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A Parent’s Guide To

PediatricTracheostomy Home Care

10M1199 Cat. No. TR00798 All trademarked items are property of Mallinckrodt Inc. unless otherwise noted. ©Mallinckrodt Inc. 1999 All rights reserved. Printed in the U.S.A.

Mallinckrodt Inc.P.O. Box 5840St. Louis, MO 631341-888-744-1414 Customer Servicewww.mallinckrodt.com

Shiley®

Tracheostomy Products

MK-326 Short Pages 2/28/01 3:25 PM

A PARENTS’ GUIDE TOTRACHEOSTOMY HOME CARE FOR YOUR CHILD

You Can Do It! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2Things you’ll need . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

How the Tracheostomy Works . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3What the doctor does . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3What’s happening inside . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

Humidity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4Weaning from the humidifier . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4

Tips For Daily Living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4Mealtime . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4Bath Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4Getting Dressed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5Playtime . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5Illness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6Getting Away . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

Safety Tips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7Suctioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

What you will need . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8How to Suction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9Changing the Ties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10

What you will need . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10How to Change Twill Tape Ties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10Changing the Tracheostomy Tube . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

What you will need . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12Cleaning the Tracheostomy Tube . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12How to Change an Uncuffed Tube . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13How to Change a Cuffed Tube . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14Cleaning Around The Opening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

What you will need . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16How to Clean Around The Opening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17Leaving Home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

What you will need . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18If it’s cold out . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18Going to school . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18Going out to play . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

Learning to Speak . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19How do I know if my infant needs me? . . . . . . . . . . . . . . . . . . . . . .19

Glossary (In Plain English) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20Uncuffed Tubes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22Cuffed Tubes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23Solving Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24What If The Power Goes Out? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27Home Care Manual Listings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28

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This guide and the product usage guidelines are intended for use with Shiley®

Tracheostomy Products from Mallinckrodt Inc. only. Use of these guidelines with oth-er tracheostomy products is not recommended. Always follow your doctor’s or hospi-tal’s directions if they differ from the directions in this guide.

This guide provides tips on how to suction, change

ties, change tubes and care for the skin around the open-

ing. It also gives you suggestions for daily living, traveling,

safety and solving problems. Plus, it has a “Plain English”

glossary to help you understand and pronounce some of

the technical terms you may hear.

MK-326 Short Pages 2/28/01 3:25 PM Page 3

WHAT THE DOCTOR DOES

The doctor makes an opening(stoma) in the front of the neck into thewind pipe (trachea). He then places acurved plastic tube (tracheostomy tube)into this opening through which yourchild will breathe.

WHAT’S HAPPENING INSIDE

Normally, we breathe through thenose and mouth so that air is filtered,warmed and moistened before it goesdown the windpipe to the lungs.

With a tracheostomy, air goesdirectly into the windpipe to the lungs.There’s no filtering, warming or moist-ening. You will learn how to make upfor this by using the proper equipmentand by learning the proper tracheosto-my care.

HOW THE TRACHEOSTOMY WORKS.

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Lungs

Air Sacs

Windpipe(trachea)

Esophagus(to stomach)

A tracheostomy is not a commonoccurrence like putting braces on yourchild’s teeth. So, it’s normal to feel a little frightened at first. But this willpass as you become more familiar withthe situation.

You will receive training for tracheostomy care while your child is still in the hospital. Participate actively,ask lots of questions and take notes.Practice makes perfect. The more timeyou spend; the more comfortable you’llbe as you care for your child.

It is a good idea for several familymembers to take the training so thatthey also will know how to care foryour child’s tracheostomy.

Your doctor, nurse or therapist are your best sources for advice. Butthis guide will provide helpful tips andreminders so that things go smoothlyonce you and your child are homeagain.

With the instruction at the hospital,practice and this guide, you’ll do fine.

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YOU CAN DO IT!

