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TRACHEOSTOMY 11

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					                                 TRACHEOSTOMY (TRACH)
                                   (Trach-E-oz-toe-me)

CONTENT
Content                                   Page
Purpose of the Tracheostomy               Page 3
      Anatomy

Caring for the Tracheostomy               Page 5
      Cleaning the tracheostomy opening
      (stoma)
      Changing tracheostomy ties
      Changing the tracheostomy tube
      Cleaning the Trach equipment
      More information

Moisture requirements                     Page 10

Signs of breathing problems               Page 10

Suctioning the Tracheostomy               Page 11
      Purpose
      When to suction
      Equipment for suctioning
      How to suction
      Cleaning suctioning equipment
      Supplies at home

Using the Ambu Bag with Tracheostomy      Page 14
      Purpose
      Using the Ambu bag
      Care of the Ambu bag

CPR                                       Page 17
      How to do CPR

General care                              Page 19
     Feeding
     Bathing
     Counting baby’s breathing
     Clothing & bedding
                                                         Tracheostomy-1
Content                           Page
      Making sounds & talking
      Baby-sitters
      Safety tips
      Weather
      Brothers & Sisters
      “To Go Bag” for traveling
      Supplies

Baby’s Schedule                   Page 22
      24 Hour
      Daily
      Every other day
      Weekly to Monthly

Help                              Page 23
       Doctor visits
       Emergency notification

Emergencies and Treatments        page 25

Call the doctor if…               page 25




                                            Tracheostomy-2
PURPOSE OF THE TRACHESOSTOMY

1. A tracheostomy is an opening in the windpipe (trachea) that your baby breathes
   through instead of breathing through his nose and mouth.
2. Often the tracheostomy is not permanent and can be removed after the problem has
   been corrected or the baby grows and no longer needs the tracheostomy.
3. Babies with the following problems may get a tracheostomy:
   a. Birth defects that affect the baby’s breathing.
   b. Soft or weak breathing passages (tubes) that cause noisy breathing. This causes
       the baby to have difficulty breathing. The noise is called stridor and the
       problem is called tracheomalacia.
   c. Needs to be on the ventilator for a very long time.
   d. BPD (Bronchopulmonary Dysplasia) with long-term oxygen needs.
   e. The baby will go home on a home apnea and cardiac monitor. The monitor counts
       the baby’s breathing rate and heart rate.
   f. The monitor alarms to tell you if the baby is not breathing (apnea) or if the heart
       beat is too slow (bradycardia).



ANATOMY
1. A small opening is made from the skin to the windpipe (trachea) by a cut in the neck.
2. A tracheostomy tube is a short piece of plastic that is placed into the trachea
   (windpipe) through a surgical hole in the neck. It does not reach into the lung.




3. The baby breathes through this plastic tube instead of through his nose and mouth.
4. You will not be able to hear the baby cry or talk with the tracheostomy tube in at
   first. He will learn to talk with the tube later.

                                                                    Tracheostomy-3
CARING FOR THE TRACHEOSTOMY

CLEANING THE TRACHEOSTOMY OPENING (STOMA)
1. Supplies:
   a. Distilled water and clear tap water
   b. Q-tips® or cotton swab
   c. Hydrogen peroxide mixture in cup (½ distilled water & ½ hydrogen peroxide)
   d. Basin
   e. Gauze trach dressing
   f. Roll to place under neck.
2. Cleaning
   a. Wrap baby in blanket with arms inside blanket to make him feel comfortable and
      secure
   b. Place roll under baby’s neck
   c. Clean area around tracheostomy opening in neck (stoma) daily and when the area is
      soiled
   d. Support tracheostomy tube with a finger while cleaning
   e. Wet Q-tip in ½ strength hydrogen peroxide
   f. Roll Q-tip over skin under tracheostomy tube to remove crusted secretions
   g. Rinse with Q-tip dipped in clear water. Pat dry with gauze or clean cloth
   h. Wash skin around neck with clear water and a mild soap such as Basis
      Neutrogena® or Dial®
   i. Check skin around trach site, neck and back of neck for irritation, redness, or
      breakdown. If any of these have happened, call the baby’s doctor.
3. Place gauze trach dressing around trach tube if trach opening is draining.
   a. Change dressing as often as necessary to keep skin dry
   b. May use pre-cut trach dressings (more expensive) or 4x4 gauze without fiber
       filling
   c. Do not cut gauze because small fibers can get in the baby’s trach or windpipe.
4. Clean stoma 2-3 times a day if an odor is present or more often if there is drainage
   present.
5. Powders and lotions must not be used around the trach stoma.
6. If ordered by the baby’s doctor to treat irritations or rashes, apply ointments as a
   thin layer of ointment (Ointments under the trach collar can make the skin irritation
   worse. Sometimes clean and dry is best.)



