Component Task: Tracheostomy Care of A Child

This is the act of performing activities for a child who has undergone tracheostomy. This involves the management of the tube and stoma.

Aims

·         Provide patent airway

·         Remove secretions more easily

·         Prevent respiratory infections

·         Provide emotional support to child and caregiver

Requirements

a.      A sterile tracheostomy tube of same size

b.      Another sterile tracheostomy tube one size smaller

c.      Obturator

d.      Humidifier/ventilator (if necessary)

e.      Prescribed topical antibiotic

f.        Empty syringe

g.      Tracheostomy ties/holder

h.      Suction apparatus with catheters

i.         Sterile normal saline

j.         Water-base lubricant

k.       Self inflating bag with mask

l.         Rolled blanket/towel

m.   Mackintosh cape and towel

n.      Sterile gauze

o.      Sterile gloves

p.      Keep emergency phone number of ENT specialist

Steps

1.        Establish rapport (Refer to steps)

2.      Explain procedure (Refer to steps)

3.      Provide privacy even if unconscious

4.      Perform five moments of hand hygiene

5.      Interact with child on developmentally appropriate approach

6.      Arrange items and send to bedside

7.       Select a tracheostomy tube based on the size the of the neck or condition

8.      Call for assistance

9.      Check baseline vital signs (temperature, pulse, respiration, pain, blood pressure, SPO2)

10.    Place infant on the back with rolled blanket/towel and a semi-Fowler’s position in older children for better access to the neck

11.      Ensure continuous pulse oximetry and cardiac monitoring

12.    Use sterile technique in suctioning and suction entire length of tracheostomy tube

13.    Suction tube for the second time if needed

14.    Suction around the stoma as blood or mucus may leak from sides of outer catheter

15.    Observe for breakdown of skin, odour, colour and dryness around stoma

16.    Clean around stoma with a dry sterile gauze after suctioning

17.    Apply prescribed topical antibiotic around stoma

18.    Reconnect child to a humidifier/ventilator if necessary

19.    Educate child/caregiver on the home management of tracheostomy tube and report in case of any emergency

20.  Inform them on the need for follow-up

21.    Express appreciation to child and caregiver

22.  Dispose off, decontaminate and clean all used items

23.  Document all findings manually/electronically