Basin (to check cuff on tube)Blanket (to swaddle child)Blunt-Nose Bandage Scissors

(to cut the twill tape)Box of Facial TissuesBulb SyringeCotton Swabs (used to clean

around the opening)Gloves (like your doctor uses)Humidifier (to moisten the air

during naps and at night)Hydrogen Peroxide and Water

(mixed half and half, used to clean around the opening)

Nebulizer (to moisten the lungs)

Replacement Tracheostomy Tube (samesize and one smaller)Resuscitation Bag (optional)Saline (to soften mucus so that it may

be suctioned)Sterile Water (for rinsing suction

catheters)Suction Catheter Suction Machine (plug in and portable) Towel or Small Blanket (to roll up and

place under your child’s shoulders during tracheostomy care)

Tracheostomy Tube MaskTwill Tape or Other Tracheostomy Tube

Holder (to hold the tube in place)Water-Based Lubricant

THINGS YOU’LL NEED

NOTE: Some items come from your home care supplier; some you must buy at the store.


GETTING DRESSED

You can dress up your child almostany way you wish. You need only becareful the clothing does not block thetracheostomy tube.

Avoid: Crew necks, turtlenecks, buttons in back, necklaces, shoulderstraps and clothes that shed fibers orlint.

Prefer: V-neck tops and clothing that buttons in the front. Cotton bibsare preferred over plastic ones.

PLAYTIME

Toddlers can enjoy most normalkinds of play, but they must be super-vised. Also, you will want to select toyscarefully.

Avoid: Small toys or toy parts thatcould fit into the tracheostomy tube,sandboxes and contact sports.

In cold or dusty weather, use aloose scarf, mask or artificial nose towarm the air and keep dust out of thetracheostomy tube.

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Normally air goes through the noseand mouth where it is filtered, warmedand moistened. This protects the liningof the lungs and keeps the mucus fromdrying.

A tracheostomy bypasses the noseand mouth. So, we need to add mois-ture, even in damp climates, or mucuswill dry and block the tracheostomytube. This is why a humidification system with flex tube and tracheostomymask is often used. Another way tohumidify is to use an “artificial nose”.This device traps warmth and moisturewhen the child breathes out and thenputs that moisture back in the air whenhe breathes in.

Be sure to use a humidifier duringnaps and at night to reduce the chanceof mucus plugging the tracheostomytube, even if your child wears an artifi-cial nose while awake.

WEANING FROM THE HUMIDIFIER

During the day (and only during the day) you can let your child go with-out humidity for longer periods of time. Do this gradually. Start with one hour.Watch for thick mucus, or mucus withtraces of blood in it. If you find either,then give him plenty of liquids to keepthe mucus thin. Notify your doctor.

If the tracheostomy tube plugs up,suction it to remove the mucus plug.(See page 9.) If you can’t remove themucus plug; change the tube.

MEALTIME

Your child will eat just like otherchildren. You just need to be careful sofoods and fluids “don’t go down thewrong way.”

When bottle feeding an infant,don’t prop the bottle or otherwise feedthe child while he is lying down. Liquidcan get into lungs this way. Hold theinfant in a nearly upright position during feeding. Lay the infant on itsside after eating. This way if vomitingoccurs, there is less risk of the child getting it in his lungs and choking.

Watch toddlers during meals sothey don’t get food in the tracheostomytube. You may wish to loosely cover thetracheostomy tube opening with themask of the humidification system orwith an artificial nose for extra safety.

BATH TIME

Children love to take baths. Yourchild will too, with you watching over him.

Always prepare a shallow bath. Usecare to prevent bath water from gettingin the tracheostomy tube because it goes directly to the lungs. For extrasafety, attach a trach mask or an artificial nose.

When it’s time to shampoo, do itwith the child lying on its back, withthe head over the sink.

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HUMIDITY. TIPS FOR DAILY LIVING.


3 Follow your doctor’s or hospital’sdirections for care. If instructions inthis guide are different from yourtraining, follow your training.

3 Only people who have been trainedby a health care professional shouldperform tracheostomy care.

3 Always have extra tracheostomytubes on hand for an emergency.(same size and one smaller)

3 Do not resterilize tracheostomytubes.

3 Don’t place the tracheostomy tubeanywhere the temperature is over120°F.

3 Avoid over inflating the tracheosto-my tube cuff. This can injure yourchild’s wind pipe.

3 Watch for these signs of infectionand notify your physician:• Red, inflamed skin at stoma• Foul-smelling mucus• Bright red blood in mucus

3 Take only a few seconds to suction.Take a short break before you suction again.

3 Use care when bathing your child.• Use shallow water• Use the trach mask

3 Keep the tracheostomy tube looselycovered during feeding.

3 Supervise meals to keep food out ofthe tracheostomy tube.

3 Position infants on their side aftereating in case they vomit.

3 Don’t use perfumes, powders oraerosol sprays around your child.

3 Keep your child away from dust andmold.

3 Don’t smoke around your child.

3 Keep clothing away from the tra-cheostomy tube except for a pro-tective scarf.

3 Encourage play but:

• Avoid sand boxes

• Avoid tiny toys

3 Supervise play at all times, especiallywith other children.

3 Learn CPR.

• You will be taught CPR at the hospital

• All care givers must know CPR

3 Post CPR instructions near bedside.

3 Post emergency numbers nearphone.

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SAFETY TIPS.

