Pediatric Trach Tips

Nurseboy1 · Sep 29, 2005

According to what I learned in school and in my practice on a pulmonary unit with multiple trachs, you should leave the old ties on the trach while you put the new ties on. Once the new ties are in place the old ties can be removed. Also what kind of trach does the patient have? Is it a plastic shiley with a cuff or a metal jackson trach?

NurseyBaby'05, BSN, RN · Sep 29, 2005

I don't see how it would hurt to provide trach care while the child is watching tv. Are you suctioning as well, or just providing trach care? If you are suctioning, maintaining a sterile field may be a little more difficult if the child is in front of the tv instead of in bed. On the other hand, I guess there would be less risk of contamination if the child is still no matter where the care is being done.

I just remember a point that was driven home to me during school and on my orientation:

Only unfasten and change one side at a time!

That tip was followed by many horror stories of trachs falling out and airways closing.

I would insist on the girl's hair being braided or ponytailed until I was done. Hair in the airway might put a damper on things. It would also shorten the time she had to be still for trach care.

rambisisking · Sep 29, 2005

I'm a new nurse working in home-health and I have 2 pediatric patients who have trachs. Each day I have to do trach cares which involves changing trach ties. What is the easiest way to change (velcro) trach ties on a child who won't sit still. Is it ok to change them while sitting watching tv? Or will the trach fall out easily? I'm very frustrated since it's difficult to hold the trach while getting the ties adjusted correctly. And it doesn't help when one girl has hair down her back and is unable to hold her head still!
Please help me master this skill!!
Thank You!!
Jacesmom2

The age of the child has something to do with what is the best way to do this. I have a 3 year old and a 5 month old patient and different ways work with them. My 3 year old girl helps me and has been for almost a year. Putting her hair up is a good tip. I do it standing, sitting, lying, and even when she is asleep at times. I usually have her stand or sit so that I can get around her, I loosen one side of the velcro, cleaning that area and bring the old ties around the back of her neck, holding the trach with my other hand in place then insert the velcro tie on that side, then remove the other side holding in the trach...(sometimes she actually holds the trach in herself)...clean that side , slide the 2x2's under then connect it to the other side. Then of course slide a finger through the back of the ties to check for tightness and security. Now with the baby, I sometimes do it in bed but she has more ability to flail around with arms and head that way. So I've learned how to hold her on my lap with the supplies next to me so not only can I work on one side at a time but I can controll her arm and head movements, then basically do the same procedure. I would highly recomend that if you are uneasy about this procedure that you have someone with you if at all possible until you feel comfortable. Maybe you could do it at change of shifts with another nurse there or when Mom or Dad are around, and also make sure that you have a half-size smaller trach available if you do have trouble when you are doing a trach change or it comes out. I hope this helps you. As absurd as this sounds the best thing you can do is to make your self as calm as possible and allow them to see that in your eyes. Over time, trust is the only thing that improves trach changes and cares in little children.

Aneroo, LPN · Sep 29, 2005

Biggest thing I remember from caring for a toddler with a trach was- watch their hands! I don't know how many sterile kits I went thru, because that lil girl would grab the sterile suction cath as I was getting ready to suction!!! Not a toy!!! :)

Home Health Columnist / Guide · Sep 29, 2005

child with long hair: get one of those giant spring clips and use few minutes doing change. any distraction tv/video is great. can't sit stil 2 minutes, have parent assist. toy/stuffed animal in hand helps too.

learned a lot here: aaron's tracheostomy page

guide to home care for children with a tracheostomy

rt2crna · Oct 2, 2005

Fresh trachs can be very scary, but once the stoma has developed (granulated skin) if a trach were to slip all the way out, the stoma won't immediately snap shut, but that situation is still something to avoid, by all means. Have one hand on the trach at all times and don't take your eyes off of it. Have your clean tie and cleaning supplies all set before you start. Do the left side removal, cleaning, and re-attatching with your right hand, while gently holding the trach with your left, then switch hands and sides. Great opportunity to practice your digital dexterity! Have a small, curved hemostat ready if you have trouble getting the ties through the slits in the trach flange. Slide the hemostat through the slit and grasp the velcro or twill tape end-on from underneath and pull through. Make sure the skin is dried well when you're done, and definately make sure you can fit a finger easily between the tie and the patient's neck. Nothing causes more trouble than a tight, torqued trach. Take your time and be methodical.

The first hundred times you do it, you'll be a little nervous but after that- hey, no sweat! };.)

jacesmom2 · Oct 3, 2005

Thank You so much for your words of advice! You don't know how much that means to me to have encouragement from a much more experience nurse than I. I definitely will try your technique tomorrow. I never thought of using hemostats to help getting the ties through.

Have a Great Week!!

Jacesmom2

Fresh trachs can be very scary, but once the stoma has developed (granulated skin) if a trach were to slip all the way out, the stoma won't immediately snap shut, but that situation is still something to avoid, by all means. Have one hand on the trach at all times and don't take your eyes off of it. Have your clean tie and cleaning supplies all set before you start. Do the left side removal, cleaning, and re-attatching with your right hand, while gently holding the trach with your left, then switch hands and sides. Great opportunity to practice your digital dexterity! Have a small, curved hemostat ready if you have trouble getting the ties through the slits in the trach flange. Slide the hemostat through the slit and grasp the velcro or twill tape end-on from underneath and pull through. Make sure the skin is dried well when you're done, and definately make sure you can fit a finger easily between the tie and the patient's neck. Nothing causes more trouble than a tight, torqued trach. Take your time and be methodical.
The first hundred times you do it, you'll be a little nervous but after that- hey, no sweat! };.)