We asked a group of experienced parents to suggest their very best trach tips. What follows is a selection of their suggestions. Remember to always ask your doctor before changing your child’s care!
Choose several designated people to do trach changes and stick with them. People who aren’t used to changing trachs can greatly increase the discomfort of the child and the likelihood of something going wrong. Make sure it is a team effort since doing things alone also increases risk. Praise the child afterward for doing a great job.
Don’t use the obturator unless you need to, but have it nearby. The obturator is bent in a generic shape and can cause pain to a child. Getting rid of it can make a resistant child much more willing to have his trach changed. You are also less likely to find blood after a change.
Be sparing with lube on trach changes. Try using just saline to wet the trach. The more lube, the more likely your child will have aspiration issues. Always used water-based lubricant.
Thread trach ties into your spare trachs and keep them in a sterile bag with surgilube taped to the outside. That way if you ever need to do an emergency change alone you aren’t scrambling for trach ties or lube. You can also tape a clear plastic bag with a trach, ties and lube to the wall in all rooms used by your child.
Obtain as many spare trachs as you can and keep them in various places, such as your suction or go bag, both floors of two level houses, and at bedside. Consider putting one at that head of the bed and one at the foot of the bed so they can be easily grabbed in an emergency. You can also stash HMEs all over the place in the same manner.
Pads, Trach Ties, and Other Equipment
Use a cloth trach pad instead of gauze. Beware that gauze can have excessive lint which gets in the stoma and can cause irritation. Many individuals make cloth trach pads that wick moisture better than gauze, are custom-shaped and fitted to your child’s size, and are much cuter than gauze! They also can be rewashed and used repeatedly. It is not difficult to make your own.
If you don’t get enough split 2x2s, order some split 4x4s to clean with and 2x2s to wear. You can always cut down the 4x4s if needed.
Put an extra 4×4 under the trach tie in the back to protect the neck from irritation from Velcro or other materials.
You can use many things as trach ties! Shoelaces, ribbons, custom sewed ties, and even chains can be made into trach ties. These allow your child to look cute and fashionable all the time.
Some people swear by stainless steel or chain trach ties. These can be cleaned and sterilized, never absorb moisture, and never smell.
Don’t feel like you have to change the trach ties every day. Changing ties can be a challenging and dangerous task with uncooperative little ones. If her neck looks fine and the ties look clean and dry, wait. Often we will go seven days without changing the ties and the skin continues to look perfect.
Consider using sleeved suction catheters. When using these, you don’t have to wear gloves to suction. These are very similar to in-line catheters, but you can use them for children who are not on a vent. Not all medical supply companies have this type, so either request them or find a supplier who carries them.
Use a humidifier that allows you to independently control both the humidity and the temperature. When it is dry or your child has thick secretions, turn up the humidity slightly.
Cold saline is good for dripping into the trach when secretions are bloody. Saline can also thin thick secretions.
Run one or more room-sized humidifiers when the weather gets colder. This will help avoid mucus plugs for your child. Just make sure to clean the humidifier daily and replace filters as needed.
If your child gets sick and needs continuous oxygen, you can get a 20-foot cord to extend the length of the HME/O2 clip. Put an old shirt on the child and use diaper pins to attach the cord to the shirt. This way when the child moves, it doesn’t pull on the trach.
Large Ziplock bags work perfectly to store assembled circuits; small ones are great for trachs.
Use clips to attach circuits to clothing or bedding. You can buy these or simply reuse the ones from clip-on hospital visitor passes.
Cleaning and Infection Control
To keep your suction canister from smelling, add about a tablespoon of alcohol-based mouthwash (such as Listerine) and leave it in the canister. This also helps with infection control.
Saline bullets make a quick and sterile rinse for trach stoma cleaning/care.
If you must reuse trachs, consider using a baby bottle electric sterilizer to sterilize trach parts. These are inexpensive and work great!
Clean suction tubing and large volume nebulizer canisters in a vinegar soak. First remove all yuck, and then soak for several hours in a water/vinegar solution. You can also use the same solution for cleaning the inner cannula, and for some children, you can even use it on the stoma.
Put a sign on the front door saying if you are sick to please visit another day. Have all visitors immediately wash hands and remove shoes upon coming in the house. If they are going to use their cell phones, have them wipe them off with a disinfecting wipe first.
Put together a photograph or diagram of your vent, humidifier, oxygen, and other attachments, with each item that can come apart labeled. Post it at the bedside. This will prevent assembly errors.
Use a hanging bag with pockets to store essential items at bedside, such as trachs, lube, saline, and syringes.
Keep two separate bags: an emergency bag for true emergencies and a travel bag for outings. The emergency bag has a list of specific items that are in it at all times. A nurse/parent checks through the list and places a piece of tape over the zipper when done. Use this bag for true emergencies, like natural disasters.
The LL Bean Family Size travel bag makes a great emergency bag. It can even hang on doors and has lots of organizational pockets. It can even hold the suction machine.
Keep an emergency bag packed for your child, and pack one for yourself as well. You can grab it in an emergency situation and be fully prepared to stay at the hospital. Make sure to include clothing, toiletries, cash, reading material, and snacks.
Bring at least one of every item your child needs with you to the hospital (circuits, filters, HMEs, connectors). Sometimes hospitals do not stock particular items, and it is best to have a backup, especially if an emergency occurs.
Travel and Outings
For doctor’s appointments, ask to wait somewhere away from the other people, preferably in a different room. Clean the room you are to see the doctor in with a disinfecting wipe, even if the nurse tells you they already did it. Don’t be afraid to ask the doctor to wipe off the stethoscope before using it–think of all of the sick kids it was used on.
Consider making a checklist with pictures of every item in your go bag, emergency bag, or travel bag. Nurses or parents can check off items and make sure the bag is fully stocked.
Instead of trekking your child’s nebulizer around with you, ask your doctor to prescribe inhalers (MDIs) for medications like albuterol. These can be stashed easily in any bag and used in emergencies.
Support and Training
Consider using a palliative care program to help support your child. Palliative care is not just for children who are dying. It can help you to improve your child’s quality of life from diagnosis until cure or death. Palliative programs will help you avoid hospitalizations, and provide services (like blood draws) at home.
Ask if your hospital has a library. Many children’s hospitals have librarians who will happily do research for you on trachs and related subjects. You are the overseer of your child’s healthcare. Equip yourself with the knowledge you need to make the best decisions for your child as individual doctors tell you what they think. Remember doctors don’t know everything; in fact, some might not even be aware of newer studies you encounter.
Get connected with other parents of children who have trachs. It is amazing what you can learn from others. It’s also nice to have someone to chat with who knows what you are going through. There are Facebook groups, internet chat boards, and more. Take advantage of the knowledge of others.
Don’t assume your nursing agency is going to do a good job training your nurse. Some nurses may have never been trained on trach emergencies, and may not know what to do. Have a list of all emergencies that are likely to happen, such as trach out, respiratory distress, mucus plugs, or aspiration. Go over the appropriate response to each situation. It is amazing what nurses are supposed to know but don’t.
Author: Melissa Stiff, Myra Young, the parents at Kids with Vents, and the MFTD Waiver Families • Date: 4/16/2013