Tracheostomy Tubes (Neos and kids)

Question 1

How do Pediatric (and neonatal) Tracheostomy tube from an adults?

Answer 1

Their tracheostomy tubes don’t have a inner cannula and Fenestrated pediatric tubes are not available.

Question 2

Why don’t kids and neonates have a inner cannula for their tracheostomy tubes?

Answer 2

The size of the tubes are too small

Question 3

Are tracheostomy tubes cuffed or uncuffed?

Answer 3

Generally uncuffed tubes are preferred.

• Cuffs can be used when a seal for PPV is required.

Question 4

What are complications of pediatric tracheostomies?

Answer 4

• Accidental decannulation or dislodgment
• Mucous plugging
• Infection
• Humidity deficit, dry retained secretions
• Tracheal bleeding, erosion, distal airway stenosis or tracheal malacia
• problems w/swallowing

Question 5

How often are tracheostomy tubes changed?

Answer 5

• Often once/month but can be different for each child
• May be done urgently when an obstruction is suspected w/respiratory distress

Question 6

What does routine tracheostomy care entail?

Answer 6

Suctioning and cleaning

Question 7

When is Decannulation of a Tracheostomy tubed considered?

Answer 7

• The original indication for the trach tube has resolved.
• Pt can tolerate capping trials during most waking hours
• Pt has effective cough and has the ability to clear secretions

Question 8

How often should suctioning be performed on Pts w/tracheostomy tubes?

Answer 8

Only when required

Question 9

What safety equipment should be ready when suctioning a Pt on a tracheostomy tube?

Answer 9

Oxygen, Bagger and mask

Question 10

What should the ideal sizing of catheters be for suctioning?

Answer 10

1/2 the size of the internal diameter of the tube (may not be possible w/small tubes)

Question 11

What suction pressures should be used on a neonatal tracheostomy Pt?

Answer 11

60-80 mmHg

Question 12

What should suction depth be for a tracheostomy tube?

Answer 12

Just to the end of the tube (must be measured and known).

• match the depth of tube w/color on suction
• its technically a predetermined depth

Question 13

How does a emergency suction differ from a regular suction for a tracheostomy patient?

Answer 13

In an emergency, suction until obstruction is met then slightly pull back 0.5-1.5 cm

Question 14

When suctioning a Pt on a tracheostomy tube what should be considered on a pre-assessment?

Answer 14

If on oxygen, increase the FiO2 by 0.1-0.2

Question 15

When applying suction (and pulling back) what is the total time the suction catheter should be in the tube?

Answer 15

Less than 10 secs

Question 16

When applying suction (and pulling back) what is the total time the suction catheter is applied?

Answer 16

Less than 5 secs

Question 17

What should be done to the suction catheter before insertion?

Answer 17

Moisten catheter tip w/normal saline.

Question 18

Add more on Sx Algorithm

Answer 18

Question 19

How can Suctioning w/closed systems be beneficial?

Answer 19

Maintains PEEP

Question 20

How is a closed Suctioning system procedure different from an open?

Answer 20

Similar procedure for depth and Sx…BUT

• May require higher suction pressures due to the higher resistance of the control valves.

Question 21

What are the steps for Tracheostomy tube managements?

• what do they entail?

Answer 21

Question 22

Equipment for Tracheostomy Care?

Answer 22

Question 23

What are the Steps of Tracheostomy Care?

Answer 23

1. Assemble and check equipment
2. Sx Patient (and evaluate)
3. Ensure tube is held in place at all times
4. Clean and examine stoma site
5. Reassess patient

Question 24

What are the steps for cleaning and examining a stoma site?

Answer 24

1. Remove ties and dressing
2. Dip applicators in normal saline to help clean site.
3. Clean area with soft tipped applicators (use quadrant system and dispose of applicators after each use)
4. Clean under the flange
5. Apply clean dressing
6. Apply clean ties
7. Reassess Pt.

Question 25

what is the most common cause of airway emergencies?

Answer 25

Tube Obstruction.

Question 26

Why are possible causes of tube obstructions?

Answer 26

- Obstruction of the tube orifice against the tracheal wall - Mucous plugging - Kinking of the tube or herniation of the cuff is possible

Question 27

What should you do if you suspect that there is a tube obstruction against the tracheal wall?

Answer 27

Move the Pts head and neck - it *may* alleviate the obstruction

Question 28

How would you trouble shoot a airway emergencies caused by mucous plugging?

Answer 28

- Immediately attempt suctioning to remove obstruction - If suction fails, the tube must immediately be replaced

Question 29

What are Tracheostomy tube complications?

Answer 29

- Tracheomalacia - Bleeding - Dilation and erosion of the trachea

Question 30

What is required for removal of a Tracheostomy Tube to be considered?

Answer 30

Need to ensure Pt has adequate cough and gag

Question 31

What is the process of Tracheostomy Tube Removal?

Answer 31

1. Initial plugging trial (may only be short duration) 2. Pt must given time to get used to breathing via upper resp. tract 3. Process of plugging trials maybe repeated over a period of time, with longer durations as the Pt tolerates progress 4. Smaller trach tube maybe required to allow easy breathing around the tube for kids. 5. Cont'd monitoring and documentation of process is required prior to making the decision to decannulate