By Adem Lewis / in , , , , , , , , , /

(music) Tracheostomy tubes can
become partially or completely plugged, resulting in an
emergency situation. Always keep emergency supplies close to your
child. The trach tube may become plugged for several reasons,
including thick secretions, lack of humidification, dehydration,
the child is unable to cough, or not suctioning enough. If you
notice your child’s secretions are thick or have a change of
color, notify your primary care provider or pulmonologist. Watch
for these signs of a plugged tracheostomy–Your child
breathing fast or working harder to breathe. Your child’s chest
muscles pulling. Your child’s coloring changes. Decrease in
oxygen saturations. Or your child is unresponsive. If your
child is on a ventilator, a high pressure alarm may sound.
Turn on the suction machine. Open the suction
catheter kit, making sure to keep everything inside sterile.
Put on gloves, making sure not to touch anything but the
contents of the package. Connect the suction to the suction
catheter. With routine suctioning, insert catheter to
the depth determined by your health care team. In an
emergency situation, you may need to suction further. Insert
suction catheter further until the child coughs. This will help
move secretions. It may help to put a few drops of sterile
saline into the trach tube. If passing the suction catheter
proves difficult or impossible, you will need to perform an
emergency tracheostomy change. All caregivers should know how
to change a tracheostomy in an emergency without help. Stay
calm. Open a new trach package, leaving the new trach inside of
the package. The new trach will have an obturator inside to make
it easier to put the trach into the stoma. If your child has a
cuffed trach, deflate the cuff using an empty 5 milliliter
syringe. Undo the trach ties or trach chain. If your child is on
a ventilator, disconnect the ventilator adaptor from your
child’s trach while continuing to hold the trach in place.
Remove your child’s trach. Remove the new trach from the
package. Immediately insert the new trach and remove the
obtruator. If you are unable to insert the same size
tracheostomy tube, use the next smallest size. If your child
appears well after the trach change, reconnect the ventilator
to the trach. Secure the new trach in place using your trach
ties or trach chain. If your child has a cuffed trach,
inflate the cuff. If your child is having difficulty breathing
after the trach change, you may need to provide breaths with the
ambu bag. “I need some help in here!” If any any point you are
concerned about your child’s airway or breathing, and your
child is not getting better, call for help and call 9-1-1. If
at any point your child becomes unresponsive, start chest pushes
or CPR immediately and then call 9-1-1 for help.

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