TRACHEOSTOMY CARE

Joanna Sidey

Paediatric Respiratory Nurse

What is a Tracheostomy

It is an incision into the trachea (windpipe) that can be temporary or permanent opening.

The opening hole is called a stoma. The incision is usually vertical in children and

runs from the 2nd to the 4th tracheal ring. A tube is inserted through the stoma.

Reasons for a Tracheostomy

Airway Problems Congenital abnormalities

i.e subglottic stenosis, haemangioma, vocal cord paralysis.

Large tongue or small jaw i.e Treacher Collins.

Cranio-facial i.e Aperts, Crouzons

Granuloma, tracheomalacia

Other Problems Chronic lung disease

BPD, Long term ventilation i.e

neuromuscular disease, fracture of cervical vertebrae, congenital central hypoventilation syndrome, cardiac disease

Types of Tubes

Shiley tubes most commonly used. Bivona tubePortex tubeTracheotwist/dual tubes

Post-operative Care

Preparation of bedside prior to child returning from theatres Spare tracheostomy 1 same size and 1 size smaller with introducers Tracheostomy dilators Tracheostomy tapes Suction equipment Humidifier Oxygen (if prescribed) Scissors Gloves

Care of post-operative tracheostomy

The tracheostomy must be examined 4 times an hour and suctioned carried out in the first 12-24 hours. New trachy’s can easily block with blood.

Humidity must be provided in the first 24 hours and slowly weaned depending on the child’s secretions.

The stoma should be cleaned regularly as it can become infected Tapes should also be changed. First tracheostomy tube changed is performed by a member of the

ENT team one week post-operatively.

Care of Tracheostomy stoma

Use normal saline or cooled boiled waterObserve stoma for signs of infectionEnsure correct tension of tapes i.e one

finger spaceDressings can be used

Changing Tracheostomy tubes

Carry out cleaning of stoma and changing tapes on a daily basis. Depending on age of child and type of tube changes take place

between 1-4 weeks. Prepare equipment

Clean tube with introducer Tapes Lubricant if used Suction

Prepare and position child Remove old tube following the curve of the tube (child may

cough) insert new tube. Remove introducer attach tapes.

Suctioning of Tracheostomy

Aim is to keep the trachy tube clear of secretions. Ensure equipment is available

Wash hands/gloves Connect catheter to suction machine tubing. Try not to handle last 7-10cm of catheter Insert catheter without suction then apply suction and withdraw

catheter Do not keep suction applied for longer than 10 seconds

Observe secretions for changes in colour and thickness Suctioning more frequently Unpleasant Tinged with specks of blood

Tracheostomy Complications

BleedingToo frequent or vigorous suctioningSuction pressure that is too highLack of humidity to the airwayInfectionTrauma

Infection –children with trachys are at higher risk from respiratory infections

Can the child breathe through their upper airway i.e how dependent are they on their trachy.

Speech with a tracheostomy

Small babies under 1 year cannot make any or very little noise An air leak around tracheostomy tube is required to allow air to

vibrate vocal cords Speaking valves can be used when there is an air leak.

Benefits are permits normal voicing, uninterrupted phonation, louder tone.

Restores sense of smell and taste Contraindications

No leak Decreased cognitive status Tenacious pulmonary secretions.

Home Equipment

Tracheostomy tubesTracheostomy tapesDressingsSuction equipment

Portable and rechargeable Stationary electric suction machine

Humidification Heat moisture exchanger humidifier

Useful information

www.tracheostomy.comwww.actfortrachykids.com