IF YOUR CHILD USES A VENTILATOR:

3 Routinely check the ventilator safety and auditory alarms to be sure they areworking properly.

3 Be sure the ventilator tubes are properly placed so that they don’t pull on thetracheostomy tube.

3 Don’t twist or pull on the tracheostomy connector any more than you must.This may cause discomfort to your child or disconnect the ventilator tubes.

3 Hold the tracheostomy tube in place when connecting/disconnecting the ventila-tor or humidification tubing.

ILLNESS

Illness is no fun for anyone. It is best avoided with tracheostomypatients. So, see that your child eatshealthy foods. Be sure he’s up to datefor all shots and vaccines and keep himaway from others who are sick.

If illness occurs, you need to bevery watchful. If your child is vomiting,or has diarrhea or fever, you may haveto suction more frequently and give the child more fluids. Also, if vomitingoccurs, loosely cover the tracheostomytube with an artificial nose, bib or scarfto keep vomit out. If you think vomitmay have entered the tracheostomytube, suction immediately. If you seebits of food, call your doctor immedi-ately.

GETTING AWAY

Taking care of a child with a tracheostomy can require much of your time. Be sure to plan extra timefor yourself, your spouse and your other children.

If you are going out, you must use a baby-sitter who is trained in tracheostomy care. It is a good idea to train a grandparent or other familymember or a neighbor. Some parentsswap baby-sitting with other parents of patients with tracheostomy tubes.

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HOW TO SUCTION.

1. Wash hands.

2. Put on glove. Use the gloved handwhen touching suction end ofcatheter.

3. Attach catheter to machine.

4. Rinse catheter by suctioning sterilewater.

5. Put 2-3 drops of saline down thetracheostomy tube to loosen mucus.

6. Gently insert catheter into tra-cheostomy tube until it reaches theend of tube. (You will be taught inthe hospital about tracheostomytube length.)

7. Cover the thumb hole on catheterto suction.

8. Gently remove the catheter as youroll it between your thumb andforefinger. (Start to finish shouldtake no longer than 5 to 10 seconds.)

9. If you need to suction again; rinsethe catheter first.

10. Look at the mucus:

Normal: Clear with no odor.Infection: Yellow or green colorwith a foul-smelling odor. Blood: A few streaks of blood isOK. But if it has more bright redor old dark blood, there could bea problem.

11. If you see signs of infection, orbright red blood, call your doctor.

Follow the hospital’s or homehealth provider’s instructions for storage or disposal of catheters.

Keep the suction machine, tubingand collection jar clean according to the home health supplier’s instructions.

The lungs and wind pipe are meantto produce mucus. The mucus cleansthe air as we breathe by trapping smallparticles. It then moves up the wind-pipe until it can be swallowed.

Mucus can collect in and aroundthe tracheostomy tube. It must beremoved so it doesn’t dry and block the tube.

Suctioning should be done only as needed, usually upon waking, beforemeals (if needed), at nap time andbefore bed. Do not suction too fre-quently. The more you suction; themore secretions can be produced.

As your child grows older, you mayneed to suction less often. But, you willstill want to assess the need for suction-ing at least twice a day.

Note: Always follow your doctor’s orhospital’s directions if they differ fromthe directions in this guide.

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SUCTIONING.

WHAT YOU WILL NEED

Suction machine

Collection jar for secretions

Suction catheter

Sterile water

Resuscitation bag (optional)

Gloves

Saline

Watch for these signs that tell whenyour child may need suctioning. If yousee any of them, suction immediately.

• Increased gurgling, bubbling orcoughing

• Anxious or restless, crying

• Flaring nostrils

• Mouth, lips and fingernails may bepale, blue or dusky color

• Difficulty eating

• Hollow in the neck

• Skin under breast bone andbetween ribs pulls in

• Can’t cough out secretions

Discuss with your physician anytimeyour child experiences signs that requireimmediate suctioning.


