tracheostomy and ventilator education program module 5...

Tracheostomy and Ventilator Education ProgramModule 5: Trach Care

DisclaimerThis material is intended for use by trained family members and caregivers of children with tracheostomies who are patients at the Alberta Children’s Hospital. Although reasonable efforts were made to confirm the accuracy of the information, Alberta Health Services does not make any representation or warranty, express, implied or statutory, as to the accuracy, reliability, completeness, applicability or fitness for a particular purpose of such information. This material is not a substitute for the advice of a qualified health professional, so please seek medical advice from an appropriate health professional for questions regarding the care and treatment of any patient. Alberta Health Services expressly disclaims all liability for the use of these materials, and for any claims, actions, demands or suits arising from such use.

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• A basic introduction about trach care for your child

• Trach care includes:o Knowing what type of tracheostomy tube your

child has and whyo Assessing the stoma and the skino Cleaning and drying the stoma and the skino Dressing changeso Tie changes and ensuring they are secure

Trach Care7/30/2018

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Children’s Home Care Edmonton Zone 2016, Used with Permission

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• There are many different types of tracheostomy tubes available • When your child had their tracheostomy inserted surgically for the first

time, your Ear Nose and Throat Specialist chose a tube that met your child’s needs in terms of size and type

• As your child grows and their airway needs change, your health care team may choose a different type of tube for your child

Tracheostomy Tubes7/30/2018

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• All tracheostomy tubes, whether they are meant for children or adults, have some common features:o All tubes have the same sized connector at the end of the tube to

breathe through and connect to baggers and ventilators if neededo All tubes have flanges on either side of the tube that has holes on

either end which is where the trach ties go to secure the tube

All Tracheostomy Tubes7/30/2018

Flange Flange

Photo Used with Permission, JD 2017

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• All tubes have markings on the flange:o The brand of the tube – the company who

makes ito Whether it’s adult, pediatric, or neonatalo What size the tube iso The inner and outer diameters of the tube

in millimeters



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• Each tracheostomy tube comes with an obturator that is used as a guide to help with tube insertion – the obturator is sized specifically for that tube

• It is very important to make sure that the obturator for your child’s current trach tube is in their emergency kit - so you know where it is if you need it



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• All tracheostomy tubes vary in:o Size including internal/external diameterso Curvature to allow for the tube to sit comfortably within the tracheao Length that is appropriate for the size of the childo Materials (silicone or plastic) – BPA and latex freeo Cuffs – uncuffed or cuffed

• A cuff may be indicated to help seal the trachea when high ventilation pressures are needed and to prevent leaks

o Fenestrated or not – larger tubes only• A window or hole in the cannula part of the trach tube that allows for air

to pass from the lungs up through the vocal cords

Types of Tracheostomy Tubes7/30/2018

Components of Single Cannula Tracheostomy Tubes

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Flange

ConnectorObturator

CuffPilot Balloon

Cannula

Uncuffed Cuffed

ConnectorFlange

Obturator

Cannula

The most common pediatric

tracheostomy tubes are single cannula types of

tubes

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• Not used in small children• Indicated when the trachea is large enough to

accommodate the 2 cannulas• The inner cannula can be taken out and cleaned• Double cannula tubes can be cuffed, uncuffed,

fenestrated or unfenestrated

Components of Double Cannula Tracheostomy Tubes

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FlangeConnector

Inner cannulaFenestration

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• Single cannula • Uncuffed or cuffed (round)• Non-toxic plastic that is firm, flexible, kink resistant• Customizable

Shiley Tracheostomy Tubes

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Bivona Tracheostomy Tubes• Single cannula• Uncuffed or cuffed• Non-toxic silicone that is soft, flexible, kink

resistant due to wire support coil ( which may not be MRI compatible)

• Customizable• Multi-use: this means that at home this

can be cleaned and re-used for the same child

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Tracoe Tracheostomy Tubes• Single cannula• Uncuffed• Non-toxic silicone that is soft, flexible, kink resistant• Customizable

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Your Child’s Tracheostomy Tube• You should know:

o Your child’s diagnosis and why they have a trach in placeo Your child’s trach type and why that type of tube was chosen for your

childo Your child’s trach size and why that size is the right oneo Your child’s history with their trach – changes in sizes, brand, weaning

