Skills to be Learned
Date Posted: 25.03.2012
Before the child goes home, parents must be confident and competent in caring for their child's tracheostomy. Training is done at a pace to suit each family and is tailored to siut each family/child's individual needs. The whole purpose of this care is to ensure that the tracheostomy tube is clear and is secured at all times. The skills necessary include, suctioning a tracheostomy tube, tracheostomy skin care, tracheostomy tie change, tracheostomy tube change, humidification and recognizing signs of a blocked tube. Parents will become skilled in recognizing early signs of illness. They will also learn basic life support skills pre discharge.
Suctioning a tracheostomy tube:
The purpose of this procedure is to remove mucus/ secretions from the child's tracheostomy tube. Mucus is the body's normal method of cleaning the airway. As the tracheostomy tube is sited below the larynx (voice box) this means that the child will not be able to cough out secretions as well. The tube initially may be an irritant and may cause excess mucus to be produced. Suction is therefore necessary to keep the tracheostomy tube clear and prevent the build up of secretions which could predispose to a blocked tube or the child may develop a chest infection. There are very clear signs when a child will need to be suctioned and parents learn to recognize these signs very quickly.
Tracheostomy skin care / stoma care:
Skin at the tracheostomy site needs to remain clean and dry, therefore daily inspection and cleaning of the skin is essential. If secretions collect around the tracheostomy tube, germs can grow and cause infection or skin rashes. If the skin is red or irritated, a special keyhole dressing can be applied. The dressing can be placed between the skin and flanges of the tube; it should be changed regularly as wet dressings can cause skin irritation and infection. The use of creams and lotions on the neck and the tracheostomy site are not recommended unless prescribed by your ENT doctor.
Tracheostomy tie change:
Tie changes are done to ensure safety by preventing the tracheostomy tube from falling out, to prevent skin breakdown and to promote the comfort and well being of the child. Ties are changed at least daily or as needed i.e. when ties are wet or dirty. A tracheostomy tube is held in place by cotton ties or by a tracheostomy tube holder, which is sometimes referred to as Velcro ties. Two people are required to change the tracheostomy ties. This is to prevent the tube accidentally falling out by the child moving or coughing. One person holds the tracheostomy tube in place while the other person changes the ties.
Tracheostomy tube change;
The purpose of changing a tracheostomy tube is to prevent mucus plugs in the tracheostomy tube and to keep the tracheostomy tube clear. Some tracheostomy tubes are changed weekly i.e tubes made from PVC, others are changed monthly, those with an inner cannula or those made from silicone. Similarly, it may be necessary to change the tube more often if secretions become very dry or if your child is producing very thick secretions. Two people are required to change a tracheostomy tube – one to change the tube and one to assist.
Normally air that we breathe is warmed, moistened and filtered by the nose and mouth. A child with a tracheostomy tube in place breathes air directly into the lungs bypassing the nose and mouth. This means that approximately 75% of normal humidification is lost. It is therefore necessary to provide an alternate method of humidification for a child with a tracheostomy tube. There are a number of ways of doing this, these include nebulisitation, heat and moisture exchangers, mist collar and occasionally it may be necessary to use a heated humidity system.
Basic life support skills:
Once you have learned the necessary skills to care for your child and when parents are comfortable with changing the tube, they will receive training in basic life support. This training will complement the skills that they have already learned and it will prepare you for emergency events such as blocked tubes, tube fallen out, when your child is having breathing problems and what to do if your child stops breathing.
A tracheostomy tube may block at any time due to thick secretions which may accumulate in the tube making it difficult for the child to breathe easily. There are many ways to prevent this such as, suctioning, nebulisitation, humidification and routine tracheostomy tube changes. There are usually very clear signs which may indicate that a tracheostomy tube may be blocked:
•Difficulty passing a suction catheter through the tracheostomy tube
•Fast, noisy breaathing, very shallow breathing or no breathing.
•Blue colour around lips, nails and skin
If a blocked tube is suspected the tube must be changed immediately.