5. Leave the old ties in place. Threadthe folded end of one of the newties through one of the holes on thetracheostomy tube, going from theskin side, out toward you.

6. Pull the tie through, until it forms aloop. Draw the other ends throughthe loop until the tie is secured tothe tracheostomy tube.

7. Repeat steps 5 and 6 for the other tie.

8. Bring the loose ends of both tiesaround to the back of the neck andtie them together using a squareknot. (Don’t use a bow.)

Note: Change the location of theknot from side to side and in theback of the neck to prevent skinirritation.

9. Cut the ends of the ties leaving only1" to 2".

10. Carefully cut and remove soiled ties.

Note: You know the ties are pulledtight enough when you can fit thetip of your little finger snuglybetween the neck and the tie.

This job may be scary at first. Butwith practice, you’ll do just fine.

It is important to keep the areaaround the opening in the neck clean tohelp prevent infection. So, change tieswhenever they become wet or soiled,but change ties at least daily.

You will be using scissors close tothe face. So, you’ll need to hold yourchild still. This job is easier with twopeople. But it can be done by one, ifneed be.

HOW TO CHANGE TWILLTAPE TIES

1. Wash hands. (Both people, if twoare involved.)

2. Cut two lengths of twill tape, eachlong enough to fold in half and stillreach around the child’s neck. Setthese nearby.

3. One person holds the child, the oth-er changes the ties. If you are doingthis alone, swaddle the child secure-ly in a blanket to restrain the hands.

4. Place a rolled towel or blanketunder the child’s shoulders.

CHANGING THE TIES.

WHAT YOU WILL NEED

Tracheostomy twill tape orother tracheostomy tube holder

Blunt-nose bandage scissors

Towel or small blanket, rolled and placed under the child’sshoulders

Clean gloves (optional) depending on institution orphysician preference

10 11


1. Wash hands. (Both people, if two areinvolved.) Put on clean gloves.

2. Insert obturator into new tracheostomy tube.

3. Attach ties as shown in “How ToChange Twill Tape Ties” on page 10.(Do this before putting the tube inyour child’s neck.) Place tube with tiesattached in the opened package near-by.

4. Lubricate the end of the new tubewith a thin layer of water-based lubri-cant.

5. Place rolled towel or blanket underthe child’s shoulders.

6. Have your partner restrain the child’sarms while you cut the ties andremove the tube. (If no partner, swad-dle the child securely.)

7. Remove the old tube.

8. Gently insert the new tube, pushingback, then down, in an arcing motion.

9. Immediately remove the obturator asyou hold the tube in place with yourfinger.

10. Fasten the ties using a square knot.

11. Throw away the old tube and ties.

Note: You probably won’t have trou-ble inserting the new tube. But if youdo, be sure the child’s head is tiltedback. If you are still having difficulty,spread the skin around the stoma andinsert the tube while the child isbreathing in. Try a smaller size. Callyour doctor immediately if you haveany problems.

HOW TO CHANGE AN UNCUFFED TUBE.

This job may be scary at first, but with practice, it becomes easier. Frequent and routine changes of the tracheostomy tube and accessories arerecommended. This helps to preventgradual mucus build-up, which can clog or block the tube. Your doctor will advise you how often to change the tube. (If your doctor instructs youto clean and reuse the tracheostomytube, Mallinckrodt recommends thatShiley® Tracheostomy Tubes be discard-ed after 29 days of use.)

Changing the tube may upset thechild, and cause coughing which canlead to vomiting following insertion.That’s why it is best to do this before ameal or at least 1-1/2 hours after eating.

CLEANING THE TRACHEOSTOMYTUBE

If you are instructed by your healthcare professional to clean the tracheosto-my tube, follow these instructions andwarnings:

Both the tube and obturator may be cleaned using either hydrogen perox-ide (half strength), household vinegar(half strength), sterile normal saline, orwater and mild detergent. After clean-ing, rinse thoroughly with sterile salineto remove all the cleaning solutionresidues. Allow to air dry.

If using a cuffed tracheostomy tube,the cuff should be rinsed gently in ster-ile saline and not come in contact with any cleaning detergents or chemicals.