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Trach Care• Trach Care includes:

o Assessing the stoma and the skino Cleaning and drying the stoma, the skin, and the outer portion of the

tracheostomy tubeo Dressing changeso Tie changes and ensuring they are secure

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Trach Care

• Effective Trach Care will:o Keep the stoma and skin clean and dryo Keep the trach tube cleano Decrease the risk of infectiono Keep the tube safe and secure

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Trach Care• Wash your hands• Gather your supplies for performing trach care• Supplies should include:

o Distilled water (for home)o A clean cupo Cotton tipped applicatorso Gloveso Tweezers and scissorso New dressings and tieso Wash clotho Suction supplieso Emergency kit

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Trach Care• Set up your supplies on a clean surface• Position your child so that they are comfortable

o Each child is different in how they tolerate trach care and what position works best for trach care

o Some families find that a roll under the shoulders is helpfulo Some families find that swaddling a child can help keep busy hands out of the way

• Position yourself so that you can perform trach care safely• We recommend that it should always take 2 people to do tie changes to ensure

that 1 person is maintaining control of the tube while the other is changing the ties

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Trach Care• Wash your hands• Family members do not need to wear gloves, unless directed to do so in the

hospital• In the home, caregivers should perform trach care with gloves and should

have access to them• Gently remove the old dressing if there is one and assess it for drainage• Assess the stoma, skin, and neck for:

o Redness, irritation, or tendernesso Signs of bleedingo Signs of a rash or infectiono Irritation from the Velcro on the tieso Odour and discharge

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Trach Care• A cotton tipped applicator is used

to perform trach care• Use each applicator only once

and then dispose of it• Use as many applicators as you

need to clean the stoma• Start from the stoma and work

your way outwards to prevent introducing bacteria to the stoma area

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Trach Care• Dip the applicator in the distilled water to moisten it• Starting at the top of the trach tube, use the moistened

applicator to wipe outwards away from the stoma in a rolling motion

• Dispose of the cotton tipped applicator• Remembering where you started from, use another moistened

applicator and repeat this process until you have gone all the way around the stoma and under the flange

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Photos Used with Permission, JD 2017

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Trach Care• Once you have cleaned all around

the stoma and under the flanges, you need to repeat the same steps to dry around the entire tube and underside of the flange

• Always use a clean applicator for each new pass and then discard your applicator and get a new one

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• Your child may have a dressing if your health care team feels they need one • Dressings are used when there is drainage from the stoma or increased

secretions• If dressings are in place, they should be changed when wet or soiled• Only use the dressings provided for you – some dressings shouldn’t be used

for trach dressings because they are made of gauze that has loose fibers (which can stick to the stoma or be inhaled into the lungs)

• You may be prescribed ointments or creams to be applied to the stoma before placing the dressings – do not use any substance on the stoma unless you talk to your health care team (no powders)

Trach Dressings7/30/2018

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• You can use either forceps/tweezers or cotton tipped applicators to help you guide the dressing under the flange

• Be very careful when placing dressings

Trach Care7/30/2018



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Tracheostomy Ties• A trach holder that goes around the neck to secure the trach tube and keep it

from becoming dislodged• There are many types of ties available from twill tape to neoprene• The ties that we use for your child are approved by your health care team

and are provided for your childo These are durable, made of non-fraying material, and have Velcro at each

end to hold and secure the tube in place

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Tracheostomy Ties7/30/2018

• Portex, Posey, and Marpac are the approved, funded types of trach ties provided for your child


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Tracheostomy Ties• 2 people are required to safely perform a tie change

o 1 person to secure the trach tubeo 1 person to change the ties

• Ties should be changed when they are wet or soiled and whenever a trach change happens

• In the hospital, the trach ties will be changed once per day at minimum• The skin under the ties and the back of the neck should be assessed and

cleaned regularly

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Tracheostomy Ties• When changing ties, you may need to trim the Velcro ends on an angle to

make them fit into the flange easier

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Photo Used with Permission, JD 2017 Photo Used with Permission, JD 2017

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Tracheostomy Ties• Ties should always be checked for tightness at

the back and the side of the neck depending on your child

• They should be “pinkie” tight – you should be able to easily put a pinkie finger under the ties at the back and the side of the neck

• If there is not enough or too much room for your finger, the ties should be adjusted

• Always recheck tightness 15 minutes after a tie change

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