CHANGING TRACHEOSTOMY TIES
1. Supplies
   a. Large colored shoe laces, twill tape, bias seam tape or Velcro holder

                                                                   Tracheostomy-4
   b. Blanket roll for shoulders
   c. Scissors
   d. Blanket for wrapping and securing baby—it may be necessary to wrap baby snugly
      to prevent wiggling
2. Changing the ties: Do not change the tracheostomy ties by yourself unless
   absolutely necessary.




   a. Change ties daily or when:
       Ties become loose (should fit snugly when neck is bent forward)
       Ties become wet or dirty
       Square knot or Velcro causes pressure on your baby’s skin
       The trach tube is changed
   b. Suction before changing ties. Suctioning decreases chances of the baby
      coughing while the ties are off. Movement of the tube often causes the baby to
      cough and bring up mucus
   c. Changing ties requires two people—one person to hold tube in place and position
      the baby and the other person to change the ties
   d. Place blanket roll under shoulders to expose tracheostomy area
   e. Slide old ties from center of hole to top on both sides of tracheostomy tube
   f. Insert new ties under old ones
   g. Secure new ties with a square knot. Ties should be tight enough to easily slip one
      finger underneath the tape




                                                                   Tracheostomy-5
   h. Cut off old ties and remove. Guard tips of scissors with your fingers to avoid
       injury to the baby
   i. Examine neck daily for redness, skin breakdown or rashes.
3. If using Dale™ trach holder:
      a. Remove one side of Velcro holder while holding the trach tube in place
      b. Thread the clean holder in this side, then go to the other side and repeat the
          process
      c. Clean the dirty trach holder with warm soapy water and hang or lay flat to dry
      d. It may be reused several times.



CHANGING THE TRACHEOSTOMY TUBE
1. Equipment
   a. Tracheostomy tube with guide (obturator)
   b. Shoestring ties or twill tape or Velcro trach holder
   c. Scissors
   d. Blanket roll to support shoulders
   e. Blanket for wrapping and securing baby
   f. Oxygen tank with Ambu™ bag attached.
2. Changing the tracheostomy tube
   a. Do not change the tracheostomy tube by yourself unless absolutely necessary.
   b. WASH YOUR HANDS
   c. Check the size of the new trach tube to be sure it is the same size as the trach
      tube you will be changing
   d. Suction baby before changing the trach tube
   e. Attach ties or Velcro holder to new or clean trach tube with guide (obturator) in
      place. The obturator serves as a guide to provide easy insertion of the trach
      tube




   f.   If needed, lubricate the new trach with a small amount of water-soluble lubricant
        or saline
   g.   Place tube in sterile tray until ready to insert new or cleaned tube. Keep tube
        portion sterile


                                                                    Tracheostomy-6
     h. Wrap baby in blanket with arms inside to prevent baby from wiggling or grabbing
        at your hands
     i. Place blanket roll under shoulders to expose neck area
     j. Cut old ties




     k. Remove old trach tube with one hand using an up-and-out motion (follow angle of
        tube)
     l. Insert new or cleaned tube gently. Direct tube back and down
     m. Remove guide (obturator) as soon as the tube is in place. Your baby cannot
        breathe unless the guide (obturator) is removed
     n. Tie snugly in place
     o. Allow baby to breathe until calm (about 30 seconds), supporting trach tube with
        your finger.
3.   Your baby may cough, cry, turn red, or sweat. He is Okay.
     a. This does not hurt the baby
     b. Calm him by talking to and holding him
     c. Give him a few breaths with the Ambu bag or a little extra blow-by oxygen to
        help calm him
     d. A pacifier may help.
4.   Change the trach tube as directed by your baby’s doctor or for:
     a. Distressed infant who does not respond to suctioning or the usual calming
        methods
     b. Difficulty inserting suction catheter
     c. Whistling through trach that is not relieved by suctioning.
5.   Change tube before feeding or at least 2 hours after feeding. Avoid changing just
     before feeding if your baby is upset because of hunger.
6.   Inspect the removed tube for color change, mucus plugs or odor.



