A Caregiver’s Guide To Tracheostomy Care

A Caregiver’s Guide toTracheostomy Care:A Team ApproachMt. Washington Pediatric Hospital1

Special Thanks toRespiratory Therapy TeamEducation TeamNursing Team

ContentsWhat is a tracheostomy? . . .4How will I care for my child at home?.5Preventing infection and transitioning home . .6-7Parts of a trach and what supplies I should have. .8-9Providing humidity . .10When to suction the trach tube . .11Suctioning with a machine and catheter . .12Suctioning with an in-line catheter . .13Daily neck and stoma care . .14Changing the trach ties . . .15Changing the trach . . .16Cleaning the trach . . .17Checking your child’s health . .18Problem solving . .19Blocked tube . .20When should I call the doctor?.21General care . .22My child’s trach information . .23Resources . .24

What is a tracheostomy?A tracheostomy (tray-kee-ah-stoh-mee, or “trach”) is a surgical openingmade in the front of the neck into the trachea (windpipe). A short tube isput in the stoma (opening in the neck). The child breathes through thetrach tube instead of through the nose and mouth.Your child needs a trach for one of these reasons: Airway problems Tracheomalacia (soft windpipe) Needs to be on the ventilator (breathing machine) for a very long time4Mt. Washington Pediatric Hospital

How will I care for my child at home?It is important to care for your child as normally as possible. However,there are some special things you will need to do: Prevent Infection Suction the mucus out of the tube Clean the trach opening Change the trach ties & tube holder Give humidity Watch for breathing problems Double check every day that you have your emergency suppliesMt. Washington Pediatric Hospital5

Preventing InfectionSteps:1 Clean hard surfaces with household cleaners (do not use a spray)and lay a clean towel on it.2 Wash your hands with liquid hand soap for at least 15 seconds,rubbing all surfaces briskly, or use an alcohol hand sanitizer.3 Equipment maintenance and cleaning instructions will be given toyou by your home care equipment company.IMPORTANT TIPDo not use sprays, powder, or cut gauze;these could go into your child’s trach and lungs6Mt. Washington Pediatric Hospital

Transitioning to HomeYou may feel afraid when you first startYou will do some cares several timestaking care of your child on your own;a day, and some a few times a week. Itthis is normal. There are many thingshelps to have a calendar with your day’sto learn, but we are here to help youactivities. Organization, a schedule, andpractice and become comfortable withhelp from family members is important.the steps.It is important for several people tolearn to care for your child, so you canhave a break.Mt. Washington Pediatric Hospital7

Parts of a Trach8Mt. Washington Pediatric Hospital

What supplies should I PortablesuctionSurgilubeTrachtiesBack-upTrach tubeScissorsDown-sizeTrach tubeIMPORTANT TIPAn emergency trach bag should accompanyyour child at ALL timesMt. Washington Pediatric Hospital9

Providing Air HumidityHumidity is the amount of moisture orAir going directly into a trach does notwetness in the air. We need to breatheget moistened, cleansed, or warmed.in moisture to keep the lung’s cleaningDry air can make lung mucous thicksystem working. This helps our lungsand sticky. It can even cause lungs tostay free from infection.make more mucous. Gum-like mucousplugs can form that are hard toThe lining of our nose and throatcough up.moistens, cleans, and warms the aireach time we take a breath.10Mt. Washington Pediatric Hospital

When do I suction the trach?ZWhen you hear loud gurgles in the trach tubeZYou see bubbles in the trachZYou feel rattles on your child’s back or chestZ Your child seems agitated and restless, is sweating, or cries andcannot be comfortedZYour child is having trouble breathing:ZZZZFaster breaths or heart ratePale, bluish, or grayish color around eyes, mouth or fingernailsFlaring nostrilsRetracting (chest or neck skin pulls in with each breath)ZYour child’s breathing machine is alarming high pressureZ You will get used to your child’s routine, try to stick with theroutine unless your child is uncomfortable or in distress (as describedabove)Mt. Washington Pediatric Hospital11

Suctioning with a machine and catheter12 Put on sterile gloves. Do not touchanything with suctioning hand so thatyou keep it sterile. Pick up the sterile catheter with yoursterile suctioning hand and the suctiontubing with your other hand & connectthe two ends.3 Open the catheter kit. If there is a cup,fill it with sterile water.4 Plan how deep you will suction safely:5 ut the catheter into the trach and bePsure to not block the thumbport.6 nce you have gone the safe depth; blockOthe thumbport and slowly twirl and pullthe catheter out.7S uction no longer than 5 seconds eachtime you move the catheter into the trach.8Y ou may need to give a few breaths withthe ambu bag and wait 15-20 seconds inbetween suctioning.12Mt. Washington Pediatric Hospital

Suctioning with an in-line catheterSuction with the machine and in-linecatheter at least every 4-6 hours and asneeded, usually in the morning, beforemeals, at bedtime, and after Chest PT.Often, a child will be able to coughup mucus.In-line suction catheters are placed andSteps for Suctioning with an In-lineCatheter1 Removecap from suction port andattach to closed catheter system.2S et suction to appropriate pressure(while holding down the thumbport adjust the pressure setting).3 dvance the catheter with theApinch and push method until themeasured color is matched up tothe suction depth.4 hen the catheter is at the correctWdepth, press suction button andhold for two seconds before slowlypulling back with continuoussuction taking about 5 seconds,until black tip is back in your sight.5 atch the window closest toWthumb port, noting the color,amount, and thickness of thesecretions.6F lush the catheter, according todirections from your child’stherapist or nurse.changed out as directed by your homeequipment provider.Before Suctioning with an In-lineCatheter: Get your work area together/prepare all equipment (normal saline,in-line suction catheter, suctionmachine).12 Clean your hands.3 Turn on machine and checkpressure on the suction machine. Check safe suction depth (checkyour child’s measurement card).Mt. Washington Pediatric Hospital13

