Monday, May 7, 2012

Helpful Hints for Trach Patients

It can be a tough transition for parents of a tracheostomy patient to feel comfortable at home taking care of their child. What do you do in an emergency? How do you trouble shoot common problems with the trach? Often times, these subjects are briefing addressed during a hospital stay but it is always best to review trach protocols to be best prepared for these situations.

What symptoms will you see?  Low oxygen saturations, labored breathing, wheezing sound coming from the trach, resistance when you try to suction the trach, blue tinge to lips or around mouth.
What will you do?  Try to suction the trach. If you get resistance or no secretions, assume it is a mucous plug. You can try normal saline drops to the trach to try and loosen the plug or just change the whole trach tube out. If you cannot fit a new trach tube in the stoma, use the next smaller size trach tube.
How can you avoid this?  Keep your child well hydrated and suction the trach frequently. If your child always has thick secretions, use saline drops or nebulizer treatments to loosen and thin secretions so you can suction them out more easily.

What symptoms will you see?  If your child is on a ventilator, the low pressure alarm will sound. You may hear whistling or the sound of air escaping from the stoma. Blue tinge to lips or around mouth, labored breathing, low oxygen saturation readings.
What will you do?  Replace the trach tube immediately! If a clean trach is not available and the trach that has come out of the stoma should be replaced if not broken. If a new trach is close at hand, you may replace with a new trach but in an emergency situation it is not necessary. Remember, it only take 3 minutes of poor oxygen to the brain to cause brain damage.
How can you avoid this?  Make sure the trach ties are secure (a good rule is if you can fit two fingers under the trach tie but no more). Make sure if your child is active to keep them occupied and do not allow them to pull on the trach or ventilator circuit. Remove any objects in the child’s environment that could snag the ventilator circuit. When transferring you child, make sure you secure the trach and/or vent circuit.