WARNINGS:DO NOT USE SOLUTIONS OTHER THAN

THOSE MENTIONED ABOVE TO CLEAN ANY

PART OF THE TUBE OR OBTURATOR.DO NOT EXPOSE THE TUBE OR

OBTURATOR TO ANY CHEMICAL AGENTS

OTHER THAN THOSE RECOMMENDED, AS

THIS MAY RESULT IN DAMAGE.DO NOT SOAK THE TUBE OR OBTURA-

TOR IN PEROXIDE.IT IS ESSENTIAL TO VERIFY THAT

LUBRICANT DOES NOT ENTER AND

OCCLUDE THE TUBE LUMEN, THEREBY

PREVENTING VENTILATION.

CAUTION: SHILEY® TRACHEOSTOMY TUBES ARE

DESIGNED FOR SINGLE PATIENT USE ONLY.

Note: Always follow your doctor’s orhospital’s directions if they differ fromthe directions in this guide.

CHANGING THE TRACHEOSTOMY TUBE.

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WHAT YOU WILL NEED

Replacement tube (with ties already attached)

Blunt-nose bandage scissors

Towel or blanket to roll under the child’s shoulders

Water-based lubricant

A helper or a blanket to swaddle the child in


9. Place a rolled towel or blanketunder the child’s shoulders.

10. Have your partner restrain thechild’s arms while you cut the tiesand remove the old tube. If no partner, swaddle the child securely.If necessary, suction accumulatedsecretions above the cuff prior todeflating.

11. Gently insert the new tube, pushingback, then down in an arcingmotion.

12. Immediately remove the obturator,as you hold the tube in place withyour fingers.

13. Continue to hold the new tube inplace while your partner fastens theties using a square knot.

14. Inflate the cuff to the proper volumeusing a syringe. (Your doctor willtell you what volume to use.)

Note: Care must be taken to placethe air line and pilot balloon so thatthey do not become damaged dur-ing the child’s normal activities.

15. Throw away the old tube and ties.

Note: You probably won’t havetrouble inserting the new tube. But if you do, be sure the child’shead is tilted back. If you are stillhaving difficulty, spread the skin on the stoma and insert the tubewhile child is breathing in. Callyour doctor immediately if youhave any problems.

Note: Always follow your doctor’sor hospital’s directions if they differfrom the directions in this guide.

1. Wash hands. (Both people, if twoare involved.)

2. Remove the new tube from thepackage. Take care to avoid damag-ing the cuff, inflation line or pilotballoon in any way.

3. Use a syringe to inflate the cuff to the proper leak test volume. The markings on the syringe showair volume.

4. Place entire tube, including inflationline, in a basin with enough sterilewater to cover it and watch forbubbles indicating an air leak.

Note: If you see any leaks, DO NOT use the tube.

5. Deflate the cuff completely using a syringe. As you are doing this,gently push the cuff away from the end of the tube. Be sure toremove all air. This makes it easierto insert the tube.

6. Attach ties as shown in “How ToChange Twill Tape Ties,” on page10, and insert the obturator. Do thisbefore inserting the tube.

7. Lubricate the tube using a thin film of water lubricant.

8. Then place the tube with tiesattached in the opened packagenearby.

HOW TO CHANGE A CUFFED TUBE.

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SHILEY® TESTTUBE SIZE VOLUME

4.0 PDC 8.0 cc4.5 PDC 8.0 cc

5.0 PDC or PLC 9.0 cc5.5 PDC or PLC 9.0 cc

6.0 PLC 11.0 cc6.5 PLC 11.0 cc


1. Wash your hands.

2. Mix four (4) tablespoons of hydrogen peroxide solution withfour (4) tablespoons of water asshown on facing page. Empty the solutions into a clean basin orcontainer.

3. Place roll under your child’s shoulders to expose the stoma area.

4. Dip a cotton swab into the hydro-gen peroxide and water mixture.

5. Roll the cotton swab between thetracheostomy tube and the skinaround the opening. Clean fromthe stoma outward. This removeswet or dried mucus.

6. Repeat steps 4 and 5, using a freshcotton swab each time, until entirearea around opening is clean.

7. Rinse the area using clean cottonswabs, dipped in clean water only.Then let it air dry.

HOW TO CLEAN AROUND THE OPENING.

Skin care is easy, but important. Itshould be done at least twice a day:once in the morning and once at night.If you smell an odor around the neck oropening, clean the area every 8 hoursuntil the odor is gone.