                                                                    Tracheostomy-7
CLEANING THE TRACH EQUIPMENT

1. The medical equipment supply company will teach you how to clean the tracheostomy
   tubes and what to use for cleaning.

Daily
   a. Change nebulizer jar:
       Dump out water; rinse and wash with soap & water
       Air dry
       Refill clean nebulizer jar with distilled water.
   b. Change trach collar:
       Wipe with damp cloth only
       DO NOT USE SOAP. DO NOT DISINFECT
       When discolored or stiff, replace collar.
   c. Check to make sure suction machine is working.

3 Times per Week
   a. Disinfect nebulizer bottle and tubing:
       Bottle: empty, rinse, and wash with soap & water
       Tubing: disinfect with solution of 1 part white vinegar & 1 part distilled water
        for 30 minutes. Rinse with clear tap water or distilled water and air dry
   b. Refill after drying.



MORE INFORMATION
1. Your baby may have the trach collar and humidity off during the day if allowed by
   your baby’s doctor.
   a. If you take the trach collar and humidity off, YOU MUST KEEP THE
       THERMOVENT (ARTICICIAL NOSE) IN PLACE.
2. Use the trach collar and humidity during naps and at night to keep trach moist and
   prevent mucus plugs.
3. If compressor is not available during long trips or power failure, place Thermovent
   (artificial nose) in the trach tube to help moisten trach tube and windpipe.
4. The windpipe (trachea) of your baby is small and easily plugged with mucus, so the
   compressor with trach collar provides a direct source of moisture that a vaporizer
   cannot.
5. If mucus becomes thick, call your Equipment Supply Company. Increasing the baby’s
   fluid intake may also help thin the mucus. Call the baby’s doctor before you increase
   his fluid intake.


                                                                    Tracheostomy-8
MOISTURE REQUIREMENTS
1. A compressor and tracheostomy collar (trach collar) are used to filter and moisten
   air entering the windpipe (trachea) because the baby does not breathe through his
   nose and mouth.
2. Supplies
   a. Air compressor machine
   b. Cascade humidifier with mounting bracket, nebulizer jar
   c. Corrugated tubing and drip bag
   d. Trach collar
   e. Distilled water
   f. Cleaning solution (recommended by home equipment company)
   g. Large container with lid for cleaning solution
   h. Spare valve for air compressor
   i. THERMOVENT™ (Artificial nose).
3. How to use
   a. Fill nebulizer jar with distilled water to line on jar
   b. Attach nebulizer jar to air compressor
   c. Connect trach collar to tubing with bag in place (corrugated tubing to bag to
       corrugated tubing) and attach to nebulizer
   d. Turn machine “on” and look for mist from trach collar.




SIGNS OF BREATHING PROBLEMS
1. Restlessness or increased irritability.
2. Increased breathing (respiratory rate.)
3. Heavy, hard breathing.
4. Grunting, noisy breathing.
5. Nasal Flaring (sides of nostrils move in and out with breathing).
6. Retractions (sinking in of breastbone and skin between the ribs with each breath).
7. Blue or pale color.
8. Whistling from the trach tube.
9. Sweating.
10. Change in pattern of heart rate (less than 80 or more than 210 beats/minute).
11. Bleeding from the trach tube:
    a. Call your baby’s doctor immediately.
    b. Call 911 (in Cumberland County) or the Emergency Number for your county.




                                                                   Tracheostomy-9
SUCTIONING THE TRACHEOSTOMY

PURPOSE
1. Suctioning the trach is done to remove mucus from the baby’s airway or breathing
   passages.
2. Your equipment supply company will teach you how to use the equipment before you
   take your baby home.



