Tracheostomy care
Description
Required to ensure airway patency by keeping the tube free of mucus buildup, maintaining mucous membrane and skin integrity, preventing infection, and providing psychological support
Three types of tracheostomy tubes: uncuffed, cuffed, or fenestrated; selection dependent on the child’s condition and the physician’s preference
Uncuffed plastic or metal tube — allows air to flow freely around the tracheostomy tube and through the larynx, reducing the risk of tracheal damage
Plastic cuffed tube (disposable) — the cuff and tube won’t separate inside trachea because the cuff is bonded to the tube; doesn’t require periodic deflating to lower pressure because cuff pressure is low and evenly
distributed against the tracheal wall; reduces the risk of tracheal damage
Plastic fenestrated tube — permits speech through the upper airway when the external opening is capped and the cuff is deflated; also allows easy removal of the inner cannula for cleaning, but it may become occluded
Equipment
Aseptic stoma and outer-cannula care
Waterproof trash bag ♦ two sterile solution containers ♦sterile normal saline solution ♦ hydrogen peroxide ♦sterile cotton-tipped applicators ♦ sterile 4″ × 4″ gauze pads ♦ sterile gloves ♦ prepackaged sterile tracheostomy dressing (or 4″ × 4″ gauze pad) ♦ supplies for suctioning and mouth care ♦ water-soluble lubricant or topical antibiotic cream ♦ materials as needed for cuff procedures and for changing tracheostomy ties (see below)
Aseptic inner-cannula care
All of the preceding equipment plus a prepackaged commercial tracheostomy care set, or sterile forceps ♦ sterile nylon brush ♦ sterile 6″ (15-cm) pipe cleaners ♦ clean gloves ♦a third sterile solution container ♦ disposable temporary inner cannula (for a child on a ventilator)
Changing tracheostomy ties
30″ (76.2-cm) length of tracheostomy twill tape ♦ bandage scissors ♦ sterile gloves ♦ hemostat
Emergency tracheostomy tube replacement
Sterile tracheal dilator or sterile hemostat ♦ sterile obturator that fits the tracheostomy tube ♦ extra, appropriate-sized, sterile tracheostomy tube and obturator ♦ suction equipment and supplies
Essential steps
Prepare the equipment properly as follows:
Wash your hands, and assemble all equipment and supplies in the child’s room.
Check the expiration date on each sterile package and inspect for tears.
Place the open waterproof trash bag next to you so that you can avoid reaching across the sterile field or the child’s stoma when discarding soiled items.
Establish a sterile field near the child’s bed and place equipment and supplies on it.
Pour normal saline solution, hydrogen peroxide, or a mixture of equal parts of both solutions into one of the sterile solution containers; pour normal saline solution into the second sterile container for rinsing.
For inner-cannula care, use a third sterile solution container to hold the gauze pads and cotton-tipped applicators saturated with cleaning solution.
If replacing the disposable inner cannula, open the package containing the new inner cannula while maintaining sterile technique.
Obtain or prepare new tracheostomy ties, if indicated.
Keep supplies in full view for easy emergency access. Consider taping a wrapped, sterile tracheostomy tube to the head of the bed for emergencies.
Assess the child’s condition to determine need for care.
Explain the procedure to the child and his parents, even if he’s unresponsive. Provide privacy.
Place the child in semi-Fowler’s position, unless contraindicated, to decrease abdominal pressure on the diaphragm and promote lung expansion.
Remove any humidification or ventilation device.
Using sterile technique, suction the entire length of the tracheostomy tube to clear the airway of any secretions that may hinder oxygenation.
Reconnect the patient to the humidifier or ventilator, if necessary.
Cleaning a stoma and outer cannula
Put on sterile gloves if you aren’t already wearing them.
With your dominant hand, saturate a sterile gauze pad or cotton-tipped applicator with the cleaning solution.
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