Tracheostomy Tube Care and Safety Newborn – Instructions

A tracheostomy tube, or trach tube, is a flexible tube that is placed in a hole (stoma) in the main airway (trachea) that leads down to the lungs. A tracheostomy allows your baby to breathe without using his or her nose or mouth. A trach tube may be needed if:

• Your baby’s airway is blocked by swelling, injury, tumor, a foreign body, a vocal cord problem, or severe narrowing of the trachea.
• Your baby needs long-term breathing assistance (ventilation).
• Your baby has excess airway mucus or other fluids (secretions) that require frequent suctioning.

If your baby has a trach, you must follow certain safety measures to keep your baby safe and free of infection.

What are some tracheostomy tube safety measures?

Always carry the emergency travel-sized trach kit for your baby when you leave the house. The kit should include:

• A portable suction machine.
• Suction catheters.
• A mucus trap.
• A bulb syringe.
• Two trach tubes. One should be the same size as the current tube, and the other should be smaller.
• Trach ties.
• A heat and moisture exchanger.
• Germ-free (sterile) water.
• 0.9% saline solution.
• Sterile gloves or hand sanitizer.
• Sterile gauze pads.
• Emergency phone numbers.

Follow these instructions at home:

Caring for the trach tube

• Secure the trach tube exactly as directed to keep the tube from moving out of place.
• Suction the trach tube as often as told by your baby’s health care provider, and exactly as directed.
• Cover your baby’s trach tube whenever you use any kind of spray product or powder. It is important that your baby does not breathe in the mist or powder.
• Do not sterilize plastic trach tubes and do not attempt to clean them in boiling water. They are to be used only once.
• Do not store replacement plastic trach tubes in a place that is warmer than 118°F (48°C).
• If you cannot remove your baby’s trach tube or the smaller tube that fits inside the trach tube (inner cannula), do not force it. Call your baby’s health care provider.
• Do not put anything in your baby’s trach tube that should not be there.
• Keep your baby’s stoma and trach tube dry when you bathe your baby.
• Keep clothing away from the trach tube. Clothing may block the trach tube. Avoid crew necks and turtlenecks. Do not dress your baby in clothes that shed fibers or lint such as fleece.

If your baby becomes sick:

• Suction more often.
• Make sure your baby is drinking enough breast milk or formula if he or she has a fever, has diarrhea, or is vomiting.
• If your baby vomits, lightly cover the trach tube with a towel, handkerchief, or gauze to keep vomit out of his or her airway. If you think vomit may have entered you baby’s trach tube, suction right away.

If your baby 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 ventilator or humidification tubing.
• Always use proper equipment and connections.

General instructions

• Clean your baby’s stoma site as directed to prevent infection.
• 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 put moisture in the air and to keep your baby’s airway and lungs from drying out. Clean the humidifier regularly to stop mold and mildew from building up.
• Get ongoing support, as needed, to adjust to living with your baby’s trach tube.
• If you are going outside in very cold air, put a filter on your baby’s trach tube to keep cold air from entering the trach tube. You can also loosely cover your baby’s trach tube with a handkerchief or gauze. This helps to warm the air as your baby breathes so the cold air does not bother his or her trachea and lungs. It also helps to keep out dust or dirt on windy days.
• Hang CPR instructions and emergency numbers where they can be seen in an emergency. All of your baby’s caregivers must know CPR.

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

Your baby may fully depend on the trach tube for breathing. Your baby’s breathing or heart may stop working if the trach tube falls out, becomes kinked, or gets blocked with mucus, a blood clot, or any other item that should not be in the tube. You will know that something is wrong with the trach tube if your baby shows the following signs:

• Breathing that is fast, difficult, or noisy.
• A fast heart rate.
• A lower blood oxygen level.

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

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

Contact a health care provider if:

• Your baby has a fever or persistent symptoms for more than 2 days.
• Your baby is vomiting.
• Your baby has swelling, redness, warmth, drainage, or tenderness around the stoma.

Get help right away if:

• Your baby has trouble breathing even after suctioning and cleaning.
• Your baby has a fever and his or her symptoms suddenly get worse.
• Your baby has trouble swallowing.
• Your baby has unusual sounds coming from the airway or continues to cough after suctioning.
• Your baby’s trach tube becomes plugged and you cannot clear it.
• Your baby’s trach tube falls out and cannot be put back in.
• Your baby is bleeding from the stoma.
• Your baby has bright red blood in his or her mucus.

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

Summary

• A tracheostomy tube, or trach tube, is a flexible tube that is placed in the main airway (trachea) that leads down to the lungs.
• If your baby has a trach, you must follow certain safety measures to keep your baby safe and free of infection.
• Clean your baby’s stoma site as directed to prevent infection.