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Trach Tips

We are happy to present these tips to you. These tips all come from our parents who have "real life" experience. Please check with your doctor regarding anything that is not standard protocol for your child. These tips are not meant to replace any medical advice, only help you take care of your child.

A very special thanks to Shannon for putting these tips together!

Suctioning the trach tube
Suction is done AS NEEDED and at the following times:
-if mucous is coughed up from the trach tube
-before and after a trach change
-when waking up
-after chest physiotherapy
-after an aerosol treatment
-when your child is sick and has excess mucous
-before or after feeding ( best to wait an hour after feeding to reduce the
chances of vomiting), of course, suction sooner if needed

*WARNING signs of breathing trouble
-increased grunting, retracting, shortness of breath
-anxiety or restlessness
-scared look on face
-wheezing
-strider
-flared nostrils
-poor sucking or feeding
-pale or blue color to lips or change in skin color
-irritability, fussiness, or sleepiness

When to use saline
-when mucous is thick or sticky
-when you suspect a plug
-you hear whistling sounds
-a few drops of saline in the trach can prevent dryness and plugs
-saline drops are good on either end of the T-vent for moisture
-a few drops is used when your child sleeps with a T-vent and not a heated
collar

If you need to suction the nose, mouth and trach do so in the following order:
trach-nose-mouth
*change catheter after suctioning nose or mouth. Suctioning the trach after
suctioning the nose or mouth may cause infection.

Routine Skin Care
Dirt, drool, sweat, mucous can cause skin to breakdown.
-check area around stoma twice a day
-wash around stoma well with soap and water or 1/2 strength hydrogen peroxide
twice daily, more or less as needed. Make sure area is dry to prevent skin
breakdown. Soaps recommended are Ivory or baby soaps/shampoo diluted in
water.
-lanolin, bactroban, bactricin, liquid vitamin E can be applied sparingly
(too much use can build up resistance) to help when there is skin
breakdown. consult your MD about use
-some children need skin care around the stoma and on the neck more often
than others, esp. when the stoma is new, red, or infected, or there is more
mucous.
-gauze (2x2's), Q-tips and washcloths are good for cleaning the neck and
stoma site. Q-tips allow you to clean the site with the trach still in place.
Split 2x2's are also good for trach "pants" which go under the flange of the
trach and catch drool and food.
Cutinova "new skin" or Duoderm also work well as trach pants.

Changing Trach Ties
-have scissors and wire cutters handy in case of an emergency if your child
uses ties or a chain
-have all supplies ready before you remove the existing ties. ex. soapy
water, clean ties, extra trach, ointment, q-tips, etc..
-it may be easier to change the trach ties and do trach care while your child
is asleep; esp. if there is only one person. If you have two people, one can
hold the trach in place while the other cleans and changes the ties.
-Velcro ties are reusable. Wash with mild soap and water and hang or lay
out on a clean surface to dry. *Careful to check the ties as they wear
easily and don't stick well risking the chance of becoming loose and causing
the trach to come out.
-Velcro ties can be cut to size. rounding the edges and cutting off the tag
can help in preventing skin irritation from rubbing against the skin
-be sure you can get one fingertip between the trach tie and your child's
neck to ensure proper tightness.
-it is easier to change ties on a changing table or on the floor, on a
blanket, straddling over him/her like they do in CPR training.
-glad ware bowls are good to have one with soapy water and the other with
water to rinse. These are easy to clean and store and inexpensive to replace.
-do not change ties right after your child has eaten...this may cause
vomiting form movement.

Changing the Trach Tube
have all supplies ready before changing the trach!
-suctioning supplies
-clean trach and obturator
-clean ties
-fresh water and soap
-Q-tips, gauze, or a washcloth
-KY jelly or other water soluble lubricant DO NOT use baby oil, Vaseline or
petroleum jelly
-scissors or wire cutters
-ambu bag and O2
-a rolled blanket or towel to put under your child's shoulders
-careful not to touch the end of the trach as this can cause infection
-be sure to wash hands before and after changing the trach
-make sure you do not block the tip of the trach with lubricant
-you can use gauze or a q-tip to apply the lubricant
-place the new trach on a clean paper towel while preparing to change the trach
-changing the trach may cause your child to cough, have suction ready
-do not force trach into stoma- have a smaller trach within reach
-have phone within reach incase of an emergency
-it's good to have a trach w/ obturator with ties attached and a smaller
trach, or ET tube, in a Ziploc bag taped to the headboard for emergencies (
if your child is not able to reach up and get the bag as this would be a
choking hazard)

Cleaning the trach tube
-glad ware containers are good for cleaning the trach tube
-mild soap
-fresh tap water
-scrub brush and pipe cleaners (some supply companies will send trach tube
cleaning kits)
-always check for cracks or rough edges. Ask your MD how long to rotate
trachs, and when to use new ones.

