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
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