Care of the Tracheostomy

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0 height="100%"><tr> <td valign="top" width=200 BGCOLOR="#FFCC80" TEXT="#080000" bgproperties="fixed" background="1088e8e3.jpg"> <div> <IMG SRC="10995810.png" border=0 width="149" height="129" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> <bR> <div> <A HREF="id17.htm" TARGET="_top" TITLE="About Tracheostomy"><U><B> About Tracheostomy Page</B></U></A></div> <bR> <div> <A HREF="index.htm" TARGET="_top" TITLE="TSNI"><U><B>Home</B></U></A></div> </td> <td valign="top" BGCOLOR="#FF9900" TEXT="#080000" bgproperties="fixed" background="10e00c82dwnjbj.jpg"> <div> <FONT SIZE="5" COLOR="#000000" FACE="Arial" ><B>TSNI</B></FONT> <FONT SIZE="1" COLOR="#3366FF" FACE="Arial" > </FONT>   |     <FONT SIZE="1" COLOR="#CC0000" FACE="Arial" ><A HREF="index.htm" TARGET="_top" TITLE="TSNI"><U>home</U></A></FONT></div> <div> <A HREF="id37.htm" TARGET="_top" TITLE="Tracheostomy Feeding"><U>Tracheostomy & Feeding</U></A>   |   <A HREF="id46.htm" TARGET="_top" TITLE="Suctioning the Trachy"><U>Suctioning the Trachy</U></A>   |   Care of the Tracheostomy</div> <div> Care of the Tracheostomy</div> <bR> <div> When you are changing the tapes, check the skin around, above, below and behind the stoma for red or irritated areas. If the skin is sore, a sterile keyhole dressing can be applied between the skin and flanges, taking care not to cover the tracheostomy tube. The dressing should be changed regularly as wet dressings can cause infection and irritate the skin. Barrier cream should not usually be necessary, but we will discuss this with you. </div> <div> Tracheostomy tubes can cause the skin to develop granulation tissue (excess new tissue) in and around the opening to the stoma. This can cause bleeding and can sometimes make it difficult to change the tube. Discuss this with the tracheostomy nurse specialist/ community nurse if this problem arises. Granulations need to be cauterised or removed.</div> <bR> <div> <B> <A NAME="tubechange"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>Tube changes</B></div> <bR> <div> Secretions from the lungs coat the inside of the tracheostomy tube. It is therefore recommended that, under normal circumstances, the tube is changed once a week, although some children may be fitted with a different tube which can be left in longer. You may have to change the tube more often if secretions become very dry (for example in hot or cold weather or if the atmosphere in your home is too dry) or if your child has a chest infection and is producing more and thicker secretions.</div> <div> The day after the first tube change, your child’s nurse will show you how to change it. You will have the opportunity to observe the whole procedure and ask questions as you go along. Each day after this, you and your partner will be helped by the nurses to change the tube, until you are able to do it between the two of you. By the time you are ready to go home, you will have changed the tube as a team at least twice. It is important to remember that the tube is being changed daily in hospital so that you can learn the skills yourselves. When you are at home, the tube should only need to be changed once a week, depending on the type of tube used. This will be discussed with you at the time of teaching. It is important that you feel confident and competent in tube changing before you go home with your child in case you need to change the tube in an emergency.</div> <div> The procedure is not without risks and in order to do it safely, it is important to plan to do it when two people can be present. You should not change the tube just after meals as any coughing may make your child vomit. Do not change the tube when your child is tired and irritable. </div> <bR> <div> <B> <A NAME="instucttubechange"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>Instructions for tube changing</B></div> <bR> <div> Prepare equipment:</div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">round-ended scissors;</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">two lengths of 1/4 inch cotton tapes or Velcro tapes;</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">new tube - check correct size and that the tube is intact and in good order;</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">a smaller sized tube in case the usual one will not go in;</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">water-based lubricant to prevent the tube sticking to the skin as it is inserted.</div> <bR> <div> Wash your hands.</div> <bR> <div> Prepare tube - take out of wrapping and hold by the flanges. Put in introducer (if applicable). Apply a small</div> <div> amount of lubricant to the outer side of the tube, taking care not to let it get into the ends of the tube. Place the</div> <div> tube on the wrapper.</div> <bR> <div> Have all equipment within easy reach.</div> <bR> <div> Suction if necessary.</div> <bR> <div> Position your child as you do for tape changing (an older child can sit up).</div> <bR> <div> Hold the tube (one person). Cut and remove the dirty tapes and place clean tapes behind your child’s neck</div> <div> (the other person).</div> <bR> <div> Continue to hold the tube (one person). Hold the new tube by the flanges and position the tip near your child’s</div> <div> neck (the other person).</div> <bR> <div> Gently remove the old tube following the curve of the tube.</div> <bR> <div> Firmly and gently slide in the new tube, again following the curve of the tube so as not to damage the trachea.</div> <bR> <div> Remove introducer if this has been used.</div> <bR> <div> Hold the new tube in securely - changing the tube may cause your child to cough which could dislodge it.</div> <bR> <div> Allow the coughing to settle. Check air flow through the tracheostomy tube and your child’s breathing pattern</div> <div> and colour. Suction if necessary.</div> <bR> <div> Clean and observe the skin around the tube.</div> <bR> <div> Tie the tapes.</div> <bR> <div> Do not let go of the tube until the tapes are secure.</div> <bR> <div> <B> <A NAME="emergtraining"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>Emergency training</B></div> <bR> <div> When you are both comfortable with changing the tube, you will have formal training in basic life support (BLS) often called the “kiss of life”. This will usually take place the day before you are discharged home.</div> <bR> </td> </tr></table></body>