Tracheostomy Care

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KEY POINTS

• A tracheostomy is surgery to make a small opening through the front of your child’s neck and into his windpipe (trachea). A tube is then placed through the opening and into your child’s windpipe. The tube keeps your child’s airway open and helps your child breathe by allowing air to flow into and out of your child’s lungs.
• Before your child leaves the hospital with a tracheostomy, you will learn know how to care for the trach. Your healthcare provider or the hospital staff will help you get any equipment you need at home.

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What is a tracheostomy?

A tracheostomy is a surgery to make a small opening through the front of your child’s neck and into the windpipe (trachea). A tube is then placed through the opening and into the windpipe. The tube keeps your child’s airway open and helps your child breathe by allowing air to flow into and out of the lungs.

Before your child leaves the hospital with a tracheostomy, you will learn know how to care for the trach. This includes:

• Making sure there is enough moisture in the air your child is breathing. Moisture helps protect the lining of your child’s lungs and helps keep mucus and fluid (secretions) thin. If the air is too dry, the secretions may get thick and hard to cough up. They may block the trach tube and make it hard to breathe.
• Removing secretions from the airway (suctioning). Suctioning makes it less likely that the tube will be blocked with mucus.
• Cleaning and changing the tube often. You may need to clean, disinfect, and reuse trach tubes.
• Cleaning the skin around the trach site and watching for irritation or infection.

Work with your child’s healthcare provider to learn how to care for the trach.

Humidifying

Before your child leaves the hospital, your healthcare provider or the hospital staff will help you get any equipment you need at home.

Humidifier: A humidifier is a machine that puts moisture into the air near the opening of the trach tube. Use the humidifier as recommended by your healthcare provider.

You will need to clean and disinfect the humidifier at least once a week, according to the supplier's instructions.

Heat moisture exchanger (HME): If your child’s secretions are thin and breathing is normal, your child may be ready to use an HME. An HME is a filter that fits onto the end of the trach tube. The HME collects moisture and warmth from the air your child breathes out, and adds warmth and moisture when your child breathes in.

Disposable HMEs are meant for single use. They should be thrown away when they get clogged with mucus. A reusable HME has plastic pieces that can be washed and a disposable filter.

A HME is usually used when your child is awake and active. When your child starts using an HME, you will need to increase how long your child uses it slowly. If the secretions don’t get too thick, your child may be able to use the HME for longer periods of time.

If your child’s mucus gets too thick while using the HME, your child may need to:

• Use a humidifier for 30 to 60 minutes to help thin the mucus.
• Use a nebulizer for 10 to 15 minutes with saline in the medicine cup and a trach collar. A trach collar is a soft plastic mask that fits over and around the tracheostomy tube to provide moisture.
• Drink more liquid to keep mucus thin, unless your provider has told you that your child should limit fluids.

Suctioning

Suctioning helps keep mucus from blocking the trach tube and makes breathing easier. It should be done only when your child cannot cough up secretions on his own. It is a good idea to suction before feeding your baby to prevent problems and help your baby sleep.

How often your child needs suctioning depends on how much mucus your child has, how thick the mucus is, and how well your child is breathing. It’s natural for the body to make saliva and cough up mucus. If you suction too much, your child may not have enough moisture in the airways. Signs that your child needs suctioning include:

• Visible mucous in the tube
• Gurgling or bubbly sounds
• Coughing or wheezing
• Trouble breathing or very fast breathing

Suctioning should be done before eating to help prevent vomiting during the suctioning.

Your healthcare provider will show you how to suction the trach tube. Be sure you understand the steps of suctioning and practice in the hospital before doing it at home.

Each time before you suction, make sure you have all the equipment you need. You will need a suction machine with tubing that attaches to a disposable suctioning tube (catheter). The catheter will be inserted through the trach opening into the airway to remove mucus and fluid. You will also need water to rinse the tubing.

Catheters can be reused as long as the tubing remains clear and flexible. Rinse the catheter with water and then allow it to air dry before storing it in a clean, dry place. Hydrogen peroxide can be used to rinse tubes with thick secretions. Also, rinse the catheter with water just before you use it.

Clean the catheter suction machine, tubing, and any other parts that have touched the secretions regularly. The equipment supplier will tell you how and when to do this.

Normal secretions are clear to white and thin to slightly thick. If your child’s secretions are very thick, you may need to suction 2 or 3 times. Your child should rest and take deep breaths for at least 30 seconds before you suction again. The best way to keep mucus thin and easy to suction is to use a humidifier and get plenty of fluids.

Signs that your child is not getting enough fluids may include urinating fewer than 3 times a day, dark yellow urine, and urine that has a strong ammonia smell.

Look carefully at the mucus and fluid removed from the trach for signs of infection. During the first 1 or 2 hours after your child wakes up, the mucus and fluid may be light yellow or green, but secretions should soon become clear or a white color. Call your child’s healthcare provider if:

• The mucus is more yellow or green than usual.
• Your child has a fever or is vomiting.
• The mucus has a bad smell.
• There is bright red blood in the secretions. (A few streaks of blood or a faint pinkish tinge in the catheter may be normal after a trach tube change.)

Talk to your healthcare provider if you have questions or concerns about suctioning.