Objectives • Understand common reasons children receive tracheostomies • Identify different types of tracheostomy tubes used in Pediatrics. • Review basic care and supplies needed when caring for a tracheostomy tube. • Identify common problems seen in tracheostomy patients and suggested treatment. • Demonstrate hands on review of tracheostomy suctioning, trach tube change and obtaining tracheal aspirates.
Basic Tracheostomy Care • Stoma Care and Tie Changes – Stoma dressings usually off by discharge – Use tap water with liquid soap • Sterile tip applicators around stoma
– Stoma care once a day and PRN – Tie changes: Emphasize 2-PERSON for safety
Basic Tracheostomy Care Suctioning • Suction to pre-measured length • Suction as needed • Suction less than 5 seconds and allow child to return to baseline • Apply suction on insertion/withdrawal • Give breaths with manual resuscitation device between suctioning passes • Clean technique at home: may reuse catheter
Routine Trach Tube Changes • Routine changes weekly; 2 person procedure • Re-clean tracheostomy tubes according to instructions • Emergency equipment (Go-Bag) with child at all times
Common Pediatrician Calls • “My child has thick yellow secretions” – Viral vs. Bacterial? • Are other household contacts ill, fever curve, do secretions have odor, are the secretions thicker and have parents increased in suctioning frequency, what is oxygen requirement or saturations • Viruses can change your normal flora and colonized bacteria can progress to bacterial tracheitis
Common Pediatrician Calls – Deciding to treat: look at results from last trach culture • Amoxicillin alone may not treat • Bactrim will cover MSSA and MRSA • H/o pseudomonas: inhaled Tobra
– Bethkis – Kitabis pak – Pari neb kit needed for some patients (trach only)
• Family history of what worked last time and repeat • In doubt, call Pulmonary and we can help guide tx
– Never wrong to obtain trach aspirate to help guide therapy, can change therapy based on results if needed – If Bactrim allergy: consider alternatives based on previous sensitivities and call Pulmonary for recommendations – 10 days coverage for both inhaled and oral
Skin Concerns related to Trach • Redness around neck or stoma – Rarely yeast – Most common: moisture-associated dermatitis – Treatments: • keep area as dry as possible • If using stoma dressing, change often or leave off • Use barrier creams around neck and stoma such as Sensicare or other diaper creams
Skin Concerns related to Trach • A tracheostomy granuloma can occur as a result of surgery, infection or irritation. • The granuloma is usually red in color and bleeds easily. It does not contain nerves, so it is not painful. • A granuloma can grow in size and occlude the stoma when the trach tube is removed for changing • If granuloma present, notify the ENT so early treatment can occur. • Treatment can include: application of silver nitrate and/or use of steroid cream or steroid drops to stoma
