Preparing For Your Child To Have A Tracheostomy

What Is a Tracheostomy? 

A tracheostomy is a surgery where a doctor places a tube into your child’s trachea to assist with breathing. This creates an opening that is called a tracheostomy or a stoma. You often will hear this opening called a “trach.”

Some common reasons for placing a trach include …
• To bypass a blockage of the airway
• To assist patients who cannot cough to clear mucus from their lungs
• To help patients who need to be on a breathing machine (ventilator) for an extended period of time

You may know already why your child needs a tracheostomy. If you still aren’t sure why a trach is needed, please ask your nurse or doctor to explain your child’s medical condition to you. A tracheostomy tube is used to keep the trach site or stoma open. Trach tubes come in many sizes and lengths. The size/length needed for your child will be based on …
• Breathing problem
• Age
• Airway size
• Special needs

lateral view of child showing sectioned upper respiratory anatomy with trach tube in place SOURCE: 1. Marilyn Hockenberry, PhD, RNCS (2004). Wong’s Clinical Manual of Pediatric Nursing, ed 6. “Unit 5: Community and Home Care Instructions,” page 693, Fig.1. 2) 7A11133/Caring for Your Tracheostomy

Pediatric tracheostomy tubes all include the same basic parts:

Flanges (or wings) are the two tabs that extend out on each side of the trach tube opening. These, with ties, are used to secure the trach.

The hub is the round opening at the end of the tube used as a connection point for tubing.

The cannula is the long tube that is inserted into the airway.

An obturator is a guide that is located inside the trach tube to assist with placing the tube into the airway. Once the tube is in place, the obturator is removed.

If your child has a cuffed trach, there will be a balloon at the end of the tube that will inflate and hold it in place. There will also be an inflation line connected to the balloon that you will use to introduce air or water into the balloon (cuff). 

Basic trach components

How Will Care at Home Be Different?

While your child is in the hospital, you will notice the nurses and respiratory therapists provide care using sterile technique.
Sterile technique (used in the hospital) includes … 
• Hand washing or the use of hand gel before providing care
• Wearing sterile gloves
• Using a new trach tube or a tube that has been sterilized each time the tube is changed
• Using a new set of trach ties each time
Clean technique (used at home) includes … 
• Hand washing or the use of hand gel before providing care
• Optional use of gloves
• Re-using a trach tube that has been properly cleaned
• Re-using the same trach ties if they are not soiled or wet
Clean technique may be used at home because your home environment has fewer germs, and your child is less likely to be exposed to other sick people. Because you will be reusing trach tubes in the home, it is very important to carefully follow the instructions provided in this booklet for the cleaning of the trach tubes to prevent infection.

Click on the link above to hear from a trach mom about a lot of myths about trachs, and gain some peace of mind about your child’s new accessory.

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