1. Keep Calm…It’s Just a Trach
Angela Wheeler RRT, BHS

2. Objectives Anatomy of Upper Airway Tracheostomy/Stoma
Assessment of Trach
Troubleshooting
Cleaning/Suctioning

3. What is a Tracheostomy?
It is an operation in which a small opening is made into the trachea via the anterior of the neck. After the skin has healed, the opening is called a stoma or tracheostomy. A tracheostomy tube is kept in the stoma to keep the hole open. This is also referred to as a “Trach”.

4. Trach Stoma

5. Upper Airway Anatomy

6. A tracheostomy is usually done for one of three reasons:
to bypass an obstructed upper airway;
to clean and remove secretions from the airway;
to more easily, and usually more safely, deliver oxygen to the lungs.

7. Trach Tube Complications:
TE Fistula
Tracheomalacia
Tracheal Stenosis
Scarring
Bleeding
Infections
Cellulitis (Wound Care)
Displacement

8. The skin around a trach can become red or sore from mucus build up if the site
is not keep cleaned and dry. The trach site may need to be cleaned several
times a day to avoid such irritations.

9. Trach tubes come in a variety of different materials such as metal, plastic (PVC), and silicon. There are also many different sizes and lengths.

10. How to care for a trach: Suctioning to remove obstructions
such as mucus.

11. Mucus is normal. It helps protect the respiratory system by filtering out dust, dirt and some germs. Sometimes there is more mucus produced because of a cold, allergies or respiratory illness. Trach patients can not close off their upper airway to create a back pressure to remove secretions. Therefore, suctioning of the trach is necessary.

12. What is effective suctioning?
Decrease possibility of upper airway infection such as pneumonia
Decrease the need for more oxygen

13. When do we need to suction?
If you see or hear mucus at the trach opening
Increase in respiratory rate and/or effort
Retractions, increased cough
Nasal flaring
Change in skin color (Pale, Blue)
Less active, upset, inconsolable
Sleepiness

14. Cleaning the trach and trach site:

15. Make sure to secure the trach.
Change the trach ties when cleaning the trach site.
Avoid oils or ointments unless doctor recommended.

16. Follow the “TRACHE” steps for optimal care Communicate with child and parents If in doubt…… Call 911