Tracheostomy Flashcards
Tracheostomy
A tube that goes into your trachea via a opening that helps you breathe
Why might a child need a tracheostomy?
Airway stenosis
Airway malacia
Need for long term ventilation >16 hours a day
Burns
Trauma
Cystic hygroma
Haemangioma
Infection
Inhalation of a foreign body
Tracheostomy placement
Surgical opening is made between the 3rd and 4th tracheal ring
What are the three types of trachy tubes
Cuff and uncuffed
Cuffed trachy
A cuffed tube has inflatable cuff at
the distal end, which when inflated with air enables positive pressure ventilation and reduces the risk of aspiration
Uncuffed trachy
Commonly used in young children
Often the type of tube that they will be discharged with
Can be easy to dislodge
Fenestrated trachy
Have small holes which allow air to pass through the vocal cords which allow them to talk and re-establish breathing through the upper airway
suctioning with fenestrated tube
If a patient has a fenestrated tracheostomy and tracheal suction is required, a non-fenestrated inner tube must be put in place before suction
Care for a newly formed tracheostomy
The first change occurs within 3-7 days
Sutures will be in place and secured to the chest to keep the stoma open
The first tube change is normally completed by the ENT CNS or ENT surgeon
The child is cared for in a HDU or PICU until this first change has occurred
Why is trachy humidification important
obstruction/occlusion of tracheostomy tube
Retention of viscous, tenacious secretions
Atelectasis, reduction in lung function
pulmonary infection
poor ventilation/perfusion coupling, and
Tracheitis
Types of humidification
- Heat and moisture exchanger(HME)
- Saline nebulisers
- Saline instilation
- Wet circuits on ventilation
Cleaning of trachy
Once a day and two people procedure
Tape changes
Performed daily or when dressing/tapes are soiled
Allows neck and skin to be assessed
Important for skin integrity
Do not attempt if the patient is unstable or deteriorating, and their tapes are adequately tied
Document