In between skin care time, keep theneck and area around the opening cleanand dry. Do not use powders or lotions.The child could breathe them into thelungs.Watch for red, irritated areas. Ifexcessive redness or pimples occuraround the opening, call your doctor,reduce humidity and use only sterilewater for cleaning. If your doctororders an ointment, spread it on according to his instructions.

CLEANING AROUND THE OPENING.

16 17

WHAT YOU WILL NEED

Water and hydrogen peroxide, mixed half and half

Cotton swabs

Towel or small blanket, rolled up

Water Hydrogen Peroxide


At first your childmay not be able to makea sound. Don’t worry. As swelling decreases, he may begin to makesounds. In the meantime,watch his face. He cantell you a lot with hislooks.

How much soundyour child is able to makedepends on his age, thetracheostomy tube, hisbreathing patterns, etc.Some children can pro-duce sound around the tube. Othersmay use things called speaking valvesthat help control the airflow so they canspeak.

Your child will need special care sothat he will be able to speak properly as he grows. Be sure to show him things.Say their names. Read to him. Point topictures and say what they are. Talk tohim. Tell him what you are doing. A little extra effort really pays off.

At nine months, children can learnsign language. If you sign to your child,always say the words out loud whileyou sign.

A speech pathologist can be a bighelp because they will give you tips tohelp your child learn to talk properly.

Not all children have speech andlanguage delays. Many problems can beavoided. You are the key to preventingproblems.

HOW DO I KNOW IF MY INFANTNEEDS ME?

Any non-speaking child, especiallyif they are less than a year old, shouldbe closely monitored. If you are worriedthat you won’t know when your infantneeds you, let your baby sleep in thesame room with you. Better yet, put anintercom in the child’s room. Alwayscheck on your child frequently duringthe day.

Some people attach bells to theirinfant’s legs, so they will hear themwhen they wake and move. (Be sureyour child can not remove and swallowthe bells.)

LEARNING TO SPEAK.

Your child doesn’t have to be stuckin the house. You may take him withyou shopping, to the park, or on visitsto friends and family. Whenever you goout, prepare a travel kit.

IF IT’S COLD OUT

If it’s below-freezing outside, don’tlet your child breathe cold air directlythrough the tracheostomy tube. Thiscan be bad for his wind pipe and causeproblems.

Use a scarf, kerchief or single layerof gauze tied loosely around the neck. If you have an artificial nose, use that.These things warm the air as the childbreathes in. They also are good ways tokeep dust and dirt out on dusty orwindy days.

GOING TO SCHOOL

If your child is school age, he mayattend. But it’s important to contact theschool nurse to make special arrange-ments ahead of time, so that the schoolcan provide the proper care.

GOING OUT TO PLAY

Your child can play with other children. But you should supervise the play. Contact sports or rough games are not a good idea for childrenwith tracheostomies. Do not let yourchild play in pools, sandboxes or areaswhere small particles could get insidethe tracheostomy tube.

LEAVING HOME.

18 19

What You Will NeedSpare tracheostomy tubes (with obturators and ties, same size and one smaller)ScissorsPortable suctioning device with suction catheterSalineTissuesBulb syringeBreathing Medications (if child uses)Manual resuscitation bag (if ordered)


Secretions (see•kree•shuns) Anotherword for mucus.

Speaking Valve (spee•king valv) A one-way valve that lets air come inthrough the tracheostomy tube, butthen sends it out past the vocal cordsand mouth to make talking possible.

Speech Pathologist (speech path•ol•o•gist) A person trained to help peoplewith speaking and swallowing problems.

Stoma (sto•ma) Hole in the neck whereyou insert the tracheostomy tube.

Sterile (steer•ill) Free from germs.

Suctioning (suck•shun•ing) Vacuumingup mucus in the tracheostomy tube.

Swaddle (swah•del) To wrap a babylike a mummy with only his headsticking out.

Syringe (seer•enj) The thing the doctoruses to give shots, only there is no

needle on it.

Trachea (tray•key•ah) Your wind pipe.

Tracheostomy (tray•key•oss•tuh•mee)An operation where they cut a hole inthe neck to make breathing easier.

Tracheotomy (tray•key•oto•mee) Sameas above.

Trach Mask (trake mask) A device thatfits on the end of the trach tube toprovide moisture.

Trach Tube (trake toob) Short for tracheostomy tube. This is the tubethe doctor puts in the opening in yourchild’s neck.

