2What is a TracheostomyIt is an incision into the trachea (windpipe) that can be temporary or permanent opening.The opening hole is called a stoma.The incision is usually vertical in children and runs from the 2nd to the 4th tracheal ring.A tube is inserted through the stoma.
3Reasons for a Tracheostomy Airway ProblemsCongenital abnormalities i.e subglottic stenosis, haemangioma, vocal cord paralysis.Large tongue or small jaw i.e Treacher Collins.Cranio-facial i.e Aperts, CrouzonsGranuloma, tracheomalaciaOther ProblemsChronic lung disease BPD,Long term ventilation i.e neuromuscular disease, fracture of cervical vertebrae, congenital central hypoventilation syndrome, cardiac disease
4Types of Tubes Shiley tubes most commonly used. Bivona tube Portex tubeTracheotwist/dual tubes
5Post-operative CarePreparation of bedside prior to child returning from theatresSpare tracheostomy 1 same size and 1 size smaller with introducersTracheostomy dilatorsTracheostomy tapesSuction equipmentHumidifierOxygen (if prescribed)ScissorsGloves
6Care of post-operative tracheostomy The tracheostomy must be examined 4 times an hour and suctioned carried out in the first hours. New trachy’s can easily block with blood.Humidity must be provided in the first 24 hours and slowly weaned depending on the child’s secretions.The stoma should be cleaned regularly as it can become infectedTapes should also be changed.First tracheostomy tube changed is performed by a member of the ENT team one week post-operatively.
7Care of Tracheostomy stoma Use normal saline or cooled boiled waterObserve stoma for signs of infectionEnsure correct tension of tapes i.e one finger spaceDressings can be used
9Changing Tracheostomy tubes Carry out cleaning of stoma and changing tapes on a daily basis.Depending on age of child and type of tube changes take place between 1-4 weeks.Prepare equipmentClean tube with introducerTapesLubricant if usedSuctionPrepare and position childRemove old tube following the curve of the tube (child may cough) insert new tube. Remove introducer attach tapes.
11Suctioning of Tracheostomy Aim is to keep the trachy tube clear of secretions.Ensure equipment is availableWash hands/glovesConnect catheter to suction machine tubing.Try not to handle last 7-10cm of catheterInsert catheter without suction then apply suction and withdraw catheterDo not keep suction applied for longer than 10 secondsObserve secretionsfor changes in colour and thicknessSuctioning more frequentlyUnpleasantTinged with specks of blood
12Tracheostomy Complications BleedingToo frequent or vigorous suctioningSuction pressure that is too highLack of humidity to the airwayInfectionTraumaInfection –children with trachys are at higher risk from respiratory infectionsCan the child breathe through their upper airway i.e how dependent are they on their trachy.
13Speech with a tracheostomy Small babies under 1 year cannot make any or very little noiseAn air leak around tracheostomy tube is required to allow air to vibrate vocal cordsSpeaking valves can be used when there is an air leak.Benefits are permits normal voicing, uninterrupted phonation, louder tone.Restores sense of smell and tasteContraindicationsNo leakDecreased cognitive statusTenacious pulmonary secretions.
14Home Equipment Tracheostomy tubes Tracheostomy tapes Dressings Suction equipmentPortable and rechargeableStationary electric suction machineHumidificationHeat moisture exchangerhumidifier