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How to Change and Clean Your Child's Tracheostomy

A tracheostomy requires regular care to keep the area clean and to prevent infection and skin breakdown. Clean and check skin at least 1 time(s) a day. Some doctors will advise cleanings at least twice a day. Change the trach tube every 10 days, or as often as you have been told by your healthcare provider. Have two adults present when changing the trach tube, if possible. Follow the general guidelines below and any other specific instructions you are given.

Collect supplies

Some people find it helpful to set up and do changing and cleaning in the same place each time. Choose a clean, well-lighted space near a sink. Supplies you will need for cleaning and changing include:

  • Rolled-up towel or pillow

  • Liquid soap, alcohol, or disinfectant foam

  • Clean, disposable, powderless gloves

  • Gauze

  • Normal saline solution

  • Trach ties and scissors, cut to the right length

  • Trach tube

  • Two sterile or disposable cups

  • Small towel

  • Suction machine

Clean and check the skin

Ask your healthcare provider if your child needs a tracheostomy dressing. If so, change this gauze when cleaning the trach site. Don't use cotton gauze because your child may inhale the tiny fibers. Use only pre-cut gauze. Cutting gauze on your own will cause frayed edges. These increase the risk for infection.

  • Have your child lie on his or her back in a comfortable position. Put a rolled-up towel under the shoulders.

  • Wash your hands and put on disposable gloves.

  • Clean the neck plate and the skin under it. Use clean gauze pads or other non-fraying material dabbed in normal saline solution.

  • A thorough cleaning technique you may consider involves cleaning the stoma in a step-wise fashion, one quarter at a time. Start at the 12 o'clock position wiping to the 3 o'clock position. Then with a new gauze pad for each section, clean from 12 o'clock to 9 o'clock, followed by the 3 o'clock to 6 o'clock position. Last, clean from the 9 o'clock to 6 o'clock position.

  • Pat the area dry with clean gauze.

  • Check the skin for signs of infection, such as redness, swelling, or warmth.

  • Wash your hands when you finish.

Replace the trach tube

Ask the doctor if you should use an obturator. This device may make it easier to insert the tube. Its rounded edges also protect the stoma during insertion. If you need to use a lubricant, be sure to ask the doctor how much to use. Have a suction machine ready, if needed. Depending on the age of your child, explain the procedure as well as you can. If two people are available, one person removes the old trach tube and the other puts the new one in place.

Child lying on back with pillow under neck. Gloved hand is removing old trach tube from child's neck.
Removing the old trach tube.

 

 

Child lying on back with pillow under neck. Gloved hand is inserting new trach tube into child's neck.
Inserting the clean trach tube.

  • Have your child lie on his or her back in a comfortable position. Put a rolled-up towel under the shoulders.

    Child lying on back with pillow under neck. Gloved hand is inserting finger under trach tie.
    Checking that trach ties aren’t too tight.

  • Wash your hands with liquid soap and warm water. Dry well. You may also use alcohol or disinfectant foam.

  • Put on disposable gloves.

  • Get the new trach ties ready by draping them around your child’s neck.

  • Open the trach tube package and insert the obturator if you’re using one into the new trach tube.

  • Remove the entire old trach tube and lay it down on the towel. Remove gauze if you have used it.

  • Replace the old trach tube right away with the new one. While holding the edges of the tube, remove the obturator right away, if you’re using one. Your child cannot breathe if it is left in place.

  • Secure the trach ties.

Take precautions with skin care

Unless the area is infected, don't use a hydrogen peroxide mixture directly on the skin. This is because it causes inflammation and increases infection risk. It can also cause mucosal irritation and increase tracheal secretions. Be sure to ask your child's doctor when and if a hydrogen peroxide mixture is OK to use before using it. If a hydrogen peroxide mixture is used on an infected site, it is important to rinse the area with normal saline solution afterward.

Be sure to not get soap or water into the stoma or trach tube. Watch for signs of infection. These include swelling, heat, redness, smelly discharge, fever, or pain when suctioning. If you suspect that the tracheostomy is infected, call your child’s doctor right away.

When to call your child's healthcare provider

Call your child's healthcare provider right away if your child has any of the following:

  • Red, painful, or bleeding stoma

  • Yellow or green, smelly, bloody, or thick mucus from the stoma

  • He or she is coughing up blood

  • Fever (see Fever and children, below)

  • Your child has had a seizure caused by the fever

  • Swelling around the trach tube

  • Pain when you suction the trach tube

  • Shortness of breath or any trouble breathing

  • Vomiting

  • Trach tube or suction catheter that is hard to insert

Fever and children

Always use a digital thermometer to check your child’s temperature. Never use a mercury thermometer.

For infants and toddlers, be sure to use a rectal thermometer correctly. A rectal thermometer may accidentally poke a hole in (perforate) the rectum. It may also pass on germs from the stool. Always follow the product maker’s directions for proper use. If you don’t feel comfortable taking a rectal temperature, use another method. When you talk to your child’s healthcare provider, tell him or her which method you used to take your child’s temperature.

Here are guidelines for fever temperature. Ear temperatures aren’t accurate before 6 months of age. Don’t take an oral temperature until your child is at least 4 years old.

Infant under 3 months old:

  • Ask your child’s healthcare provider how you should take the temperature.

  • Rectal or forehead (temporal artery) temperature of 100.4°F (38°C) or higher, or as directed by the provider

  • Armpit temperature of 99°F (37.2°C) or higher, or as directed by the provider

Child age 3 to 36 months:

  • Rectal, forehead, or ear temperature of 102°F (38.9°C) or higher, or as directed by the provider

  • Armpit (axillary) temperature of 101°F (38.3°C) or higher, or as directed by the provider

Child of any age:

  • Repeated temperature of 104°F (40°C) or higher, or as directed by the provider

  • Fever that lasts more than 24 hours in a child under 2 years old. Or a fever that lasts for 3 days in a child 2 years or older.

 

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