Ventilator (vin•till•a•tor) A machinethat helps a person breathe.

Vocal Cords (vo•cal cords) Two stripsof tissue in the voice box in the neckthat vibrate to make sounds when we talk.

Artificial Airway (ar•teh•fish•allair•way) Another word for tracheostomy tube.

Artificial Nose (ar•teh•fish•all noz)Also called HME (heat and moistureexchanger). A device that warms and moistens the air your childbreathes in.

Bacteria (back•teh•ree•ah) Germs.

CPR A method for getting someone tobreath again once they have stopped.

Cannula (can•you•la) The tube part ofthe tracheostomy tube.

Cartilage (car•till•age) The tough tissue rings the wind pipe is made of.

Cuff The inflatable balloon on sometracheostomy tubes.

Diaphragm (die•ah•fram) The big muscle below the lungs that controlsbreathing.

Encrustation (in•cruss•ta•shun) Hard,crusty, dried mucus.

Exhale (x•hale) Breathe out.

Expiration (x•pire•a•shun) Breathe out.

Health Care Provider Nurses, nursepractitioners, doctors, respiratorytherapists, speech pathologists orothers that visit your home.

Health Care Supplier The companywhere you get special medical equipment.

Inhale (in•hale) Breathe in.

Inspiration (in•pire•a•shun) Breathe in.

Lumen (loo•men) Inside part of thetube, where the air goes in and out.

Mucus (mu•kuss) Slippery fluid that’sproduced in the lungs and windpipe.This dries and sticks to any surfaceand forms a crust.

Nebulizer (neb•you’ll•eyes•er) Amachine that puts moisture and/or medicine directly into the lungs.

Obturator (ob•tur•a•tor) The semi-rigid stick you put into the tra-cheostomy tube to help guide it intothe opening in the neck.

Phonation (fo•nay•shun) Talking ormaking sounds with the vocal cords.

Pliable (ply•ah•bull) Soft, flexible.

Saline (say•leen) Solution similar towater found in the body.

GLOSSARY (IN PLAIN ENGLISH).

20 21


1. Connector: The part of the tubethat sticks out of the neck.

2. Cannula: Another name for thetube part of the tracheostomy tube.

3. Neck Plate: This is where the ties are attached to hold the tracheostomy tube in place.

4. Size and style tracheostomy tube.

5. Size of the opening on the tra-cheostomy tube.

6. Size of the outside of the tra-cheostomy tube.

7. Cuff: Once the tracheostomy tube isin the neck, this is filled with air. Ithelps keep food, water or vomitfrom getting into the lungs.

8. Inflation Line: Carries air to andfrom the cuff.

9. Pilot Balloon: If there is air in thecuff, this will be puffed up. If youhave sucked all the air out of thecuff this will be flat.

10. Luer Valve: This is where you insertthe tip of the syringe to put air in,or take air out, of the cuff.

SHILEY® CUFFED TUBES.

7

1

3

4

PDC/PLC

2

6

5

8

10 9

1. Connector: The part of the tubethat sticks out of the neck.

2. Cannula: Another name for thetube part of the tracheostomy tube.

3. Neck Plate: This is where the ties are attached to hold the tracheostomy tube in place.

4. Size and style of the tracheostomytube.

5. Size of the opening on the tra-cheostomy tube.

6. Size of the outside of the tra-cheostomy tube.

7. Obturator: This is used to helpguide the tube during insertion.

SHILEY® UNCUFFED TUBES.

22 23

7

1

3

4

PDLPEDNEO

2

6

5


WHAT MAYSYMPTOM HAVE HAPPENED WHAT TO DO

Unable or difficult to pass Mucus plugging Put 2 or 3 drops of salinesuction catheter through tracheostomy tube. into the tracheostomytracheostomy tube. tube and suction. If this

doesn’t open it, change the tracheostomy tube.

Catheter too large for Contact your Home tube size. Health Care Supplier.

When you change diapers: Dehydration. Call your doctor.You notice your child has stopped wetting or is wetting a lot less.Dark urine with a strong ammonia smell.

Tube, or any part of the Faulty tracheostomy Replace the tube.tube is broken or doesn’t tube.work.

Tracheostomy tube was Replace the tube. cleaned using improper Always use only cleaning agents. those cleaning agents

recommended by the tube manufacturer.

