These preventive measures may help to avoid some problems:
- Make sure your child is getting enough humidity – humidity will keep the mucus loose and decrease the chances of a mucus plug (if you hear a whistling sound from the trach, this might mean that your child’s airway is dry)
- Always make sure the trach ties are securely fastened and are tight enough around your child’s neck
- Make sure that the trach is open to air and that nothing is blocking it such as clothing or bedding
- Always have your child nap or sleep with their apnea monitor or pulse oximeter on and do not discontinue their use unless discussed with your ENT doctor
If Your Child Has Trouble Breathing
Signs and symptoms of difficulty breathing are:
Retractions: Pulling of the skin between the ribs, under the breastbone or around the trach itself
Sweaty and pale skin: Your child is sweaty and pale and seems to be working hard to breathe while at rest.
Dusky lips or nail beds: Your child’s lips or nail beds look dark, dusky or blue
Feeling restless or frightened: Your child is restless or looks frightened for no apparent reason
The most common reason for breathing problems, other than an illness, is that the trach tube becomes plugged with dried mucus. Making sure your child is getting enough humidity can help prevent this problem. However, if the trach does become plugged, try to remove the plug by suctioning.
If you have trouble passing the catheter into the trach and it feels tight, put a few drops of saline into the tube and try to suction again. Do not force the catheter; it may push the plug in further. If you are unable to remove the mucus plug, change the trach tube and try to suction again.
If Your Child Stops Breathing
Remember the ABCs of CPR
- A-AIRWAY – Check to make sure that the tube is open to air. Look, listen and feel for air coming from the trach and watch the chest for movement. Position your child’s head so that the neck is exposed.
- B-BREATHING – Use your mouth or self-inflating bag to give your child two breaths through the trach. Feel for air leaking from the nose and mouth. If this happens, cover the mouth and nose with your hand. If you cannot pass air through the trach, change the tube. You should squeeze the bag slowly and gently with only enough force to see the chest rise.
- C-CIRCULATION – Check for signs of movement such as coughing or signs of breathing after giving 2 breaths. After giving the two initial breaths, start compressions.
If someone is available, have them call 911. If no one is available, perform CPR for one minute then call 911. Continue CPR as you were taught until help arrives. You will not be sent home without learning CPR. This will be taught to you while your child is here in the hospital.
When You Cannot Insert a New Trach Tube
If you are having difficulty inserting a new trach tube, make sure your child’s head is in the correct position and try to insert the new tube again. If it still will not go in, try to put the old tube back in. The old tube that was removed should be able to go back in without difficulty.
Emergency steps to follow if the new or old tube cannot be inserted:
- Use smaller step-down tube (1/2 size smaller than the original tube) and notify your doctor if the smaller tube is used
- The longer the smaller tube is in, the more difficult it will be to insert the original size tube
- If you are unable to insert the step down tube, have someone call for emergency help
- Do not panic if your child passes out
- If your child passes out, the neck muscles will relax, and you may find it easier to insert the trach tube at this time
If the Trach Tube Falls Out
If the trach tube comes out accidentally, you will need to act quickly and calmly. Remember that you have changed the trach many times before.
- Always have a clean tube and ties available
- If you do not, quickly put the old trach back in until you can get a clean tube
- Put the obturator in the tube and lubricate
- Insert the tube and quickly remove the obturator
- Secure the tube and ties
Give your child a bath in a shallow tub. Never leave them alone in the bathtub. When bathing, never allow water to enter the trach tube. If it does, suction immediately.
Do not use powder or aerosol sprays around a tracheostomy. These products may cause irritation or breathing problems.
You may dress your child according to your taste. However, avoid clothes that could cover the trach opening such as turtlenecks. Avoid necklaces, beads, strings or fuzzy clothes because the fibers or tiny beads could get into the trach and cause breathing problems.
Older children should avoid contact sports. Sand boxes and water sports are allowed with close supervision. Physical education is allowed if age appropriate and not too strenuous.
- When playing or traveling outdoors wear an artificial nose over the trach tube (never sleep in the artificial nose)
- Use the trach collar with heated humidity
- Never leave your child alone
- Anyone taking care of your child must be trained in the care of a child with a tracheostomy and be CPR certified
All children with trachs go home with either a pulse oximeter or apnea monitor. They should be placed on the monitor when their activity is not being directly supervised. Use the monitor any time your child is asleep, whether for a nap or for the night.