Tracheostomy Care in children

A distinctly serious  topic.But a necessary  one.

I realized this when working as a resident in Safdarjung  Hospital New Delhi, many caregivers would often ask persistent   questions  regarding home care.

All children  may not be fit for home care.

But for those who are otherwise alright, home environment  often speeds up their recovery to a tube free life.

What is tracheostomy?

Tracheostomy  is an opening made in the anterior wall of the  breathing tube or trachea.

For children the opening is generally a slit in the tracheal cartilage and the cartilage  itself is never removed.

It’s a life-saving procedure.

 

What are the indications of tracheostomy  in children?

Indication  for Pediatric tracheostomy

1. To  relieve upper airway obstruction(most common)
2. To prevent complication of prolonged  ventilation
3. To reduce anatomical dead space
4. Allow suction toilet of trachea

 

Indication of upper airway obstruction  potentially  requiring tracheostomy

Nose, Nasopharynx, oropharynx, base of tongue:

1. Choanel atresia
2. Macroglossia
3. Treacher Collins/Goldenhar  Syndrome
4. Cystic hygroma

 

Supraglottis and glottis:

1. Supraglottic cyst
2. Vocal cord palsy
3. Physical trauma

 

Subglottis trachea:

1. Tracheomalacia
2. High tracheal stenosis

 

Conditions which may require prolonged  ventilation

1. Failure of control over breathing
2. Chest wall dysfunction
3. Disorders of Lung parenchyma
4. Large Airway disease
5. Central sleep apnea (Ondine’s  curse)
6. Thoracic dystrophy
7. Bronchopulmonary dysplasia
8. Tracheobronchomalacia.

The serious nature of the conditions which require tracheostomy  will give you an idea, about why this procedure helps to save lives. is only done when all other conservative options fail.

Itis only done when all other conservative options fail.

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So what should parents and caregivers of children living with tracheostomy  know?

 

1)Acceptance

I know it’s difficult to watch a child breathing through a tube.

You wonder why innocent  children have to suffer.

But that tube will help the child live healthier.

 

Always remember  when condition improves , tracheostomy is a totally reversible procedure , with little morbidity.

 

[Tweet theme=”basic-white”]Having faith and hope is must[/Tweet]

 

Acceptance of a tracheostomized child is  important. As your child breathes and feeds better , your unconditional love and support will help him/her accept the tube and live healthier.

As your child breathes and feeds better , your unconditional love and support will help him/her accept the tube and live healthier.

 

2)Suctioning the tracheostomy  Tube

The suction catheter should not be passed more than 1cm beyond tube tip to avoid tracheal damage.

With time , secretions become less.

Then you need to  suction less frequently.

Humidification  of inspired air by using nebulizer & tracheostomy mask helps to prevent excessive drying and irritation  of trachea.

The suction should be made to suck some clean water after every tracheostomy  Tube suction and kept clean.

The suction tube should be changed regularly.

The frequency of change ideally should be every 2 to 3  days , but will depend on the condition  of child.

 

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3)Supervision and sleeping

Baby with a new tracheostomy  should be sleeping  near parent.

This helps in becoming familiar with the sounds she makes and to determine the frequency  of suctioning.

It’s good to keep a child monitor next to the child at all times.

 

4)Change of tube

First change of tube is always done by a doctor.

Then after you can learn to change tube under supervision by a trained healthcare worker.

This makes you confident and keeps you aware about potential hazards.

• When you come home the tube may be changed weekly if no cheat infection present.
• If the child has Chest infection  then it’s better you change tube, every 2-3 days
• Never change tube at home alone.Always 2 caregivers should be present during the change of tracheostomy  Tube.
• In hot humid climate, it’s better to change the Tracheostomy  Tube tape  daily.One side at a time should be changed by 1 caregiver while the other caregiver holds the tube in place
• Always wash your hand with soap and water before touching the tube.
• Before insertion of fresh tracheostomy  tube, lubrication with xylocaine jelly helps to lessen the irritation.

 

5)Bathing

Swimming is not allowed.

The bath should always be supervised even for older children.

Better not to use an overhead shower.

A handheld shower or bucket -mug technique works best.

 

6)School

If the child has no other problem, regular schooling should be continued.

But it’s important  for the teachers, healthcare workers, and school authorities to be aware of the condition, potential  hazard, and emergency management procedure.

 

7)Discipline

When we are ill we are pampered.

But as the child gets better it’s best to treat him /her as you would any other child.

Discipline and all other activities should be like a normal child.

You should encourage him /her to participate  in activities as far as possible  (discuss with your doctor if your child’s special condition has any restrictions ).

Dress the tracheostomy  Tube with a nice scarf to avoid unpleasant  curiosity and help your child feel like the other little ones.

 

8)Speech and Language development

An assessment  by a speech therapist early helps you plan better.

 

• Tracheostomy tube with a speaking valve is a must.

• Encourage both verbal and nonverbal  means of communication  with your child.

9)Travel

Wherever child goes, a suction pump must go.

 

• Suction pump

• Spare tracheostomy  Tube

• Tape

• Xylocaine jelly

• Suction catheter

• Syringe

• Saline

• Scissors

 

 

10)Equipment needed for Home care of Tracheostomy  tube

 

• Tracheostomy  Tube
• Suction catheter
• Suction pump  3

a)Permanent  at home

b)portable suction pump for travel

c)Manual: in case of power disruption, malfunction, regular  cleaning and service of pump

 

11)Skin Care:

• Keep the tape clean and dry at all times
• Every day put a clean soft piece of gauze tucked between the skin of the neck and the side flanges of the tube.
• This gauze should be changed as soon as it gets wet
• Clean the skin around the tracheostomy  opening  with a gauze soaked  (and rinsed dry) in mild antiseptic  solution, keeping in mind to make  the skin dry afterward.

 

12 )Requirement  for children at home with tracheostomy

• Caregiver : At least 2 responsible adults
• The environment at home: Adequate space, heating, cooling, humidifying  facility.Having a telephone and access to transportation.
• Healthcare Support system:

District Nurse

Community pediatrician

General  Physician

Hospital nearby

Community support

 

Having a child with a tracheostomy  is a big challenge.

But if your child is otherwise healthy and you are willing to learn .

You can take care of a tracheostomy  at home.

But every case is unique and the best guide to your child’s conditions  is your doctor.

Stay informed  and stay healthy.

Sign up below and get a handy guide for home care of  tracheostomy tube.

 

Disclaimer :

The information  provided  here is strictly for the purpose  of helping you live better and not to be confused with professional  medical  advice which is only given after professional consultation.