Pulling or weight at Hold the neck plate withconnector. one hand while removing

ventilator tubing to re-duce pulling. Move venti-lator and tubing so it doesn’t pull on the trach-eostomy tube.

SOLVING PROBLEMS.

24 25


Your Child is: Build up of mucus. Suction. If symptoms• Restless remain after suctioning,• Crying call your doctor.• Scared look on face• Making a bubbling or

wheezing sound• Can’t cough out mucus• Pale color or blue,

dusky color around mouth and nose

• Flaring nostrils• Trouble eating• Looks hollow in the

neck• Skin on the chest is

sucked in

Yellow or green mucus, Infection. Call your doctor.bad smelling mucus or bright red blood comes out when you suction.

Tube comes out of the Pulling or weight at Hold the neck opening in the neck. connector. plate with one hand

while removing ventila-tor tubing to reduce pulling. Move ventilator (if used) and tubing so it doesn’t pull on the tracheostomy tube.

Tracheostomy ties Put the tube back into too loose or tied the the opening and retie wrong way. the tracheostomy ties

(refer to pages 10 and 11).


The best way to deal withthis is to have a plan.

Before the powergoes out, notify the powerand phone companies, inwriting, that your childuses a tracheostomy tube.Ask for priority for restor-ing service.

You may purchase aspecial light that goes on ifthe power goes off. Use thisto alert you.

You may go to a friend’sor family’s home. Also, youmight go to a hospital or firehouse where there will be anemergency generator.

27

IMPORTANT PHONE NUMBERS

Doctor

Home Care Provider

Home Care Supplier

Emergency

WHAT IF THE POWER GOES OUT?


Ventilator’s “High Ventilator tubing is Clear tubing of kinkPressure” alarm goes off. blocked or kinked. or blockage.

Mucus is plugging the Suction to clear mucus.tracheostomy tube.

If the first two sugges- Contact Home Healthtions don’t work, there Care Supplier.may be a ventilator problem.

Ventilator “Low Pressure” Ventilator tubing is not Make sure all tubing toalarm goes off. connected at machine. machine and patient is

connected.

If you have a cuffed Remove ventilatortracheostomy tube: tubing from tracheosto-Leak in cuff, inflation my tube. Deflate and line or pilot balloon. re-inflate cuff with

proper volume. Attach ventilator tubing. Turnon machine. Replace the tube if it will not remain inflated.

If the first two sugges- Contact Home Healthtions don’t work, there Care Supplier.may be a ventilatorproblem. Deliver breaths with a

manual resuscitation bag, if available.

26

The following applies only to patients on ventilators.


Your Child Has A Tracheostomy A Guide for Home CareOrder through:Beatrice Ames, RN, MS, CNAABoston City Hospital 818 Harrison AvenueNursing Education Bldg., 4th FloorBoston, MA 02118

Pediatric Tracheostomy Care Loma Linda Medical Center11234 Anderson Loma Linda, CA 92354Contact:Sherry BlansfieldRespiratory Discharge Therapist714-909-4488 Ext.: 6204

Tracheostomy Home Care For ChildrenContact:Sheila Kun, RN, MSBox 50Children’s Hospital of Los Angeles4650 Sunset Blvd.Los Angeles, CA 90027213-669-2554

HOME CARE MANUAL LISTINGS.

28

This section contains a listing of additional tracheostomy/laryngectomy care manualsthat are available through the authors or institutions listed below. Since patienthome care needs vary, please contact your physician or home health care provider for guidance in obtaining any of the following manuals.

NOTE:The information and procedures contained in the above listed Home Care Manuals are those of theauthors and institutions and do not necessarily reflect the opinions of Mallinckrodt Inc.

Our thanks goes to:Susan G. Engleman, RN, MSN, CS, PNP, CCRN, Clinical Nurse Specialist, Progressive Care Unit,Texas Children’s Hospital, Houston, TX for her assistance editing this publication.

A special note of gratitude to:Debra Prater, RN, MSN, Clinical Nurse for Otolaryngology, St. Louis Children’s Hospital for herhelp and advice provided during design, editing, illustration and photography for this publication. Her participation was an important factor in the success of this endeavor.

Home Care Of Your Child With A TracheostomyContact:Patient & Family Education CoordinatorChildren’s National Medical CenterTrinity Square216 Michigan Avenue NEWashington, DC 20010


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