This paediatric patient has a

NEW TRACHEOSTOMY
Patient ID: Patient Label / Details

Tracheostomy: Add tube specification

including cuff or inner tube

______mm ID, ______ mm distal length

Suction: Indicate on this diagram

______ FG Catheter to Depth ______ cm any sutures in place

UPPER AIRWAY ABNORMALITY: Yes / No

Document laryngoscopy grade and notes on upper airway management or patient specific resuscitation plans

Due 1st tracheostomy change: ___ / ___ / ___ (by ENT ONLY)
In an Emergency: Call 2222 and request the Resuscitation Team and ENT surgeon
Follow the Emergency Paediatric Tracheostomy Management Algorithm on reverse
 Emergency Paediatric Tracheostomy Management
SAFETY - STIMULATE - SHOUT FOR HELP - OXYGEN
SAFE: Check Safe area, Stimulate, and Shout for help
AIRWAY: Open child’s airway: head tilt / chin lift / pillow or towel under shoulders may help
OXYGEN: Ensure high flow oxygen to the tracheostomy AND the face as soon as oxygen available
CAPNOGRAPHY: Exhaled carbon dioxide waveform may indicate a patent airway (advanced response)

SUCTION TO ASSESS TRACHEOSTOMY PATENCY

Basic Response

Remove
Remove attachments:
attachments: humidifier
humidifier (HME),
(HME), speaking
speaking valve
valve The
The tracheostomy
tracheostomy tube
tube isis patent
patent
Change
Change inner
inner tube
tube (if
(if present)
present) Perform
Perform tracheal
tracheal suction
suction
Inner
Innertubes
tubesmay
mayneed
needre-inserting
re-insertingto
toconnect
connectto
tobreathing
breathingcircuits
circuits Consider
Consider partial
partial obstruction
obstruction

Can
Can you
you pass
pass aa SUCTION
SUCTION catheter?
catheter? CONTINUE
CONTINUE ASSESSMENT
ASSESSMENT (ABCDE)
(ABCDE)
Yes
No
EMERGENCY TRACHEOSTOMY TUBE CHANGE
Deflate cuff (if present). Reassess patency after any tube change
1st change – same size tube
2nd change – one-half size smaller tube
3 change - over suction catheter to guide
rd

IF UNSUCCESSFUL – REMOVE THE TUBE

IS
IS THE
THE PATIENT
PATIENT BREATHING?
BREATHING? -- Look,
Look, listen
listen and
and feel
feel at
at the
the mouth
mouth and
and tracheostomy/stoma
tracheostomy/stoma
No Yes
CALL FOR HELP: 2222 in hospital, 999 in community
Continue
Continue oxygen
oxygen
Stabilize
Stabilize
5 RESCUE BREATHS Reassess
Reassess
Review
Review
Patent Upper Airway – use the nose/mouth
Obstructed Upper Airway – use the tracheostomy/stoma Plan
Plan for
for definitive
definitive
airway
airway ifif tube
tube
NO SIGNS OF LIFE? START CPR change
change failure
failure
15 compressions : 2 rescue breaths
Ensure help or resuscitation team called
Advanced Response

Primary emergency oxygenation Secondary emergency oxygenation

Standard
Standard ORAL
ORAL airway
airway manoeuvres
manoeuvres ORAL
ORAL intubation
intubation with
with endotracheal
endotracheal tube
tube
Cover
Cover the
the stoma
stoma (swabs
(swabs // hand).
hand). Uncut
Uncut tube, advanced beyond stoma
tube, advanced beyond stoma
Use:
Use: One
One half-size
half-size smaller
smaller than
than tracheostomy
tracheostomy tube
tube
Bag-valve-face
Bag-valve-face mask
mask ‘Difficult Airway’ Expert and Equipment*
‘Difficult Airway’ Expert and Equipment*
Oral
Oral or
or nasal
nasal airway
airway adjuncts
adjuncts
Supraglottic Airway (SGA)
Supraglottic Airway (SGA)
e.g.
e.g. Laryngeal
Laryngeal Mask
Mask Airway
Airway (LMA)
(LMA) Attempt
Attempt intubation
intubation of
of STOMA
STOMA
3.0
3.0 ID
ID tracheostomy
tracheostomy oror endotracheal
endotracheal tube
tube
‘Difficult
‘Difficult Airway’
Airway’ Expert
Expert and
and Equipment*
Equipment*
Tracheostomy
Tracheostomy STOMA
STOMA ventilation
ventilation
Paediatric
Paediatric face-mask applied
face-mask applied to
to stoma
stoma *EQUIPMENT:
*EQUIPMENT: Fibreoptic
Fibreoptic scope,
scope, bougie,
bougie,
SGA applied to stoma
SGA applied to stoma airway
airway exchange catheter, Airway trolley
exchange catheter, Airway trolley

