Tracheostomy Care for Children
What is tracheostomy care? Tracheostomy (trach) care is done to ensure your child's trach tube and the area around it stays clean. This helps prevent a clogged tube and decreases the risk of infection. Trach care includes suctioning and cleaning your child's skin and parts of the tube. Your caregiver will show you how to care for the trach tube, and what to do in an emergency.
What are the parts of a trach tube?
Flanges: These are the curved wings on each side of the trach tube. The flanges help keep the trach tube in place.
Trach ties: The ties go around your child's neck and hold the flanges in place. The ties may be made of fabric tape. A trach holder made from hook and loop fasteners may also be used.
Obturator: This is a small device used to insert a new trach tube.
What supplies do I need for trach care? Keep spare supplies with your child at all times while he has a trach tube. You may at any time need to suction or change the tube if it gets clogged or needs to be replaced quickly.
- One trach tube the same size as the current tube and another trach tube that is 1 size smaller
- Obturator for each trach tube
- One set of trach ties or a trach holder
- Portable suction machine with battery backup and tubing that connects to the suction machine
- Catheters with a suction valve and sterile saline
- Rescue breathing bag and mask
- Emergency phone numbers
How can I prevent infections?
Wash your hands: Always wash your hands before and after any trach tube care.
Clean the trach equipment: Use clean or sterile trach care methods and clean the equipment as your child's caregiver directs.
Keep your child's neck clean and dry: Change the gauze and trach ties when they are wet or dirty.
Keep your child's mouth clean: Saliva and mucus contain germs that cause infection if they enter your child's airway. Your child's teeth should be brushed twice a day. Suction his mouth as needed to help prevent infections.
How do I suction my child's trach tube? You may be told to suction your child's trach tube at least twice a day. Your child's caregiver will tell you if you need to suction more often.
Watch for signs that your child needs suction: Suction when your child cannot cough up his secretions. Your child may seem restless or scared, and his breathing may be louder or faster than usual. Mucus may be coming out of the trach tube. His skin may look gray or blue.
Wait after feedings: Do not suction your child's trach tube soon after he has eaten. He may cough or vomit if you suction too soon. Ask how long you should wait to suction.
Prepare the suction machine: Suction machines have a pressure gauge. Your child's caregiver will tell you what amount of pressure to use when you suction the trach tube. You can test the pressure before you suction by covering the suction valve on the catheter with your thumb.
Use saline only as directed: Your child's caregiver may tell you to insert a few drops of sterile saline into the trach tube to make your secretions thin. Do not use saline unless directed by your child's caregiver.
Suction the trach tube: The catheter should be inserted until it is just past the end of the tube. Your child's caregiver will tell you how far to insert the catheter. The catheter may have measurements marked on it for you to follow. You can also measure and mark the catheter so you do not put it in too far. Have your child take a deep breath and try to cough up the secretions before you suction the trach tube. Only cover the suction valve as you remove the catheter. Gently twist the catheter as you pull it out. It should take less than 15 seconds.
How do I care for my child's trach tube? Clean the area around the tube at least once each day.
Check for signs of infection: Wash your hands before you remove your child's trach dressing. Look for redness or swelling of the skin around the tube. Clean the area and replace the trach dressing as directed. Do not cut the gauze. Fold the gauze instead so your child does not breathe in the cut fibers.
Change wet or dirty trach ties: A finger should fit snugly between your child's neck and the trach ties. Ties that are too tight can cause skin breakdown. The trach tube can move out of place when the ties are too loose. You may need someone to help you hold the trach tube in place or attach the new ties.
How do I change my child's trach tube? Change the trach tube as often as your child's caregiver directs. You may also need to change the trach tube if it moves out of place or feels uncomfortable. You may need someone to help you change the trach tube.
Prepare the new trach tube: Insert the obturator into the new tube. Place a small amount of lubricant on the lower end of the tube as directed by your child's caregiver. Wipe off excess lubricant.
Insert the new trach tube: Remove the obturator after the trach tube is in place. Use trach ties or a trach holder as directed to secure the tube.
Check your child's breathing: Make sure your child can breathe well after the new trach tube is in place.
How do I keep my child's secretions thin?
Keep water and other materials out of your child's trach tube: Do not let your child swim. Cover the opening with a shower shield or trach cap while your child bathes to keep water from entering his airway. Prevent him from breathing in dust. Do not use powders or sprays near your child's trach tube.
Give plenty of liquids: Ask your child's caregiver which liquids are best for your child. Ask how much liquid your child should drink each day.
Humidify the room: Use a room humidifier or vaporizer as directed.
Humidify your child's airway: You may be directed to use a heat moisture exchanger (HME), a trach collar, or fabric stoma covers. An HME attaches to your child's trach tube and prevents moisture loss. A trach collar connects to a machine that supplies humidified air to the trach. Fabric stoma covers are moistened and worn over the trach tube.
What steps do I follow if my child is having trouble breathing?
Try to clear the trach tube: Have your child cough to help move mucus, water, or irritants out of his airway. Small children often put small objects into the trach tube. Check the tube for any objects that may block your airflow. Suction the tube if coughing does not clear his airway and there are no objects present.
Gently move the trach tube: The tube opening may be against your child's airway. Gently reposition the tube to make sure it sits in your child's airway properly.
Replace the trach tube: Insert a new trach tube. Try a smaller size if a regular sized tube will not go in properly.
Call 911: Call 911 if your child still cannot breathe easily.
When should I contact my child's caregiver? Contact your child's caregiver if:
- Your child has a fever.
- Your child has increased or thicker secretions than usual.
- Your child's secretions are yellow or green.
- You see thick, red tissue growing around your child's stoma, or the skin is red, swollen, or leaking pus.
- It is harder for your child to breathe than usual. He may be breathing faster than normal.
- Your child tells you that it hurts to swallow.
When should I seek immediate care? Seek care immediately or call 911 if:
- You see food or liquids coming from your child's trach.
- Your child's breathing problems are getting worse.
- There is blood coming from the stoma or trach tube.
- You cannot insert a new trach tube for any reason and your child is having breathing problems.
You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.
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