WHEN TO SUCTION
1. Loud gurgles are heard from the tracheostomy tube.
2. Bubbles are noticed in the trach.
3. Rattles are felt on the baby’s back or chest.
4. Your baby seems agitated, restless, cries and cannot be quieted.
5. Increased breathing rate or increased heart rate.
6. Your baby becomes pale or blue.
7. Flaring nostrils (move in and out when breathing).
8. SUCTION ONLY AS NEEDED, usually in the morning, before meals, after chest
   therapy (CPT) and at bedtime.



EQUIPMENT FOR SUCTIONING
1. Suction machine (portable or stationary).
2. Sterile suction catheter with sleeve.
3. Saline.
4. Cup of water.
5. Ambu™ bag.



HOW TO SUCTION
1. Wash your hands before suctioning, except in emergencies.
2. Have all equipment together and ready to use.
   a. The suction machine’s pressure is pre-set by the equipment supply company
   b. Change the machine’s pressure setting only as instructed by the baby’s physician
       or the equipment supply company
   c. Check the machine daily to make sure it is working correctly.
3. Open catheter package, taking care to keep the catheter as clean as possible.
4. Pick up catheter with sleeve and connect catheter to suction tubing.
5. If needed, place 3-4 drops of sterile saline into the trach tube.
6. Insert catheter into the trach only the length of the trach tube.

                                                                  Tracheostomy-10
   a. Keep a pre-marked catheter available to check this length against. Most suction
      catheters have measurement markings on them
   b. You will be shown how far this distance is for your baby
   c. DO NOT block the finger hole when inserting the catheter.




7. Suction the trach by blocking the finger hole and withdrawing the catheter slowly.
    a. Rotate the catheter between your fingers to get better suctioning of the trach
    b. Suctioning should last only 5 seconds during each entry
    c. Stop suctioning when mucus cannot be seen or heard
    d. It may take more than one entry of the catheter to completely suction the baby.
        Remember, each pass should last only 5 seconds.
8. The baby may need to be suctioned again after bagging with the Ambu bag.
9. The catheter with sleeve may be reinserted for additional suctioning.
10. The mouth may be suctioned using the same suction catheter after the trach is
    clear.
    a. Never suction the mouth and then go back to suction the trach again
    b. If the catheter with sleeve is used only for suctioning the trach, it may be
        reused for 8 hours and then thrown away
    c. If the catheter with sleeve is used to suction the mouth, throw it away
        immediately after using
    d. If the baby’s nose needs suctioning, use the bulb syringe.
11. After use, rinse the catheter and suction tubing with tap water. If catheter used in
    the mouth, throw it away.
12. Turn the suction machine off and make sure supplies are ready for the next time.



                                                                   Tracheostomy-11
CLEANING SUCTIONING EQUIPMENT
1. Empty and wash suction bottle and tubing in hot soapy water and rinse in hot water
   daily.
   a. Use the solution recommended by your home care company.
2. We suggest you save all equipment that must be cleaned and disinfected and do this
   every other day. The end of each day will then be less hectic. You have enough
   supplies to do this.



SUPPLIES AT HOME
1. The home equipment company provides most of the home supplies you need. The
   hospital makes these arrangements with a company near where you live.
2. The equipment and supply company will talk with you before you take your baby home.
3. The supply company will teach you when and how to reorder supplies.
   a. They will give you their phone number
   b. Call them if your equipment breaks or to reorder supplies.




                                                                  Tracheostomy-12
USING THE AMBU™ BAG WITH A TRACHEOSTOMY

PURPOSE
1. Babies with a tracheostomy are discharged with an ambu bag.
2. The type of bag you will use is a self-inflating bag. It does not need to be connected
   to oxygen, but can be used with oxygen.
3. The medical equipment company will give you a bag and mask before the baby is
   discharged.
4. Always keep the bag close to the baby. The bag should always be kept assembled.
5. A facemask should be available for emergencies.