NTSP (Paediatric Working Group) www.tracheostomy.org.uk Review January 2022

 This paediatric patient has a

TRACHEOSTOMY
Patient ID: Patient Label / Details

Tracheostomy: Add tube specification

including cuff or inner tube

______mm ID, ______ mm distal length

Suction:
______ FG Catheter to Depth ______ cm

UPPER AIRWAY ABNORMALITY: Yes / No

Document laryngoscopy grade and notes on upper airway management or patient specific resuscitation plans

In an Emergency: Call 2222 and request the Resuscitation Team and ENT surgeon
Follow the Emergency Paediatric Tracheostomy Management Algorithm on reverse
 Emergency Paediatric Tracheostomy Management
SAFETY - STIMULATE - SHOUT FOR HELP - OXYGEN
SAFE: Check Safe area, Stimulate, and Shout for help
AIRWAY: Open child’s airway: head tilt / chin lift / pillow or towel under shoulders may help
OXYGEN: Ensure high flow oxygen to the tracheostomy AND the face as soon as oxygen available
CAPNOGRAPHY: Exhaled carbon dioxide waveform may indicate a patent airway (advanced response)

SUCTION TO ASSESS TRACHEOSTOMY PATENCY

Basic Response

Remove
Remove attachments:
attachments: humidifier
humidifier (HME),
(HME), speaking
speaking valve
valve The
The tracheostomy
tracheostomy tube
tube isis patent
patent
Change
Change inner
inner tube
tube (if
(if present)
present) Perform
Perform tracheal
tracheal suction
suction
Inner
Innertubes
tubesmay
mayneed
needre-inserting
re-insertingto
toconnect
connectto
tobreathing
breathingcircuits
circuits Consider
Consider partial
partial obstruction
obstruction

Can
Can you
you pass
pass aa SUCTION
SUCTION catheter?
catheter? CONTINUE
CONTINUE ASSESSMENT
ASSESSMENT (ABCDE)
(ABCDE)
Yes
No
EMERGENCY TRACHEOSTOMY TUBE CHANGE
Deflate cuff (if present). Reassess patency after any tube change
1st change – same size tube
2nd change – one-half size smaller tube
3 change - over suction catheter to guide
rd

IF UNSUCCESSFUL – REMOVE THE TUBE

IS
IS THE
THE PATIENT
PATIENT BREATHING?
BREATHING? -- Look,
Look, listen
listen and
and feel
feel at
at the
the mouth
mouth and
and tracheostomy/stoma
tracheostomy/stoma
No Yes
CALL FOR HELP: 2222 in hospital, 999 in community
Continue
Continue oxygen
oxygen
Stabilize
Stabilize
5 RESCUE BREATHS Reassess
Reassess
Review
Review
Patent Upper Airway – use the nose/mouth
Obstructed Upper Airway – use the tracheostomy/stoma Plan
Plan for
for definitive
definitive
airway
airway ifif tube
tube
NO SIGNS OF LIFE? START CPR change
change failure
failure
15 compressions : 2 rescue breaths
Ensure help or resuscitation team called
Advanced Response

Primary emergency oxygenation Secondary emergency oxygenation

Standard
Standard ORAL
ORAL airway
airway manoeuvres
manoeuvres ORAL
ORAL intubation
intubation with
with endotracheal
endotracheal tube
tube
Cover
Cover the
the stoma
stoma (swabs
(swabs // hand).
hand). Uncut
Uncut tube, advanced beyond stoma
tube, advanced beyond stoma
Use:
Use: One
One half-size
half-size smaller
smaller than
than tracheostomy
tracheostomy tube
tube
Bag-valve-face
Bag-valve-face mask
mask ‘Difficult Airway’ Expert and Equipment*
‘Difficult Airway’ Expert and Equipment*
Oral
Oral or
or nasal
nasal airway
airway adjuncts
adjuncts
Supraglottic Airway (SGA)
Supraglottic Airway (SGA)
e.g.
e.g. Laryngeal
Laryngeal Mask
Mask Airway
Airway (LMA)
(LMA) Attempt
Attempt intubation
intubation of
of STOMA
STOMA
3.0
3.0 ID
ID tracheostomy
tracheostomy oror endotracheal
endotracheal tube
tube
‘Difficult
‘Difficult Airway’
Airway’ Expert
Expert and
and Equipment*
Equipment*
Tracheostomy
Tracheostomy STOMA
STOMA ventilation
ventilation
Paediatric
Paediatric face mask applied
face mask applied to
to stoma
stoma *EQUIPMENT:
*EQUIPMENT: Fibreoptic
Fibreoptic scope,
scope, bougie,
bougie,
SGA applied to stoma
SGA applied to stoma airway
airway exchange catheter, Airway trolley
exchange catheter, Airway trolley

NTSP (Paediatric Working Group) www.tracheostomy.org.uk Review January 2022