what to do when a trach comes out

Some children demand a tracheostomy (trach) tube to assistance them breathe with a clear airway. They might depend on a trach tube temporarily or they might rely on information technology over their lifetime. Either way, parents and caretakers need to practice good habits when changing and cleaning a trach tube. They also demand to know what to do in example of an emergency, such as when the trach tube comes out accidentally or becomes blocked.

What's an emergency trach kit?

An emergency trach kit contains everything you need to help your child breathe again if the trach tube comes out accidentally or becomes blocked. Earlier your child comes dwelling from the hospital, gather what you need for your emergency trach kit. Then keep the kit with your child at all times, whether your child is at home, at school, visiting friends or elsewhere.

What should I keep in the emergency trach kit?

Always have these items in your kid's emergency trach kit:

• Two make clean trach tubes with holders attached and obturators in place:
  • One tube that'south the same size as the tube your child has in place
  • One tube that'south a size smaller than the tube your kid has in place
• Trach ties (twill tape, Velcro or bead chain)
• Trach noses
• Spare inner cannula (if needed)
• Pocket-sized blanket or towel roll
• Blanket for mummy restraint (if needed)
• Sterile water
• Water soluble lubricant
• Saline lavage (if used at home)
• Suction and catheter kits
• Portable suction car
• Bulb syringe — for sometime shallow suctioning if no power is available
• Manual resuscitation handbag and confront mask
• Luer-Lock syringe (if trach tube is cuffed)
• Instructions for cardiopulmonary resuscitation (CPR) and troubleshooting an obstructed tube
• Bandage pair of scissors
• Tissues
• Tweezers or forceps
• Wipes or hand sanitizer
• Oxygen tank
• Emergency phone numbers

What should I know before I modify the trach tube?

Typically, a trach tube requires changing every one to four weeks to preclude mucus buildup and to proceed information technology clean. Nonetheless, this frequency might vary depending on your child's needs and what your doctor advises.

Trach tube changes should happen before feeding or at to the lowest degree 2 hours afterwards feeding.

Always change the trach tube with two people present — unless it'south an emergency and this isn't possible.

Earlier changing a trach tube, you demand to know some bones information. You should be able to reply the following questions correctly and confidently.

• Is this a new tracheostomy or an established 1?
• Is the trach tube cuffed or uncuffed?
• Is there an inner cannula?
• Tin can your child breathe on his or her own, or is he or she dependent on a ventilator?
• Practise you accept suction set up and ready to employ?
• Where are your backup trach tubes, trach ties, syringe and lubrication?
• Do you know how to use a manual resuscitator?

If yous're uncertain about your responses to any of the above questions, or if you have any questions about changing your child's trach tube, talk to your doc before starting the change process.

One time yous're confident in your knowledge near changing your child'southward trach tube, you lot can begin.

www.gillettechildrens.org/EDR115

How practise I change a trach tube?

See folio 1 for a link to video instructions.

Gather your supplies (included in the emergency trach kit).

Talk to your child, whether yous're making a routine change or changing a trach tube that's fallen out by blow. Explain what yous're doing in a way that'southward appropriate for your kid's historic period and understanding. Employ a calm, gentle approach. If y'all appear anxious, your child might sense this and go anxious, also.

Follow these instructions:

1. Wash your hands.
2. Cut trach ties to the appropriate length.
3. Inspect all tubes for cracks, tears or decreased flexibility earlier you utilize them, peculiarly if tubes are beingness reused. For cuffed tubes, inflate the cuff to ostend information technology's functioning properly, and check for leaks. Then deflate the cuff completely earlier inserting the tube.
4. Bring a trach tie through ane end of the new trach tube. Avoid touching the part of the tube that is inserted into the trachea. Attempt to keep it sterile.
5. Insert the obturator into the new tube. Be certain it slides in and out hands. The obturator helps to guide the tube, and the rounded tip adds protection to the stoma during insertion.
6. Place a modest amount of sterile h2o or soluble lubricant (Surgilube or KY Jelly) on the end of the new trach tube, and place the tube on a sterile tray or a clean surface until you're fix to insert it. Notation: Never use Vaseline or whatever petroleum jelly equally a lubricant. And if you lot practise use a lubricant, utilise it sparingly and wipe off any backlog.
7. Accept a suction motorcar, a catheter and an oxygen tank handy, in case any are needed.
8. Identify your child on his or her back with a pocket-size blanket or towel roll under the shoulders to help with slight hyperextension. Information technology might be helpful to wrap your child in a blanket, mummy-way, especially if your kid isn't cooperative. Your child may also sit down up for the trach tube change.
9. Administrate oxygen, if directed by your doctor's instructions.
10. If your child has a cuffed trach tube, deflate the cuff and gently remove the onetime trach tube. (Follow the bending of the tube, an upward and outward arc.)
11. Release the one-time trach ties while holding onto the trach tube. Ever hold the tube when ties aren't secure; a cough tin can dislodge the tube.
12. Insert the new tube in a smooth curving motility, directing the tip of the tube toward the dorsum of the cervix in a downwards and inwards arc (similar inserting a suction catheter).
13. Exercise not forcefulness the tube.
14. Remove the obturator immediately, while property the tube deeply with your other paw. Recollect: Your child cannot breathe with the obturator in place.
15. Changing the trach tube will cause your child to cough; do not allow go of the tube.
16. If the trach tube is a cuffed tube, inflate the cuff with the prescribed amount of air.
17. Thread the trach tie through the other finish of the tube and necktie it, assuasive one finger betwixt the neck and the ties. Yous might need tweezers or hemostats to thread ties through the hole of the wing of the trach tube.
18. Inspect the old tube for color, mucus plugs or smell, and and then ready it aside. When changing a trach tube, wait for skin irritation or breakdown. As well, wait for signs of infection.
19. Remember to encourage and praise your child. A trach tube change can be emotionally hard for some children.

What should I do if the trach tube is blocked?

A blocked trach tube is an emergency: Your child cannot exhale. Aid clear your child's airway by following these instructions:

1. Try suctioning through the trach tube.
2. If the catheter doesn't pass, modify the trach tube. (See instructions provided before in this handout.)
3. If yous're unable to keep quickly, remove the trach tube, hold gauze over the stoma, and use the transmission resuscitator to ventilate through your child's oral cavity and olfactory organ.
4. Modify the trach tube when you're ready.

When should I telephone call the medico?

Phone call your Gillette physician if yous notice whatever of the following:

• Redness, peel breakdown or rashes around the stoma
• Fever: temperature above 101.5 F orally or 100.5 F under the armpit
• Signs of dehydration (getting dried out), such every bit:
  • No urine (or wet diaper) for eight hours
  • Urine color darker than normal
  • Urine's olfactory property stronger than normal
• Mucus is yellow, light-green, ruby-red or claret-tinged, or it develops a olfactory property
• Any breathing problem that doesn't go better after suctioning

Call 911 if:

• Your kid is bleeding more than a footling from the trach tube. Practise not remove the trach tube, just suction it ofttimes until trained aid takes over.
• Your kid stops breathing.
• Your kid becomes unconscious.
• You feel you cannot handle the situation.
• You have to do CPR.
• You lot accept to practise an emergency trach tube alter and are concerned nearly it.

This data is for educational purposes merely. It is not intended to replace the advice of your health intendance providers. If y'all take any questions, talk with your medico or others on your wellness intendance squad. If you are a Gillette patient with urgent questions or concerns, please contact Telehealth Nursing at 651-229-3890.

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Source: https://www.gillettechildrens.org/your-visit/patient-education/emergency-tracheostomy-care-at-home

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