USING THE AMBU BAG
1. The Ambu bag is used to breathe for the baby if the baby:
   a. Is not breathing
   b. Is having difficulty breathing
   c. During suctioning, if needed.
2. The baby’s airway should be clear of mucus and formula before bagging.
   a. Suction the baby’s mouth and nose with a bulb syringe to remove the mucus or
      formula
   b. Suction the baby’s trachea with a catheter to remove the mucus or formula
   c. If you have difficulty getting the suction catheter down the tube, change the
      tracheostomy tube.
   d. A new or cleaned and disinfected trach tube should always be at the baby’s
      bedside!!!
3. If the baby is not breathing, stimulate the baby to breathe by either flicking the
   sole of the foot or rubbing the baby’s back or chest vigorously a few seconds.
   a. If the baby does not breathe, proceed.
4. Place the baby so the tip of his nose is pointed straight up in the air. A small towel
   or roll under the shoulders may help to keep the baby in this position.
5. Connect the oxygen tubing to the bag.
   a. Be sure the tubing is connected to the regulator on the oxygen tank
   b. Turn the oxygen on
   c. Set the regulator on a flow of 5-8 liters per minute or a flow ordered by your
       baby’s doctor.
6. Connect the ambu bag to the trach tube.
   a. It should fit snugly
   b. Hold the bag at a 900 angle (horizontal) to the baby’s neck.




                                                                     Tracheostomy-13
7. Squeeze the bag briskly using your thumb to exert pressure on the bag and fill the
   baby’s lungs with air/oxygen.
   a. You should squeeze the bag hard enough to see the chest rise, as if the baby
      were taking an easy breath.
8. The rate and length of time to bag the baby depends on the reason for the bagging.
   a. Generally, the rate should be about 20 breaths per minute.
   b. If the baby is having difficulty breathing, bagging can be continued until the
      baby begins to breathe normally or until emergency help arrives.

            COUNT:
            Breathe                   1                  2            Breathe
                                                                        
            Squeeze                Pause              Pause           Squeeze

9. If the baby’s chest does not rise and you have already suctioned the baby, try to
    exert slightly more pressure on the bag.
    a. If the baby’s chest still does not rise, replace the tracheostomy tube. This must
        be done quickly without panicking!!!
10. If the baby is having difficulty breathing, bagging can be continued until the baby
    begins to breathe normally or until emergency help arrives.



CARE OF THE AMBU BAG
1. Ambu bags should be taken apart and cleaned with the solution recommended by your
   home equipment company or soaked in a white distilled vinegar mixture.
2. Store the Ambu bag and facemask in a covered container or plastic bag.
3. Bags should be cleaned
   a. Twice a week if the bag is used daily
   b. Once a week if it is out of the package and lying in the crib or near the baby
   c. After every use in an emergency.

                                                                   Tracheostomy-14
To clean with Vinegar
1. Mix 64 ounces of tap water and 64 ounces of white distilled vinegar in a covered
   plastic container at room temperature.
2. Bottled water is best, but tap water may be used. If using tap water, allow the hot
   water to run for 3-5 minutes before mixing.
3. Wash bag and mask with mild liquid soap and warm water. Do not use bar soap.
4. Rinse well with warm water.
5. Place disassembled (taken apart) bag and mask in the solution.
6. Soak for at least 3 hours or overnight.
7. Remove equipment, rinse with water and let air dry.
8. Throw away vinegar solution after each use.



To clean with the Control III (usually recommended by your home equipment
company)
1. Follow the directions on the package for mixing solution.
2. Bottled water is best, but tap water may be used. If using tap water, allow the hot
   water to run for 3-5 minutes before mixing.
3. Store the mixture in a covered container at room temperature.
4. Wash bag and mask with mild liquid soap and warm water. Do not use bar soap.
5. Rinse well with warm water.
6. Place disassembled (taken apart) bag and mask in the solution.
7. Soak for 10 minutes. Do not leave it longer as it may harm the bag and mask.
8. Remove equipment, rinse with water and let air dry.
9. Throw away vinegar solution after each use.




                                                                   Tracheostomy-15
CPR (CARDIOPULMONARY RESUSCITATION)

1. CPR for an infant or child with a tracheostomy (trach) follows the same process as
   regular CPR.
   a. The difference is that the breathing is done through the trach rather than
      through the mouth.
2. You will take a basic CPR class. We will teach you how to do CPR with the trach and
   how to use an Ambu bag to breathe for the baby.



