Wilson & Hockenberry: Wong’s Clinical Manual of Pediatric Nursing, 8th Edition: Patient Teaching Guide

Wilson & Hockenberry: Wong’s Clinical Manual of Pediatric Nursing, 8th Edition

Patient Teaching Guide

For additional information regarding tracheostomy care see www.tracheostomy.com/resources/pdf/TrachHandbk.pdf.

This section may be photocopied and distributed to families.

Source: Wilson D, Hockenberry MJ: Evolve resources for Wong’s clinical manual of pediatric nursing, ed 8. Copyright © 2012, Mosby, St Louis.

Caring for the Child with a Tracheostomy

A small opening (stoma) was made in the child’s windpipe (or trachea) (Figure 1) to help her breathe more easily. The tracheostomy (“trach”) will require special care while you are at home. Suctioning equipment, a humidifier, and other supplies will be needed. While the child is in the hospital, you should practice using the same suction machine (and monitor) that you will be using at home. This helps you to become familiar with the Equipment.

Supplies that you will need when you are outside the house are the following: a mucus trap that can be used when the suction machine is not available, sterile saline, water-soluble lubricant, tracheostomy tube with ties attached, scissors, and emergency phone numbers. These items should be kept in a to-go bag that is ready at all times. Practice with these items while the child is in the hospital.

Special Considerations

Certain precautions are needed for the child with a tracheostomy. Because the air that the child breathes no longer passes through the nose and mouth, it is no longer warmed, moistened, and filtered before it enters the lungs. To keep the mucus liquid, so that it is easy to remove by both suctioning and coughing, added moisture is needed. Your health professional will advise you on the amount of liquid that should be given to the child to drink throughout the day.

When the child is out in hot, dry, or cold weather or on very windy days, wrap a handkerchief or scarf around the child’s neck. This will help warm and filter the air the child breathes. Humidifying or filtering devices can also be bought. A heat and moisture exchanger (HME), also called an artificial nose, provides humidification when you are not using the mist collar and heated humidifier. Children in stable condition who are not requiring supplemental oxygen can wear the HME as tolerated, usually not longer than 4 hours. The tracheostomy mist collar is recommended for sleeping. To keep food and liquids from falling into the tracheostomy, use a cloth bib with short ties when the child is eating.


The tracheostomy makes it harder for the child to make her needs known. Nursery monitors or intercoms can be used to listen for changes in the child’s breathing while you are in another room. This may signal that the child needs you.

Older children can use bells to call you, or talking boards, where they can point to different words. If the child is old enough to write, the child may choose to communicate in this way. Some children are able to talk by placing their finger over the tracheostomy for short periods of time.

A Passy-Muir valve can be attached to the tracheostomy tube, which allows for vocalization and an audible cry. This usually requires a speech therapy consultation but can be of great value to families and may foster parent–infant bonding and allow the parent to better meet the infant’s or child’s needs.

Skin Care

The moist secretions from the tracheostomy can irritate the skin. It is important to keep the area around the tracheostomy clean and dry to prevent skin irritation and infection. Wash the skin with soap and water, and dry well. Change the tracheostomy ties each day or if they become wet or dirty. If tracheostomy ties are used, tie the knot in a new place each time to keep from irritating the skin. Do not tie the ties in a bow. Do not apply any ointments or other medications on the skin unless you are told to do so by your health professional.

In some children a small tracheostomy dressing may be used to prevent the tracheostomy tube from rubbing against the skin. If your health practitioner or surgeon recommends a dressing, change the tracheostomy dressing each time it becomes soiled or dirty. However, a dressing is not always necessary, and it may add moisture to the site and encourage a yeast rash. Avoid using gauze dressings because the fibers may become loose and be inhaled into the trachea. A cotton mesh dressing may be used.

Barrier creams or ointments (Desitin, Vaseline, Ilex, etc.), or barrier wafers, wipes, or dressings (Cavilon No Sting Barrier Film, AllKare Protective Barrier Wipe, Stomahesive Skin Barrier, Coloplast Skin Barrier) can be used to protect the skin around the tube if leaking occurs.


Careful adult supervision is needed when the child is near water. Tub baths can be given, but be careful not to allow water into the trach. Swimming and boating must be avoided; however, the child can use a wading pool with supervision.

Any smoke, aerosol sprays, powder, or dust can irritate the lining of the child’s trachea. Therefore the child should not be in the same room with anyone who is smoking or where aerosol sprays (e.g., hairspray, antiperspirants) are being used. Strong cleaning liquids such as ammonia are also irritating. Hair from animals that shed can clog the child’s trachea. Avoid stuffed animals and toys with small parts that can be removed and put into the tracheostomy by a curious child.

All the people who provide care for the child must be aware of how to suction fluids from the tracheostomy so that they can help you. Anyone caring for the child alone must also know cardiopulmonary resuscitation (CPR). Tape a list of emergency phone numbers to each telephone in the house. Include 911 (if available in your area), numbers for the local hospital and your health professional, and any other numbers that are needed.

Call your health professional at (phone number) if any of the following occurs for 12 to 24 hours:


You will need to suction secretions from the child’s tracheostomy to keep the airway clear of mucus. Suctioning helps the child to breathe more easily. Suctioning should be done when the child wakes up and before sleep, and when any of the following occurs:

Jan 16, 2017 | Posted by in NURSING | Comments Off on Wilson & Hockenberry: Wong’s Clinical Manual of Pediatric Nursing, 8th Edition: Patient Teaching Guide

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