Ventilator & Tracheostomy Care Guide – Breath By Breath With ALS

For individuals living with ALS who rely on a ventilator, airway care becomes one of the most important parts of daily caregiving. A ventilator supports breathing, but it also requires regular monitoring, equipment checks, and airway maintenance.

This guide outlines the basic routines caregivers often perform to help maintain a clear airway, ensure ventilator safety, and respond to potential breathing problems.

Always follow the instructions provided by your medical team, respiratory therapist, and equipment provider, as individual care plans may differ.

⚠️ Quick Emergency Response

If breathing suddenly becomes difficult or the ventilator alarm sounds, act quickly and check the airway and equipment.

Ventilator Failure

If the ventilator stops working:

Check the power connection and tubing.
Disconnect from the ventilator if necessary.
Use the manual resuscitation bag (Ambu bag) to provide breaths if trained.
Call emergency medical services if breathing cannot be supported.

Tracheostomy Tube Dislodged

If the tracheostomy tube comes out:

Attempt to insert the backup tracheostomy tube if you have been trained.
Keep the airway open if possible.
Call 911 immediately.

Oxygen Saturation Below 90%

If oxygen levels drop:

Check ventilator tubing and connections.
Suction the airway if mucus may be blocking airflow.
Use a cough assist device if available.
Contact your medical provider or emergency services if oxygen levels do not improve.

Emergency Supplies

Always keep emergency equipment nearby, including:

Manual Ambu bag
Backup tracheostomy tube
Portable suction machine
Extra trach ties and supplies

Quick access to these supplies can be critical during an emergency.

Daily Ventilator Safety Check

Caregivers often perform a quick safety check of the ventilator and airway equipment each day.

Daily Ventilator Checklist

Ventilator plugged into power outlet
Backup battery charged
Ventilator alarms working and audible
Humidifier filled with sterile water (if used)
Tubing free of excessive condensation
Suction machine functioning
Ambu bag nearby
Backup tracheostomy tube available

These quick checks help ensure the ventilator and airway equipment are functioning properly and ready for use.

Ventilator System Monitoring

The ventilator is a critical piece of life-support equipment. A quick daily review helps ensure everything is functioning properly.

Power Supply

Ventilator connected to a reliable power outlet
Internal backup battery charged
External batteries (if used) ready and available

If possible, use a dedicated outlet for the ventilator.

Ventilator Settings

Confirm that ventilator settings match the doctor’s prescribed orders.

Common settings may include:

Tidal Volume (Vt)
Respiratory Rate
Pressure levels
Alarm limits

Never change ventilator settings unless instructed by a medical professional.

Alarm System

Ensure ventilator alarms are working and audible.

Alarms may alert caregivers to:

Disconnections
High pressure in the airway
Low pressure or leaks
Power failure

Never silence alarms without identifying the cause.

Humidification

Ventilator air must be humidified to prevent dryness and irritation.

Heated Humidifier

If using a heated humidifier:

Ensure the water chamber is filled with sterile water
Check tubing for excess condensation (“rainout”)
Empty condensation if it collects in the tubing

Heat and Moisture Exchanger (HME)

An HME acts as an artificial nose, helping retain moisture and warmth.

Replace the HME if it becomes:

Clogged with mucus
Damp or heavy
Visibly soiled

Tracheostomy Tube Care

A tracheostomy tube provides the airway connection between the ventilator and the lungs. Keeping the tube clean helps prevent infection and airway blockage.

Inner Cannula Care

Many tracheostomy tubes contain a removable inner cannula.

Inner cannulas are often replaced once daily, or more frequently if secretions are thick.

Typical steps include:

Wash hands thoroughly
Put on clean gloves
Stabilize the trach faceplate
Remove the inner cannula gently
Insert the clean replacement cannula
Lock it securely in place

If the cannula is reusable, clean it according to manufacturer instructions.

Stoma Care

The stoma is the opening in the neck where the tracheostomy tube enters the airway.

Typical care includes:

Cleaning the skin around the stoma with saline or mild soap and water
Checking for redness, irritation, or drainage
Replacing the trach dressing if it becomes damp

Trach Ties

Trach ties hold the tracheostomy tube in place.

They should be:

Snug enough to secure the tube
Loose enough to fit one finger between the tie and the neck

Loose ties may allow the tube to move or become dislodged.

Managing Secretions

Because the ventilator bypasses the nose and throat, the body cannot clear mucus naturally. Caregivers often assist with suctioning and cough support.

Suctioning

Suctioning removes mucus from the airway.

Signs suctioning may be needed:

Visible mucus in the trach tube
Rattling or gurgling sounds
Coughing that does not clear mucus
Oxygen levels dropping
Increased breathing difficulty

Basic suction technique:

Insert the suction catheter just beyond the trach tube
Apply suction while withdrawing the catheter
Limit suction to 10–15 seconds per pass
Allow time to recover between attempts

Cough Assist Devices

Mechanical cough assist machines help move mucus from the lungs.

These devices:

Deliver a deep positive pressure breath
Quickly reverse airflow to pull mucus upward

Many respiratory therapists recommend 4–6 cycles per session, depending on individual needs.

Emergency Go-Bag

Many caregivers keep an emergency bag near the bed or wheelchair.

Common items include:

Manual resuscitation bag (Ambu bag)
Spare tracheostomy tube
Portable suction machine
Extra trach ties and dressings
Spare HME or humidification supplies

This bag should travel with the patient whenever possible.

Signs of Respiratory Infection

Changes in secretions can sometimes indicate infection.

Contact your healthcare provider if mucus becomes:

Yellow
Green
Brown
Thick or foul smelling

Early treatment can help prevent serious complications.

Warning Signs Something May Be Wrong

Changes in breathing, equipment, or secretions can signal that something needs attention.

Contact your medical provider or respiratory therapist if you notice:

Breathing Changes

Breathing appears more difficult or labored
Faster or unusually slow breathing
Frequent ventilator alarms
Increased fatigue during breathing

Oxygen Changes

Oxygen saturation repeatedly dropping below normal levels
Oxygen not improving after suctioning or cough assist

Tracheostomy Site Changes

Redness or swelling around the stoma
Drainage or unusual irritation
Bleeding around the tracheostomy tube

When in doubt, contact your healthcare provider.

A Word to Caregivers

Learning ventilator care can feel intimidating at first. Many caregivers worry about making mistakes or missing something important.

But like all caregiving skills, ventilator care becomes easier with time and practice.

Each day you provide care, you are helping someone breathe easier and live more comfortably.

That quiet work matters more than you may realize.