Daily Tracheostomy Care

DAILY CARE

Your child has a tracheostomy to breathe. Air now passes directly into the trachea rather than through the nose. For a while your child will not be able to talk because the air does not go through the vocal cords.

You may feel afraid when you first start taking care of your child. This is normal. Keep in mind that you are helping your child to breathe. Things will become easier after you get used to doing the suctioning and “trach” care. The following information will help you.

FEEDING

Follow the guidelines given to you about what your child can eat. It is a good idea to suction before a feeding because the secretions increase during the feeding. While breast feeding or bottle feeding your baby, be careful not to let the formula drip into the trach. You can use a bib (without a plastic liner) to prevent this. Be sure to burp your baby well.

An adult should always be with your baby when they have a bottle in case they choke. NEVER PROP THE BOTTLE. Wait 30-60 minutes after feeding your baby to suction. Coughing stimulated by the suction may cause vomiting. If you can’t wait the 30-60 minutes, remember not to suction down past the end of the trach tube. This causes coughing and gagging.

NOTE: If food or liquid is seen in the trach, suction the trach and mouth immediately. Then, call your child’s doctor.

PLAY

Your child can take part in most play activities for his/her age. For an infant or small child, all small toy parts or objects should be removed from the play area because they might be put into the trach. Outdoor play is fun, but you must protect your child’s trach from extreme temperatures and/or dirt in the air. Very cold or very hot air may irritate your child’s lungs, making it hard for him/her to breathe. An artificial nose works well to protect your child’s trach and maintain moisture if needed. Your child may go to the beach, as long as an artificial nose or scarf is worn to keep the sand out. Your nurse will show you how to use the artificial nose.

Like all children, your child should be closely watched when in or near the water. Do not allow water to be splashed into your child’s trach.

COMMUNICATION

At first, your child may not be able to talk to you. This is because the air from the lungs does not pass through the vocal cords. It is important that you talk to your child, read stories, and talk about pictures. Your child may be able to learn to “talk” soon after the trach is in place, especially if he could speak or verbalize before the trach. Speech therapy is important for all children with a tracheostomy.

Infants

• Use your apnea monitor or pulse oximeter if ordered. Daily Tracheostomy Care Page 2 of 4
• Use your infant intercom.
• You may want to leave your infant’s door open during naptime and at night.

Child

An older child may use a Passy-Muir™ valve, or other speaking valve to assist with speaking. If your child cannot use a speaking valve, they may be able to learn sign language to better communicate. Your child’s doctor or speech therapist may discuss speech therapy with you.

Your child must have a way, if he cannot vocalize, to “call” for you when you are needed.

• Young child: A bell or squeeze toy can be given to the child. Be sure the pulse oximeter is on when you are not in the same room with your child.
• Older child: Keep paper and pencil at child’s side if they can get up and come to you for help, or a bell can also be given to the child.

BATHING

You may bathe your child in the tub and wash his/ her hair, but do not let water get into the trach. To wash an infant’s hair, hold your child on his/her back over a sink or tub. Wash and rinse the hair using a cup of water or spray carefully. You may allow your child to play in the water, but never submerge your child in the water or leave your child alone in the tub. An older child can take a shower as long as the trach is protected. You need not stay with an older child but it is a good idea to stay close by to help if they need you.

CAUTION: Avoid baby powder and spray cans. Particles and fumes from powders and aerosol sprays can get into the lungs through the trach. This can cause a burning feeling and breathing problems. Keep your home as free from lint, dust and animal hair as you can. Do not allow anyone to smoke cigarettes, cigars, etc. around your child. Smoke will irritate your child’s lungs.

SLEEPING

You may feel concerned that your child might need suctioning during the night and you want to hear him/her. Here are some suggestions you can follow to make sure you will know if your child needs you.

• Many infants need an apnea monitor at home. An alarm will sound if your baby is having problems breathing. Check your baby immediately to see if your child needs suctioning or other care. If the alarm repeatedly signals apnea, make sure your child’s doctor or nurse knows this.
• An intercom is another method you could use to know if your child is having breathing problems. One monitor can be placed in your bedroom and one in your baby’s room. You will be able to hear your baby moving around, and coughing or you could hear the bell ringing. Intercoms can be bought at baby stores and most department stores. If your child is older, they can call for your help or come get you if they have problems breathing. You can put a bell or a horn by your child’s bed for them to use if they are unable to call for help.

HUMIDIFICATION

It is important to keep the air your child breathes moist. This is because the air your child breathes no longer goes through the nose which moistens the air. One way to add moisture is to use a trach collar connected to a humidifier. This is usually worn during naptime and at night. Your doctor may tell you to use a saline nebulizer or to put saline directly into the trachea for additional humidification.

SKIN CARE AND THE TRACH

Gently wash the skin around the trach with soap and water. Make sure you rinse the skin well with water (be careful not to let water get into the trach). Gently pat dry. Do this at least once a day and more often if your child has a lot of secretions. Keep the skin around the trach clean and dry to prevent infection.

If there is a rash, drainage, or unusual odor around the trach, call your child’s doctor.

Check the trach ties often to make sure they are secure. Hold the trach in place as you check the ties. You should be able to get only one finger underneath the trach ties. If the ties are loose, change or tighten them.

The trach ties should be changed every day or more often if dirty. If you see skin breakdown around the trach ties, use padding such as moleskin around the trach tie to decrease the rubbing and change the trach ties more frequently.

TRAVEL

The trach may become clogged or come out when you are shopping, riding in a car, or doing other normal activities. Always carry the following equipment with you when you are away from home.

GO BAG & TRAVEL SUPPLIES

• Portable suction
• DeLee suction
• Resuscitation bag
• Scissors
• Extra trach tie
• Trach same size
• Trach smaller size
• Trach dressing
• Emergency telephone numbers
• Suction catheters
• Small bottle of normal saline or normal saline “bullets”
• Water soluble lubricant
• An extra artificial nose
• List of Go Bag items
• Hospital Discharge Summary or History and Physical
• Home Care Orders

ALTERNATE CAREGIVERS

A child with a trach needs to be watched closely. Parents cannot do this alone. You need and deserve a break. At least one other person should be taught how to suction a trach, change a trach and do trach CPR. If this person is not able to join you for teaching sessions at the hospital, talk to your home health nurse about providing training in your home.

ILLNESS

Your child is just like any other child in that she can get the flu, colds and other illnesses. Make sure your child gets immunizations and regular check-ups.

When your child is sick, usually they have more secretions. Your child may need more frequent suctioning. Remember, if your child’s secretions are thick, he may need more fluids and humidification. Always check with your doctor or healthcare provider for any unusual changes in your child’s condition.

If you notice any signs of illness or infection, call your child’s doctor.