Tracheostomy Care For Children
WHAT YOU SHOULD KNOW:
Tracheostomy (trach) care is done to ensure your child's trach tube and the area around it stays clean. This helps prevent a clogged tube and decreases the risk of infection. Trach care includes suctioning and cleaning your child's skin and parts of the tube. Your child's healthcare provider will show you how to care for the trach tube, and what to do in an emergency.
- Antibiotics: This medicine will help fight or prevent an infection. Make sure your child takes his antibiotics until they are gone, even if he feels better.
- Give your child's medicine as directed: Call your child's primary healthcare provider if you think the medicine is not helping or if he has side effects. Tell your child's primary healthcare provider if your child takes any vitamins, herbs, or other medicines. Keep a list of the medicines he takes. Include the amounts, and when and why he takes them. Bring the list or the pill bottles to follow-up visits.
Follow up with your child's primary healthcare provider as directed:
Write down your questions so you remember to ask them during your child's visits.
- Wash your hands: Always wash your hands before and after any trach tube care.
- Clean the trach equipment: Use clean or sterile trach care methods and clean the equipment as your healthcare provider directs.
- Keep your child's neck clean and dry: Change the gauze and trach ties when they are wet or dirty.
- Keep your child's mouth clean: Saliva and mucus contain germs that cause infection if they enter your child's airway. Your child's teeth should be brushed twice a day. Suction his mouth as needed to help prevent lung infections.
If your child is having trouble breathing:
- Try to clear the trach tube: Have your child cough to help move mucus, water, or irritants out of his airway. Small children often put small objects into the trach tube. Check the tube for any objects that may block your airflow. Suction the tube if coughing does not clear his airway and there are no objects present.
- Gently move the trach tube: The tube opening may be against your child's airway. Gently reposition the tube to make sure it sits in your child's airway properly.
- Replace the trach tube: Insert a new trach tube. Try a smaller size if a regular sized tube will not go in properly.
- Call 911: Call 911 if your child still cannot breathe easily.
Keep your child's secretions thin:
- Keep water and other materials out of your child's trach tube: Do not let your child swim. Cover the opening with a shower shield or trach cap while your child bathes to keep water from entering his airway. Prevent him from breathing in dust. Do not use powders or sprays near your child's trach tube.
- Give plenty of liquids: Ask your child's healthcare provider which liquids are best for your child. Ask how much liquid your child should drink each day.
- Humidify the room: Use a room humidifier or vaporizer as directed.
- Humidify your child's airway: You may be directed to use a heat moisture exchanger (HME), a trach collar, or fabric stoma covers. An HME attaches to your child's trach tube and prevents moisture loss. A trach collar connects to a machine that supplies humidified air to the trach. Fabric stoma covers are moistened and worn over the trach tube.
Suction your child's trach tube:
You may be told to suction your child's trach tube at least twice a day. Your child's healthcare provider will tell you if you need to suction more often.
- Watch for signs that your child needs suction: Suction when your child cannot cough up his secretions. Your child may seem restless or scared, and his breathing may be louder or faster than usual. Mucus may be coming out of the trach tube. His skin may look gray or blue.
- Wait after feedings: Do not suction your child's trach tube soon after he has eaten. He may cough or vomit if you suction too soon. Ask how long you should wait to suction.
- Prepare the suction machine: Suction machines have a pressure gauge. Your child's healthcare provider will tell you what amount of pressure to use when you suction the trach tube. You can test the pressure before you suction by covering the suction valve on the catheter with your thumb.
- Use saline only as directed: Your child's healthcare provider may tell you to insert a few drops of sterile saline into the trach tube to make your secretions thin. Do not use saline unless directed by your child's healthcare provider.
- Suction the trach tube: The catheter should be inserted until it is just past the end of the tube. Your child's healthcare provider will tell you how far to insert the catheter. The catheter may have measurements marked on it for you to follow. You can also measure and mark the catheter so you do not put it in too far. Have your child take a deep breath and try to cough up the secretions before you suction the trach tube. Only cover the suction valve as you remove the catheter. Gently twist the catheter as you pull it out. It should take less than 15 seconds.
Contact your child's healthcare provider or pulmonologist if:
- Your child has a fever.
- Your child has increased or thicker secretions than usual.
- Your child's secretions are yellow or green.
- You see thick, red tissue around your child's stoma, or the skin is red, swollen, or leaking pus.
- It is harder for your child to breathe than usual. Your child may be breathing faster than normal.
- Your child says that it hurts to swallow.
Return to the emergency department if:
- You see food or liquids coming from your child's trach.
- Your child's breathing problems are getting worse.
- There is blood on the trach tube or stoma.
- You cannot insert a new trach tube and your child is having breathing problems.
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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.