HOW TO DO CPR
1. Stimulate baby by gently rubbing his back or feet to arouse him.
2. CALL FOR HELP!! if anyone is in the home.
3. Position baby on a hard flat surface with his nose pointed straight up.
4. SUCTION TRACH TUBE.
   a. If the trach tube has come out, is blocked with mucus or your baby does not
       improve with suctioning, replace the tube. REMEMBER TO TIE THE TRACH
       TIES!!!
   b. Begin CPR if baby does not breathe when trach tube is clear.
5. Listen and feel for breaths by placing ear over tracheostomy. Look at chest to see
   if baby is breathing.
6. If no signs of breathing, place mouth or attach Ambu bag over trach tube.
7. Give 2 quick puffs—just enough to see the chest rise like the baby is taking an easy
   breath.




8. Feel for a heart rate (pulse) for 5 seconds and check to see if baby is breathing
   (look, feel, and listen for air movement).
9. If you feel a pulse, but the baby is not breathing, give rescue breaths with mouth or
   Ambu bag over the tube.
       Count:        1—2—breathe              1—2—breathe

10. If air is leaking from the nose and mouth, close mouth & nose with your hand.

                                                                    Tracheostomy-16
11. If you DO NOT feel a pulse in 5 seconds or if the pulse is less than 70 beats per
    minute (bpm), start chest compressions with the breaths.
    a. Press ½ to 1 inch with each compression.
    b. Count:
       1            2            3            4           breathe
       press        press        press        press       breathe
    c. This rate is about 100 times a minute.
    d. The breath is about 1 to 1½ seconds long.

12. Check pulse and breathing about every 15-30 seconds.
13. After 1 minute, Call 911 or ambulance team for help if your baby does not respond.
14. Every 1 or 2 minutes check for breathing and heart rate until help arrives.
15. Have infant taken to the nearest hospital.




                                                                    Tracheostomy-17
GENERAL CARE

FEEDING
1. Your baby can be fed as a normal baby.
2. Burp well and place on right side or in infant seat after feeding.
3. DO NOT PROP THE BOTTLE.
4. Do not let your baby have a bottle unless you are present in case choking occurs.

BATHING
1. NEVER LEAVE YOUR BABY ALONE IN THE TUB.
2. Your baby can be bathed in tub, but do not let water get into the trach. Use the
   Humid-Vent (artificial nose).
3. Do trach care after the bath.
4. Change the trach ties if they get wet.

COUNTING BABY’S BREATHING
1. You may want to count the baby’s breathing rate twice a day when the baby is quiet
   or asleep. You can write the number in a record book and bring it to the doctor.
2. One count is a breath in and out. Sometimes the baby holds his breath briefly,
   breathes fast then slow, stretches or moves. Count the breathing as best you can.
3. Call the doctor if the breathing rate is 15-20 counts higher than usual or you baby is
   working harder to breathe. Make sure the baby is not too warm or does not have
   mucus in his trach.

CLOTHING AND BEDDING
1. You do not need to buy special clothing for your baby.
2. Clothing that covers the trach should not be worn.
3. Necklaces, strings, fuzzy clothing, fuzzy blankets and stuffed animals should be
   avoided. Tiny beads or fibers from these articles can get into the trach.
4. Purchasing a portable intercom system so you can hear the baby when you are in
   another room is often helpful.

MAKING SOUNDS AND TALKING
1. At first you will not be able to hear the baby cry or make sounds. This is because
   the air from the lungs does not pass through the vocal cords.
2. He will learn to talk around the trach tube.
3. It is important that you talk to him as you would any other baby.




                                                                    Tracheostomy-18
BABY-SITTERS
1. A baby with a trach needs to be watched closely all day. Plans must be made in
   advance to teach another person how to care for the baby and how to use the
   equipment.
2. It is important that parents be able to rest and go out without the baby!

