TRACHEOSTOMY
TEACHING GUIDELINES
FOR PATIENTS/FAMILIES
PICU
TRACHEOSTOMY TEACHING PATHWAY
• Explain possible reasons for tracheostomy.
• Discuss how the tracheostomy will work.
Pre-trach
Post-op
Day 1-5
Post-op
Day 5-7
• Ensure caregiver watches trach care video (EZTV 1093)
• Provide caregiver with trach care booklet which is obtained from Family Resource
Center (62558)
• Begin in the moment/bedside teaching with caregiver(s)
• Obtain tracheostomy teaching record from eDocs (this will guide teaching expectations)
• Consider teaching steps 3-7 located on teaching record
• Continue in the moment/bedside teaching with caregivers
• Provide CPR schedule and help coordinate class enrollment for families (see class schedule for
Post-Op
contact information)
Day 7 until • Collaborate with Case Management to ensure discharge supplies have been ordered
discharge
Key Points of Tracheostomy Teaching
.
Reasons for tracheostomy
.
How does the tracheostomy work
.
Tracheostomy type and size
.
Suctioning
.
Cleaning
.
Stoma Care
.
Tracheostomy ties and changes
.
Tracheostomy change
.
Bagging
.
When to call the doctor
Please place check mark bedside item as completed
PRE-OP DISCUSSION
Reasons for a Tracheostomy
 A tracheostomy may be temporary (used for a short time) or
permanent.
 Here are some possible reasons for a tracheostomy:
 Need for long-term use of a ventilator (a machine that helps with
breathing)
 Obstruction in the airway due to an accident, paralysis, surgery, or
malformation
 The need for frequent suctioning of secretions in the airway
 Obstruction of the airway during sleep (sleep apnea)
HOW DOES THE TRACHEOSTOMY WORK
H ow Yo u r C h i l d ’s Tra c h eo sto my Wo r k s
 T h e s u rg e r y i s d o n e i n a n o p e ra t in g ro o m .
 T h e s u rg e on c re a t e s a s m a l l o p e n i n g i n t h e
n e c k , c a l l e d a s to m a .
 T h e t ra c h e o s tomy t u b e i s p u t i n t o t h e s t o m a .
 O n e e n d o f t h e t ra c h e os tomy t u b e re s t s
o u t si d e t h e s t o m a . T h e o t h e r e n d re s t s i n s i d e
t h e w i n d p i p e ( t ra c h ea ) .
 W h e n yo u r c h i l d b re a t h e s i n , a i r g o e s t h ro u gh
t h e t u b e i n t o t h e t ra c h e a t o t h e l u n g s.
 W h e n yo u r c h i l d b re a t h e s o u t , a i r c o m e s o u t o f
t h e t ra c h e os tomy t u b e .
 Yo u r c h i l d c a n s t i l l a l s o b re a t h e i n a n d o u t
t h ro u gh h i s o r h e r n o s e .
Print this form from eDocs
and keep at patient’s
bedside until discharged.
Please do not scan and file
electronically until all
sections are completed.
SUGGESTED TIMELINE:
• Before trach placed
1&2
• After first trach change
4, 5d, 6, 7, 8, 9, 11
• Any time
3, 5 a/b/c, 6, 10
TRACHEOSTOMY CARD
SUCTIONING
1.
Collect Your Supplies
 Find a clean, well-lighted space. Collect your supplies: a
suction machine, a clean suction catheter, and a small
bowl of distilled water.
 Wash your hands with soap and warm water. Then, put on
clean, disposable, powderless gloves.
2. Prepare to Suction
 Turn on the suction machine to _________ mm Hg.
 Attach the suction catheter to the suction machine. Dip
the catheter tip into the distilled water to assure the
suction is working.
 Do the following only if your health care provider tells
you to: Put a small amount of sterile saline solution into
the tracheostomy tube. This will help loosen mucus.
SUCTIONING (CONT.)
3. Insert the Catheter
 Allow your child to take a few deep breaths or provide manual
breaths with the bag.
 Gently insert the catheter into the tracheostomy tube. While you
insert the catheter, do not suction. Stop inserting the catheter at the
predetermined measurement.
4. Apply Suction
 Apply suction. At the same time, slowly pull the catheter out of the
tracheostomy tube. Move the catheter tip in a circle as you pull the
catheter out.
 The catheter should be out of the tracheostomy tube within 5–10
seconds. If you need to suction more , allow your child to relax and
breathe for a few minutes before you start again.
 When you have finished suctioning, turn off the suction machine.
Discard the used catheter, water, and gloves. Parents may reuse
catheter at home, but in the hospital it is one use only.
CLEANING/STOMA CARE
Keeping the Tracheostomy Clean
 To take care of the skin and prevent infection, you need to keep
your child’s tracheostomy clean.
 Clean the tube and the skin around it at least once a day, or more
often if instructed by your doctor. Follow these steps and any other
guidelines you have been given. Choose a clean, well -lighted space.
Step 1
 Collect the following supplies:




Gauze pads or other non-fraying material advised by your doctor
Cotton swabs
Tracheostomy tube brush
Bowl filled with the type of solution recommended by your doctor. Your
doctor may recommend normal saline solution or a mixture of equal parts
normal saline and hydrogen peroxide.
 Wash your hands with soap and warm water. Put on clean,
disposable, powderless gloves.
CLEANING/ STOMA CARE (CONT.)
Step 2
 Clean the neck plate and skin.
 Remove the gauze from behind the neck plate. Check the area for signs of skin breakdown
or infection.
 Clean the neck plate and the skin under it. Use clean gauze pads or other non-fraying
material dabbed in normal saline solution. A thorough cleaning technique you may
consider involves cleaning the stoma in a step -wise fashion, one quarter at a time. This
pattern can also be followed on the surrounding skin and tube flange.






