1. Joanna Sidey Paediatric Respiratory Nurse
TRACHEOSTOMY CARE
Joanna Sidey
Paediatric Respiratory Nurse

2. 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.

3. 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

4. Types of Tubes Shiley tubes most commonly used. Bivona tube
Portex tube
Tracheotwist/dual tubes

5. 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

6. Care of post-operative tracheostomy
The tracheostomy must be examined 4 times an hour and suctioned carried out in the first 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.

7. Care of Tracheostomy stoma
Use normal saline or cooled boiled water
Observe stoma for signs of infection
Ensure correct tension of tapes i.e one finger space
Dressings can be used

9. 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.

11. 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

12. Tracheostomy Complications
Bleeding
Too frequent or vigorous suctioning
Suction pressure that is too high
Lack of humidity to the airway
Infection
Trauma
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.

13. 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.

14. Home Equipment Tracheostomy tubes Tracheostomy tapes Dressings
Suction equipment
Portable and rechargeable
Stationary electric suction machine
Humidification
Heat moisture exchanger
humidifier

15. Useful information