SAFETY TIPS
1. Animals with fine hair should not be in the house.
2. Keep home as free from lint and dust as possible.
3. Do not use powders, chlorine bleach, ammonia or aerosol sprays in the same room as
   the baby. Particles and fumes get into the lungs through the trach. This will cause a
   “burning feeling” and breathing problems.
4. Do not smoke around your baby. Smoke is irritating to the baby’s windpipe.
5. If you do smoke, smoke outside the house and change your clothes BEFORE caring
   for your baby.
6. Watch play with other children so that toys, fingers and/or food is not put into the
   trach tube.
7. Do not buy toys with small parts that can easily be removed.
8. Always carry your “TO GO BAG” supplies when you leave home.

WEATHER
1. During freezing temperatures, avoid allowing your baby to breathe cold air directly
   into the trach.
   a. This can cause tracheal tightening (spasm) and form small ice particles in the
       mucus if exposed for long period of time.
   b. Wrap a scarf or small blanket loosely around the neck of the older child with a
       trach.
   c. Also, when out of doors, use the Humid-Vent.
2. Protect the tracheostomy on dusty windy days when dust particles may enter the
   trachea and cause drying or crusting mucus. Use the Humid-Vent.

BROTHERS AND SISTERS
1. It is important to help older brothers and sisters to understand why and how the
   baby breathes through a trach.
2. This may be a frightening situation for the older brothers and sisters and requires
   parents’ support and teaching to make them feel more comfortable with the baby.
3. It may be helpful to involve brother and sister’s help in small tasks such as holding
   the baby still, helping clean equipment, etc.
4. Watch young brothers and sisters around the baby!


                                                                     Tracheostomy-19
“TO GO-BAG” FOR TRAVELING
1. Bulb syringe.
2. Suction catheters with sleeve.
3. Trach tube with tie and obturator (same size and size smaller).
4. Scissors.
5. Water soluble lubricant (sterile single use packets)
6. Saline (2-3 5cc vials).
7. 4x4’s or trach sponges.
8. Portable suction machine.
9. Emergency phone numbers.
10. Baby blankets.

SUPPLIES
1. Most of the home supplies you need are provided through a home equipment and
   supply company.
   a. The hospital makes these arrangements with a company near where you live.
2. The equipment supply company will contact you while you are visiting with your baby.
   a. The supply company will tell you when and how to reorder supplies.
   b. They will give you a phone number to call if you have equipment problems.
   c. Call them if your equipment breaks or to reorder supplies.
3. Sterile distilled water: Buy distilled water by the gallon.
4. Hydrogen peroxide: Buy at the drug or grocery store.
   a. Keep out of sunlight
   b. Replace opened bottle EVERY 60 DAYS even if all the contents are not used.




                                                                     Tracheostomy-20
BABY’S SCHEDULE

24-HOUR SCHEDULE
1. You will be very busy at home.
2. It helps to have a calendar with your day’s activities clearly marked.
3. Some things you do several times a day and some things you do several times a week .
   Organization and a schedule are important, so is help from other family members.
4. It is important to teach several people to care for the baby so you can have a break
   and get out by yourself.

Daily
1. Stoma Care:
   a. 1-2 times a day, or more if necessary
   b. Use ½ strength hydrogen peroxide if there are secretions around the trach or
       stoma. Repeat with a Q-tip and clear tap water. Pat dry
   c. Do more often if skin breaks down, there is a large amount of secretions, or odor
       noticed
   d. Replace trach ties when wet (may use Dale velcro trach holder or large colored
       shoelaces).
2. Wash suction bottle with hot soapy water.
3. CPT
   a. 2-3 times a day (if recommended by the baby’s doctor)
   b. Before feeding or at least 2 hours after feeding.
4. Change trach collar and tubing,
5. Change water bottle of humidifier.
6. Check to make sure suction machine is working.

Every other day
1. Clean nebulizer bottle in solution recommended by home equipment supply company.
2. Clean suction bottle and tubing in solution recommended by home equipment supply
   company.
3. Clean trach collar and tubing in solution recommended by home equipment supply
   company.

Weekly to Monthly (or as needed)
1. Change trach tube.
   a. Always suction before changing trach.
   b. Change before feeding or at least 2 hours after feeding.