Use a new gauze pad/cotton swab for each section.
Start at the 12 o'clock position and wipe to the 3 o'clock position
Next, clean from 12 o'clock to 9 o'clock
Next, clean the 3 o'clock to 6 o'clock position.
Lastly, clean from the 9 o'clock to 6 o'clock position.
Gently pat the skin dry.
 Don't use a hydro gen peroxide mixture directly on your skin unless your
doctor specifically tells you to do so. Hydrogen peroxide can irritate the skin
and increase the risk for infection. If you are instructed to use a hydrogen
peroxide mixture on your skin, be sure to rinse the area with normal saline
afterward.
 Put a clean, precut gauze pad under the neck plate. This pad protects your
skin. Do not cut a gauze pad because the frayed edges will increase risk for
infection and a loose thread could potentially be inhaled into the trach .
TRACHEOSTOMY TIES
Keeping the Tracheostomy Ties Clean
 Tracheostomy ties fit around your child’s neck to hold the
tube in place.
 Fabric ties need to be changed when they are dirty.
 Supplies:




Velcro ties
Blanket roll to place under your child’s shoulders
Suction equipment and catheter
Second caregiver
 Step 1
 Wash your hands
 Step 2
 Place blanket under the shoulders to allow you to see the
tracheostomy better
TRACHEOSTOMY TIES (CONT.)
 Step 3
 Remove one side of the Velcro tie while the second caregiver holds
the tube in place.
 While the tie is removed, clean the neck with soap and water; dry
thoroughly
 Thread the clean Velcro tie into this side and attach
 Repeat with the opposite side
 Step 4
 Check the tightness of the new ties (ties should be just tight enough
to slip one to two fingers under the tie).
 Gently pull on the tracheostomy to make sure it is snug.
TRACHEOSTOMY CHANGE
Some people find it helpful to set up and do changing and cleaning in the
same place each time.
Choose a clean, well -lighted space near a sink. Supplies you will need for
cleaning and changing include:
Collect Supplies
 Rolled-up towel or pillow (to place behind child’s neck)
 Liquid soap, alcohol, or disinfectant foam
 Clean, disposable, powderless gloves
 Gauze
 Normal saline solution
 Tracheostomy ties and scissors, cut to the right length
 Tracheostomy tube
 Two sterile or disposable cups
 Small towel
 Suction machine
TRACHEOSTOMY CHANGE
Replace the Tracheostomy Tube
 Ask the doctor about whether or not to use an obturator, which
may make it easier to insert the tube. Its rounded edges also
protect the stoma during insertion.
 If you need to use a lubricant, be sure to ask the doctor how
much to use.
 Have a suction machine ready, if needed.
 Depending on the age of your child, explain the procedure as
well as you can.
 If two people are available, one person removes the old
tracheostomy tube and the other secures the new one.
BAGGING
 The manual resuscitator bag is often called “the bag”.
 It is used to give your child extra breaths.
How to bag
 Place the bag on your child’s trachoestomy
 As you squeeze the bag, watch your child’s chest rise
 As soon as your child chest rises, release the bag
 Repeat the cycle of squeezing and releasing until your child is
back to their baseline or usual breathing
WHEN TO CALL THE DOCTOR
Call the doctor right away if your child has any of the
following:
 Red, painful, or bleeding stoma
 Yellow or green, smelly, bloody, or thick mucus from the stoma
 Fever of 100.4°F or higher
 Swelling around the tracheostomy tube
 Pain when you suction the tracheostomy tube
 Shortness of breath or any trouble breathing
 Vomiting
 Tracheostomy tube or suction catheter that is difficult to
insert
Tracheostomy Discharge Supplies
.
Suction kits
.
Tracheostomy (type and sizes)
.
Sterile split gauze: 2x2’s or 4x4’s
.
Sterile cotton tipped applicators
.
Tracheostomy tube holders
.
Ambu bag (appropriate patient size)
.
Oxygen source (if needed)
.
Portable suction
.
Tracheostomy collar humidity
.
Pulse Oximeter (indication of alarm limits)
.
Little suckers
.
Home Medical Equipment (HME)
.
KY jelly
.
Flex and adaptors
.
Tracheostomy care kits (for cleaning)
Please place check mark bedside item as completed
ADDITIONAL
INFORMATION/RESOURCES
Please check in with the patient’s Case Manager
frequently to ensure all steps/processes are on
target for discharge The topics they review with
the family include:








2 competent/consistent/adult caregivers must be identified
Education participation by caregivers/rooming in/CPR
Home supplies/equipment/delivery
Insurance coverage
Private duty nursing
Home electricity – making the home a priority in power outage
No smoking in the home
Contacting the local EMS/fire station to notify them of a special needs
child
Respiratory Therapists will continue to serve as
a resource and integral part of caregiver
teaching
CPR FOR FAMILIES: CLASS SCHEDULE
Contact Person: Debra Hardy
Email: debra.k.hardy@Vanderbilt.Edu
Date: Every Monday and Thursday
Time: 1230
Place: 7A Expansion Area
Contact 7A CSL or RSL for same day registration (20361)
Parents can choose either class, depending of their scheduling needs
REFERENCES
 Krames Patient Education Material, retrieved November 18,
2013
 Mosby’s Nursing Skills Consult, retrieved November 20, 2013