Cleaning Medical Equipment
-dishpans are good for cleaning supplies, supplies can soak while others
are in use
-hot water and white vinegar, with a little dish detergent (not lemon, it isn't
recommended) vinegar 1: water 3, are best for cleaning every 24 hours.
-tubing can be hung over a door to dry
-ask your supply co. about replacing filters for nebulizers and suction
machines and air compressors and what they recommend to clean the equipment.
-have a box of extras clean and ready to use
-plastic shoeboxes are also good for cleaning and storage -after cleaning the suction canister, pour a small amount of mouthwash into
the canister. This helps decrease odor and bacteria.

Reusing Suction Catheters
-between each use, clean the catheter with clean tap water and place the
catheter back in the plastic container, or in a Ziploc bag. Throw out if
the tip touches any surface.
-do not reuse if your child is sick
-flush the catheter until it is clear of mucous

Humid vent - "artificial nose"
-the paper on the edges acts as a filter
-be sure not to get wet
-throw out if it comes in contact with mucous
-do not wash the thermo vent
-a few drops of saline on either end will help with moisture
-a humid vent helps keep an infant's chin from covering the trach
-always carry an extra with you if you go out

General Travel Bag
-suction machine, chargers, cigarette lighter charger for the car
-trach tubes. one smaller and one the current size
-suction catheters
-clean trach ties ( can already have the ties in the trachs)
-ambu bag, self inflating
-extra humid vents, PMVs,
-scissors or wire cutters
-lubricant
-sterile water
-saline
-Q-tips, gauze
-MD and emergency numbers and insurance information
-your child's medical history
-portable O2

Restock your general travel bag with extra supplies when traveling.
When traveling it is good to call ahead and get info. about the local
hospital. Ask your child's MD if he knows any MDs in that area. Some
equipment can be shipped ahead. If flying, arrive early to check in
equipment. It's best to tell security that you're traveling with medical
equipment. Have plenty of emergency supplies in your carry-on bag in case of
an emergency. Call ahead to check on outlets. May want to carry two
portable suction machines and canisters. One to carry with you throughout
the day, and the other to leave charging and cleaning. Take Ziplocs for
storage of humid vents, saline bullets, trach ties, trach masks, neb bottles,
drain bags, extra trachs, feeding tubing and syringes and and
glad ware/Tupperware containers to clean and store bigger supplies. Carry a
clean towel to use for drying supplies. Q-tips, soap, distilled water,
disinfectant, vinegar, paper towels, etc. can be bought there, less to carry
on and home. Place several drops of saline in your child's trach as needed
to keep secretions loose while traveling. Also, carry a pair of non-latex
gloves for cleaning supplies and a flashlight for a power outage! Your "back
up" emergency trach can be put in a Ziploc bag and marked with a red X so as
not to be mistaken in a rush! There are manual suction devices for trips and one
can be made by using a urine catheter with a cap tip on the end, and you
create a manual suction by attaching a catheter tip syringe on the catheter tip end.
****don't forget your charger!!

Troubleshooting

Difficulty breathing:
1) give several breaths w/ ambu bag
2) suction, use saline if needed
3) change trach if suctioning does not help
4) call 911

Trach is difficult to insert:
1) make sure head is tilted, use towel or blanket under shoulders to help
with positioning before trying to change trach.
2) try reinserting with an obturator and lubricant
3) use the next smallest size
4) insert clean suction catheter or ET tube into stoma, give breaths and call
911

Reddened are or rash on neck or around stoma:
1) clean area and dry well, apply clean, dry trach ties
2) apply meds as ordered by your MD
3) call your MD if no improvement

Recipes

Sterile water:
boil tap water for 5-10 minutes( rolling boil )
let it cool and pour into large clean jars or plastic containers with lids
wash jars or plastic with hot soapy water between use
sterile water may be stored for 3 days at room temperature

Homemade saline solution:
add 1/4 tsp. salt ( not iodized) to 1 cup of fresh tap water into a small jar
or cup with screw on lid. Screw lid loosely. Place jar in a pot of water
with the water level in the pot at least 3/4 the ht. of the jar. Cover pot.
Bring water to a boil and boil for 25 min. Allow to cool. Remove jar and
tighten jar lid. Store saline in the refrigerator for one week. Be sure to
date. Discard any solution not used after a week.

Letters for priority service
Letters addressed to the telephone, electric, gas, fire and ambulance
companies can be written by your physician( some will have some preprinted)
explaining your child's special medical needs and that you need your
utilities in service at all times, and need to be delivered *before your
child's discharge date. Should your services be interrupted for any reason,
you need to call that company immediately to alert them that:
1) your service has been interrupted and
2) your child's well being depends upon continued service

It's good to visit your local fire dept. and deliver the letter explaining
your child's needs and making them aware of the trach size and any other life
saving information that would be important in an emergency.

Handicapped Parking
Ask your physician for a form to request a handicapped parking permit for
your equipment. Call your local tag office for further instructions.

One last tip: Get a "No Smoking" sign for your front door if your prone to
have visitors who smoke. It's especially harmful to a child with a
compromised airway and very dangerous if O2 is in use.
 

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