                                                                   Tracheostomy-21
HELP
1. Before your baby is discharged from the hospital, the NICU Case Manager makes
   arrangements for your baby’s home care needs.
2. Several programs are available to help provide medical and financial care for your
   baby. The Child Services Coordinator in your community or a social worker can help
   find out if you are eligible for these programs.
   a. Babies are eligible for different reasons and some babies may not be eligible or
        approved
   b. Some of the programs are:
         Medicaid
         SSI (Supplemental Security Income)
         Private Duty Nursing
         Doula Services
         Community Alternative Program (CAP).
3. It is hard work to care for a baby with a trach. Yet most parents prefer to have
   their baby at home. Babies thrive in a loving home environment and you will be more
   comfortable the more you care for your baby.
4. Some insurance companies approve home-nursing care for a baby with a trach. We
   will contact your insurance company to find out if they provide this service.
5. Home health agencies are used for short visits.
   a. These visits are an hour or less
   b. The nurses answer questions, help with special treatments and help with
        medications
   c. They may weigh the baby or watch a feeding
   d. They work with your doctor to follow the baby’s condition and progress and are an
        excellent resource person for the baby’s care.
6. We ask several family members learn the baby’s care so everyone can get some rest.
7. Even though it is difficult to find people to baby-sit, it is important to teach other
   people to care for the baby so you can go out.
8. If you have questions or concerns after the baby is at home, call the home health
   nurse, baby’s doctor or your Child Service Coordinator. They will try to help.



DOCTOR VISITS
1. Your baby may return to the Follow Up Clinic to follow his breathing problems and
   trach. We mail your baby’s doctor a report of your visits to the Follow Up Clinic.
2. If you see more than one doctor (eye, surgery, breathing, x-ray, lab, development),
   check to see if the appointments can all be made for the same day.
3. At first, it seems you spend most of your time going to the doctor.


                                                                    Tracheostomy-22
4. As the baby’s health gets better the visits becomes less frequent and some doctors
   will not need to see you as often.
5. You will take the baby to a local baby doctor for routine baby care and “shots.”
   a. Your first visit will be within the 1st week after the baby is discharged from the
        hospital
   b. The appointment is given to you when the baby is discharged.



EMERGENCY NOTIFICATION
1. The home equipment supply company will call and write the following agencies to
   inform them that your baby has a serious medical problem:
   a. Rescue squad
   b. Telephone company
   c. Electric/gas company.
2. The letter asks that you be placed on the priority list for notification of anticipated
   interruption of service.
3. The letter asks that you be placed on the priority list for service restitution
   (restarting service) in the event of unexpected interruption of service.




                                                                     Tracheostomy-23
EMERGENCIES AND TREATMENTS
1. Plugged trach
   a. Suction and use Ambu bag
   b. Change trach tube if baby does not improve.
2. Coughing trach tube out of stoma
   a. Insert new clean trach tube as soon as possible
   b. Reinsert old trach tube until clean trach tube available.
3. Vomiting
   a. Suction if you think vomit has gone down the trach tube
   b. Observe for coughing, respiratory distress or fever
   c. Call baby’s doctor.
4. Baby stops breathing
   a. Start CPR and CALL 911 or ambulance team.
5. Unable to replace trach tube
   a. Stay calm!
   b. Try to insert a smaller sized trach tube. IF THE SMALLER TRACH TUBE IS
       USED, NOTIFY EQUIPMENT SUPPLY COMPANY SO IT MAY BE PRELACED
   c. Call 911 or ambulance team
   d. TRACH OPENING (STOMA) WILL NOT CLOSE UP SUDDENLY
   e. Give mouth-to-trach CPR if baby is not breathing or block trach opening and use
       mouth-to-mouth CPR.



CALL THE DOCTOR IF…
1. Food or liquid comes through the trach.
2. There is a rash, drainage or unusual odor around the trach opening.
3. Mucus becomes green or foul smelling (normal color is clear or whitish).
4. Bleeding occurs from the trach tube.
5. Breathing rate is 15-20 counts higher than usual for your baby.
6. Difficult breathing not relieved by suctioning or changing the trach tube.
7. Unable to replace the trach tube.
8. Baby stops breathing. START CPR!!! first.




Reviewed/Revised: 07/98…..09/11




                                                                    Tracheostomy-24

				
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