Daily cleaning of the neck and stomal1214 Wash your hands. Get ready. You will need: 2 wet gauze pads 2 dry gauze pads (one for left, one forright side) Cotton swab Sterile water Any ointment or powder prescribed byyour doctor Hold the trach tube at the flange with yourfingers while cleaning (a 2-person job)3 ash the skin around the neck withWsterile water, wiping the gauze away fromthe stoma, (as you don’t want to pushdirt and germs toward the stoma).4 at dry with a clean gauze (starting at thePstoma, and wiping towards the back ofthe neck).Every day as you clean the stoma area and neck,check the skin around the stoma and neckfor redness, drainage, rash, dampness, orunusual smell.Mt. Washington Pediatric Hospital

Changing the trach tiesYou will need 2 people for this job—both people should wash their hands.1 Put a blanket under your child’sshoulders. You may need anotherblanket to swaddle them if he orshe is wiggling.23 Suction if needed.4 Person B takes off the old Velcrostrip or twill tapes. Person A holds the trach tube bythe flange.Mt. Washington Pediatric Hospital5 ut on the new Velcro strip or twillPtapes, & check tightness (a littlefinger should fit snuggly under thecenter back of the neck).6 elcro strips can stretch. If they getVloose, hold the flange securely &tighten them.7 lean Velcro strips by soaking inCsoapy water, rinsing and air drying.8 heck Velcro before re-using it toCmake sure it sticks together. If usingtwill tape, resize by measuring thechild’s neck, not the old strips.15

Changing the trachChange trach tube once a week or sooner,if needed.l Wash your hands.1 If possible, have someone help you (everyone must wash their hands).234 Prepare clean trach with ties. lace a small roll under shoulders of smallPchildren.67 Suction, if necessary.8 hile trach tube is held in place, cut oneWside of tie, gently remove trach tube andold trach tie.9 oint curve of clean trach tube down.PSlowly insert trach tube into stoma. Place obturator in clean trach tube. Dip the end of tube in the jelly.Trach in.165 ive extra oxygen before trach change,Gif necessary.Obturator out.Mt. Washington Pediatric Hospital

Cleaning the trach tubel Wash your hands.5 eek inside the cannula to makePsure it is free of any mucus.1 Put saline in one bowl and peroxidein another bowl.6 inse the inside cannula in theRsaline. Take out the inside cannula andhold the flange in place.7 ut the cannula back in the obturaPtor (and hold the flange in place). Put the inside cannula in theperoxide bowl and let it soak.8 urn cannula until you hear it clickTinto place. Use the brush to scrub the outside& inside of the cannula.9 ug ever so slightly on the cannulaTto double check that it is locked inplace.234Mt. Washington Pediatric Hospital17

Checking your child’s health1 Check the color of your child’s gums,lips, and fingernails:The normal color is pink (but everybodyis different, just be sure to be aware ofyour child’s normal (or baseline) color).If the color changes from normal tograyish or bluish and you have suctionedthe trach, this means your childneeds oxygen.3 Thick mucus means your child needsmore humidity or to drink more fluids. If there is a different smell or color toyour child’s mucus, or if there is bloodor streaks of blood, call the doctorright away.42 Check breath sounds: Check without a stethoscope—Is thereeven chest rise? How is your child’s color?Can you hear and/or feel anythingdifferent with your child’s chest? Checkthe mucus for changes: More mucus means you need tosuction more often. your child is sick, check his or herIftemperature: Normal body temperature is around97.6º (under the arm) to 99.0º. A feverwould be about 99.5º under the arm,or about 100.5º rectally. A fever willoften make the heartbeat and breathingrate increase. Keep in mind, there are certain thingsthat make your kid special; just be sureto know what is normal for your child. Check with a stethoscope—Does yourchild’s chest sounds like it normally does?Can you hear air moving in and out ofthe lungs?18Mt. Washington Pediatric Hospital

Problem solvingWhat should I do for breathing problems?123456 Suction. Give breaths with the resuscitation bag. Give oxygen if you have it. Repeat suction with lavage. Change the trach tube. Call your child’s doctor (phone # ) or call 911.What should I do if the trach tube comes out?12Insert a clean tube with obturator.3 If you can’t find the trach tube, stay calm!The stoma may stay open and the childmay be able to breathe for a short time.4 Then get the travel kit and insert theclean trach tube. If a clean tube is not handy, insert the same tube that came out using theobturator. Do not waste time looking for a clean tube! Being prepared is vital,you must have a clean obturator available and with you at all times. You can evenask your nurses for the obturators they use in the hospital (given that their trachsize doesn’t change).Mt. Washington Pediatric Hospital19

Blocked tube procedure1 Suction.2 Give breaths with bag. Look for gentle chest rise.3 Put 3ml normal saline into the trach.4 Give breaths with bag.5 Suction.6 Give breaths with bag. Look for gentle chest rise.7 Get travel kit. Change trach tube. Give breaths with bag.8 Call 911.9 Give breaths with bag. Look for gentle chest rise. T ry to give breaths with face mask over nose & mouth.Never use the mask over the stoma.Continue steps of CPR.20Mt. Washington Pediatric Hospital