The registered nurse (RN), licensed practical nurse (LPN), respiratory therapist, family member or caregiver performs tracheostomy care, including suctioning, tie change, and stoma care as needed to provide safe effective management of the airway.
An assistant is always present when tracheostomy care is performed.
A comprehensive oral hygiene program (per institutional policy) is provided daily to the child with a tracheostomy.
Stoma care is to be provided every shift and more frequently on the basis of the clinical assessment and individual characteristics of the child, including the following:
Age
Muscular and neurological status
Activity level
Ability to generate an effective cough
Viscosity and quantity of mucus
Maturity of the stoma
Cleaning of the fresh stoma should be completed every 8 hours or more frequently if indicated by the accumulation of secretions.
After tracheostomy tube placement, stoma integrity and the area under the tracheostomy ties are assessed every 2 hours for the first 48 hours and then every 12-hour shift. Devices for securing the tracheostomy tube are checked regularly to assist in the prevention of accidental tube dislodgement.
To prevent accidental decannulation, a securing device is used to maintain the tracheostomy tube in place. Selection of the type of securing device is based on the individualized needs of the child (e.g., twill tie, self-fastening). The frequency of tracheostomy securing device changes varies from child to child based on the particular type of securing device and the condition of the device (e.g., unraveling ends, soiled or wet ties).
Care and management techniques may vary on the basis of the setting and the degree of prevention required to prevent microbial contamination:
Sterile technique (sterile catheters, sterile dressings, sterile gloves)
Aseptic Non-Touch Technique (ANTT) (sterile catheters, sterile dressings and nonsterile gloves. See Figure 125-1).
Clean technique (clean catheters, nonsterile dressings, and nonsterile disposable gloves or freshly washed clean hands)
Equipment is available at the bedside at all times for suctioning, ventilatory breaths, and recannulation.
The tracheostomy obturator and tube of the same type and size as being used by the child remain and in a smaller size is in a visible or readily accessible location at all times.
Before discharge, two adults, who will be consistent caregivers to the child, are trained in all aspects of the child’s care.
Shoulder roll—diapers or small rolled towel
Gloves (sterile or nonsterile, depending on the type of technique used)
Appropriate personal protective equipment (PPE) (gown and face shield)
Gauze or cotton swab applicators
Towel (sterile or clean, depending on the type of technique used)
Hydrogen peroxide solution (1.5%)
Sterile or clean cup to soak inner cannula
Soft sterile brush or sterile pipe cleaners
Water (sterile or clean, depending on the type of technique used)
Washcloth
Split gauze dressing (sterile or nonsterile, depending on the type of technique used)
Scissors
Split gauze dressing
Securing devices
Appropriate PPE (gown and face shield)
Stethoscope
Manual ventilation bag (as needed for ventilatory breaths)
Suction equipment (as needed) (see Chapter 103)
Oxygen source (if needed)
Extra obturator
Extra tracheostomy tubes of same size as being used by the child and one of a smaller size
Suction equipment (see Chapter 103)
Manual ventilation bag (as needed for ventilatory breaths)
Assess medical record for previous history of the child’s condition, current healthcare status, and for a summary of care needs in relation to tracheostomy.
Explain the procedure to the child and the family.
Determine the family’s ability to perform procedure and, if appropriate, have the family perform this procedure.
Determine the need for distraction measures to be implemented with the child to enhance cooperation during the procedure.
Assess condition of the stoma for redness, swelling, character of secretions, granulation, presence of purulence, or bleeding.
Assess the condition of the skin under the tie area.
Assess neck range of motion.
Assess the child’s breath sounds and work of breathing.
Suction the child before initiating tracheostomy care (see Chapter 103).
Ensure that the equipment is available at the bedside for use if the child requires suctioning, ventilatory breaths, or recannulation.
Maintenance of adequate hydration is of utmost importance in a child with a tracheostomy to prevent crusting and secretions around the trachea.
PROCEDUREPreprocedural Care
|
There is a concern that young children may pull self-fastening securing devices apart, leading to accidental decannulation. This type of device may not be indicated for young, active children.
PROCEDURECleaning the Stoma and Outer Cannula
|
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
