Tracheostomy Tube Care and Safety Children

A tracheostomy tube, or trach tube, is a plastic or metal tube that is placed in a hole (stoma) in the neck. The tube goes into the airway (trachea) that leads down to the lungs. A tracheostomy allows your child to breathe without using his or her nose or mouth. A trach tube may be needed if your child has:

• Swelling, injury, tumor, or severe narrowing of the trachea that blocks the airway.
• A breathing machine (ventilator)for long-term breathing assistance.
• A swallowing problem that causes him or her to accidentally inhale food or saliva (aspiration).
• Excess airway mucus or other fluids (secretions) that require frequent suctioning.

If your child has a trach tube, you must follow certain safety measures to keep your child healthy.

What are some tracheostomy tube safety measures?

• Have an emergency trach kit and backup trach tube with you at all times. Ask your child’s health care provider what the emergency kit should include.
• Keep small toys that could fit in the trach tube away from your child.
• Have your child avoid contact sports and water sports. Ask your child’s health care provider what sports are safe for your child.
• Try not to get water in the trach tube. If your child is too young for a shower, bathe the child in 1–2 inches of water. Older children can shower.

Follow these instructions at home:

Caring for the trach tube

• Clean and care for the trach tube as instructed by the health care provider and the manufacturer.
• Secure the trach tube to keep the tube from moving out of place.
• Suction the trach tube as often as told by your child’s health care provider.
• Cover your child’s trach tube whenever you use any spray product or powder.
• Do not store replacement plastic trach tubes in a place that is warmer than 118°F (48°C).
• If you cannot remove your child’s trach tube or the smaller tube that fits inside the trach tube (inner cannula), do not force it. Call your child’s health care provider.
• Do not put anything in your child’s trach tube that should not be there.
• Keep clothing away from the trach tube. Avoid crew necks and turtlenecks. Do not dress your child in clothes that shed fibers or lint, such as fleece.

If your child becomes sick:

• Suction the trach tube more often.
• If your child vomits:
  • Lightly cover the trach tube with a towel, handkerchief, or gauze to keep vomit out of his or her airway.
  • Suction the trach tube right away if you think that vomit may have entered it.

If your child uses a ventilator:

• Routinely check the ventilator alarms to be sure they work properly.
• Be sure the ventilator tubes are properly placed so they do not pull on the trach tube.
• Do not twist or pull on the trach connector more than needed. This may cause discomfort or disconnect the ventilator tubes.
• Hold the trach tube in place when hooking up or disconnecting the tubes from the ventilator or humidifier.
• Do not leave your child alone. Children who are on ventilators must have an awake and fully trained caregiver with them at all times.

Preventing infection

• Wash your hands often with soap and warm water.
• Clean your child’s stoma site as directed by the health care provider.
• Make sure your child receives all the appropriate vaccines for his or her age.
• Keep your child away from people who are sick.
• Avoid crowded places, such as day care centers.
• Make sure your child brushes his or her teeth regularly.

General instructions

• Avoid dust, mold, tobacco smoke, other types of smoke, and fumes from cleaning solutions, such as ammonia or bleach.
• Use a humidifier at home to keep your child’s airway from drying out. Clean the humidifier regularly.
• If you are going outside, put something over your child’s trach tube, such as a handkerchief or gauze. This will:
  • Prevent dust or dirt from getting into the tube.
  • Keep cold air from entering the trach tube rapidly and causing irritation and coughing.
• Hang CPR instructions and emergency numbers where they can easily be seen. All your child’s caregivers must know CPR.

What if my child fully depends on the tracheostomy tube for breathing?

If your child fully depends on the trach tube for breathing, his or her breathing may stop if the trach tube falls out, becomes kinked, or gets blocked. You will know something is wrong with the trach tube if your child has:

• Breathing that is fast, difficult, or noisy.
• A fast heart rate.
• A lower blood oxygen level as indicated by an oxygen monitor (pulse oximeter).
• Bluish skin.

Have your emergency trach kit nearby at all times to handle this situation.

If you think your child’s breathing or heart function is in danger because of a blocked or dislodged trach tube, follow instructions from your child’s health care provider. If you are not able to do this, call your local emergency services (911 in the U.S.) for help.

Contact a health care provider if your child has:

• Trouble breathing.
• Trouble eating, swallowing, or speaking with the trach tube.
• Food or drink coming out from the trach tube.
• Vomiting.
• Mild bleeding around the stoma.
• Signs of infection, such as a fever.
• Swelling, redness, warmth, drainage, or tenderness around the trach stoma.

Get help right away if:

• Your child:
  • Cannot breathe, even after suctioning and cleaning.
  • Has a fever and symptoms suddenly get worse.
  • Is bleeding heavily from the trach stoma, or if bright, red blood or mucus is coming out of the trach tube.
• Your child’s trach tube:
  • Becomes blocked and you cannot unblock it.
  • Falls out and cannot be put back in.

Summary

• A tracheostomy tube, or trach tube, is a flexible tube that is placed in a hole in the neck.
• A tracheostomy allows your child to breathe without using his or her nose or mouth.
• Have an emergency trach kit and backup trach tube with you at all times.
• Get help right away if your child’s trach tube falls out or becomes severely blocked.