Presentation on theme: "TRACHEOSTOMY CARE Joanna Sidey Paediatric Respiratory Nurse."— Presentation transcript:
TRACHEOSTOMY CARE Joanna Sidey Paediatric Respiratory Nurse
What is a Tracheostomy It 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 2 nd to the 4 th tracheal ring. A tube is inserted through the stoma.
Reasons for a Tracheostomy Airway Problems Congenital abnormalities i.e subglottic stenosis, haemangioma, vocal cord paralysis. Large tongue or small jaw i.e Treacher Collins. Cranio-facial i.e Aperts, Crouzons Granuloma, tracheomalacia Other Problems Chronic lung disease BPD, Long term ventilation i.e neuromuscular disease, fracture of cervical vertebrae, congenital central hypoventilation syndrome, cardiac disease
Types of Tubes Shiley tubes most commonly used. Bivona tube Portex tube Tracheotwist/dual tubes
Post-operative Care Preparation of bedside prior to child returning from theatres Spare tracheostomy 1 same size and 1 size smaller with introducers Tracheostomy dilators Tracheostomy tapes Suction equipment Humidifier Oxygen (if prescribed) Scissors Gloves
Care of post-operative tracheostomy The tracheostomy must be examined 4 times an hour and suctioned carried out in the first hours. New trachys can easily block with blood. Humidity must be provided in the first 24 hours and slowly weaned depending on the childs secretions. The stoma should be cleaned regularly as it can become infected Tapes should also be changed. First tracheostomy tube changed is performed by a member of the ENT team one week post-operatively.
Care of Tracheostomy stoma Use normal saline or cooled boiled water Observe stoma for signs of infection Ensure correct tension of tapes i.e one finger space Dressings can be used
Changing 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 equipment Clean tube with introducer Tapes Lubricant if used Suction Prepare and position child Remove old tube following the curve of the tube (child may cough) insert new tube. Remove introducer attach tapes.
Suctioning of Tracheostomy Aim is to keep the trachy tube clear of secretions. Ensure equipment is available Wash hands/gloves Connect catheter to suction machine tubing. Try not to handle last 7-10cm of catheter Insert catheter without suction then apply suction and withdraw catheter Do not keep suction applied for longer than 10 seconds Observe secretions for changes in colour and thickness Suctioning more frequently Unpleasant Tinged with specks of blood
Tracheostomy Complications Bleeding Too frequent or vigorous suctioning Suction pressure that is too high Lack of humidity to the airway Infection Trauma Infection –children with trachys are at higher risk from respiratory infections Can the child breathe through their upper airway i.e how dependent are they on their trachy.
Speech with a tracheostomy Small babies under 1 year cannot make any or very little noise An air leak around tracheostomy tube is required to allow air to vibrate vocal cords Speaking valves can be used when there is an air leak. Benefits are permits normal voicing, uninterrupted phonation, louder tone. Restores sense of smell and taste Contraindications No leak Decreased cognitive status Tenacious pulmonary secretions.
Home Equipment Tracheostomy tubes Tracheostomy tapes Dressings Suction equipment Portable and rechargeable Stationary electric suction machine Humidification Heat moisture exchanger humidifier