowa Hospitals and Clinics, Iowa City, Iowa.

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