23.9 Removing and replacing a tracheostomy tube Ronald A. Dieckmann Background Children with tracheostomy tubes are increasingly common in out-of-hospital and emergency department settings. Laryngeal trauma, cervical cord injury, subglottic stenosis, and conditions requiring prolonged ventilation often need short- or long-term tracheostomy-tube placement. Most of these children live at home and have trained caregivers, often parents. Because the tracheostomy tube may be the primary airway for the child, if the tube comes out (decannulation) or becomes obstructed (mucus plugging), immediate action is necessary to secure the airway and preserve gas exchange. Treatment of most tracheostomy problems requires only simple techniques to establish a patent airway, such as suctioning of the existing tube, or removal of the old tracheostomy tube and replacement with a new tube. The child’s major ongoing risk is airway obstruction from clogging of the old tube with secretions or foreign bodies. Occasionally, it is impossible to ventilate a child through an existing tracheostomy tube because of frank decannulation or complete tube obstruction. Under these conditions, ventilating through the nose and mouth with a bag–valve–mask (BVM) device, or inserting a new tracheostomy tube or another temporary airway will save the child’s life. Indications for emergent replacement Respiratory distress or failure in the presence of: • decannulation; • tube obstruction. Contraindications Inadequately sized tract or stoma for insertion of a new tracheostomy tube. In this case, insert an endotracheal tube or replacement tracheostomy tube that is smaller in diameter than the original tracheostomy tube. Equipment Suction device. Sterile suction catheters. Oxygen. BVM, standard paediatric and adult mask sizes. Tracheostomy cannulas, appropriately sized for patient (see Fig. 23.9.1). Endotracheal tubes, standard paediatric and adult sizes. Laryngoscope handle with blades. Tape or tracheostomy ties. Gauze pads. Syringes, 5 mL or 10 mL. Water-soluble lubricant. Scissors. Sterile saline. Stethoscope. Fig. 23.9.1 Tracheostomy cannulas. Preparation Ask the caregiver if there are any special problems with the child’s trachea or special requirements involving the child’s tracheostomy. If the child has an obstruction of the airway as a reason for tracheostomy placement, rescue breathing with a BVM may be difficult or impossible. Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Syncope Abdominal and pelvic trauma Paediatric advanced life support (PALS, APLS) Pertussis Infective endocarditis Availing web-based resources Tags: Textbook of Paediatric Emergency Medicine Sep 7, 2016 | Posted by admin in EMERGENCY MEDICINE | Comments Off on Removing and replacing a tracheostomy tube Full access? Get Clinical Tree
23.9 Removing and replacing a tracheostomy tube Ronald A. Dieckmann Background Children with tracheostomy tubes are increasingly common in out-of-hospital and emergency department settings. Laryngeal trauma, cervical cord injury, subglottic stenosis, and conditions requiring prolonged ventilation often need short- or long-term tracheostomy-tube placement. Most of these children live at home and have trained caregivers, often parents. Because the tracheostomy tube may be the primary airway for the child, if the tube comes out (decannulation) or becomes obstructed (mucus plugging), immediate action is necessary to secure the airway and preserve gas exchange. Treatment of most tracheostomy problems requires only simple techniques to establish a patent airway, such as suctioning of the existing tube, or removal of the old tracheostomy tube and replacement with a new tube. The child’s major ongoing risk is airway obstruction from clogging of the old tube with secretions or foreign bodies. Occasionally, it is impossible to ventilate a child through an existing tracheostomy tube because of frank decannulation or complete tube obstruction. Under these conditions, ventilating through the nose and mouth with a bag–valve–mask (BVM) device, or inserting a new tracheostomy tube or another temporary airway will save the child’s life. Indications for emergent replacement Respiratory distress or failure in the presence of: • decannulation; • tube obstruction. Contraindications Inadequately sized tract or stoma for insertion of a new tracheostomy tube. In this case, insert an endotracheal tube or replacement tracheostomy tube that is smaller in diameter than the original tracheostomy tube. Equipment Suction device. Sterile suction catheters. Oxygen. BVM, standard paediatric and adult mask sizes. Tracheostomy cannulas, appropriately sized for patient (see Fig. 23.9.1). Endotracheal tubes, standard paediatric and adult sizes. Laryngoscope handle with blades. Tape or tracheostomy ties. Gauze pads. Syringes, 5 mL or 10 mL. Water-soluble lubricant. Scissors. Sterile saline. Stethoscope. Fig. 23.9.1 Tracheostomy cannulas. Preparation Ask the caregiver if there are any special problems with the child’s trachea or special requirements involving the child’s tracheostomy. If the child has an obstruction of the airway as a reason for tracheostomy placement, rescue breathing with a BVM may be difficult or impossible. Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Syncope Abdominal and pelvic trauma Paediatric advanced life support (PALS, APLS) Pertussis Infective endocarditis Availing web-based resources Tags: Textbook of Paediatric Emergency Medicine Sep 7, 2016 | Posted by admin in EMERGENCY MEDICINE | Comments Off on Removing and replacing a tracheostomy tube Full access? Get Clinical Tree
