Date Posted: 26.03.2012

The Operation
Naturally you as a parent are going to be very anxious and worried coming up to and during the operation. The following are the steps involved during the operation.

* The operation is carried out under general anaesthesia. One parent accompanies the child into the pre-op room where the general anaesthesia is administered.
* During the course of the operation a member of the ENT team will keep you up to date with your child's progress
* The child is then brought into the operating theatre and is placed lying on his/her back with the neck extended on a shoulder roll.
*A 1-2cm horizontal skin crease incision is made in the neck and local anaesthetic is applied.
* A tracheostomy tube of appropriate length and diameter for the child is chosen.
*Further incisions are then made in order to visually identify the trachea(windpipe).
* Stay sutures are then positioned through the second and third or third and fourth rings of the tracheal cartilage. The stay sutures are taped to the chest wall and labeled clearly. Their function is to assist with the first tube change or in an emergency should the tube become blocked or dislodged before the tract has become established.
* In conjunction with the anesthetist, a vertical incision is performed between the stay sutures and a stoma is fashioned.
* A tracheostomy tube is then introduced into the trachea.
* Once the tube is sited, the wound is closed loosely around the tube and the tube is secured in place with tapes and sutures.
* A chest Xray is performed routinely after surgery to confirm tube position and rule out any complications post surgery.
* After the surgery the child is transferred to paedriatric intensive care unit or to a designated ENT unit for a period of 5-7 days approximately.
* After the operation no food or drinks will be allowed for a minimum of three hours until the anaesthetic has worn off.

Naturally you are going to have many questions regarding your child's trachaestomy. It is important that you ask questions regarding your fears and worries. The following points are an indication of some of the things to expect during your stay in hospital.

* A minimum stay of 6-8 weeks in hospital from the time of surgery. This will allow time for your child's recovery and time for you as parents to learn to care for your child's tracheostomy. It will also help you to gain confidence in preparation for discharge.
* Multidisciplinary team approach - There will be many people involved in your child's care. Some people you will meet include: ENT Consultant, ENT Registrar, ENT Senior House Officer (HSO), Airway nurse specialist, Staff nurses, Speech and Language Therapist, Psychologist, Medical Social Worker, and Dietician.
* The ENT/Airway team will explain the operation in detail, discuss any worries you may have and will continue to provide up to date information regarding your child's progress.
* Parents are encouraged to participate in their child's care and they will be involved in all decision making. The team's approach is open, frank, and honest. No false hopes will be given to the parents. It is very important that parents are aware of all possible outcomes.
* An approximate timeframe will be given to parents for the length of time the tracheostomy tube will be required depending on your child's condition.
* Following surgery your child will spend approximately 5-7 days in an intensive care environment or ENT unit. This is because the tracheostomy is new and needs special attention at this stage. This can be a very stressful/frightening time for parents due to the nature of the environment, which is surrounded with monitors and equipment and also emotionally parents are trying to come to terms with the shock of their child needing a tracheostomy tube. It is important to remember that your child is in the best place possible and is getting the best of medical attention while in the Intensive Care Unit. It is also essential for you to ensure that you are getting adequate rest/diet at this time.
* Encourage your family to come to visit you and to give you as much help and support as they can. Don't be afraid to ask for help. It is not a sign of failure.
* Become familiar with the staff and the ward and talk to them whenever you have any fears.
* Once you feel ready, training will begin and you will learn the necessary skills to care for your child's tracheostomy at home.
* After about 5-7 days your child will be transferred from the Intensive Care Unit to one of the hospital wards.
* The Speech and Language therapist will work with you and your child in relation to feeding and a method of communication will be introduced.
* Once you have learned the necessary skills that are required to care for your child you will be encouraged to take your child out for a few hours prior to discharge. This will help you gain confidence before leaving the hospital and it will allow you to become familiar with your equipment and supplies.
Source : www.TagIreland.com