EMERGENCY SUPPLIES tube same size /

smaller size

It is essential need to be beside each patient to be CATHETER

Tracheal
SUCTION
ready for the worst when caring for a patient who Dilator
( CORRECT
has a tracheostomy. Tracheostomy situations fall SIZE )
into three categories: occlusion, dislodgement,
and bleeding.

AMBU pulse oximeter

( OXYGEN )
BAG
Emergency respond pediatric
airway with new tracheostomy
Sutures secureed attached to the
patient's chest through the
thrachea.
Pulling these sutures will elevate
the trachea and widen the stoma

Stay sutures in site following

insertion of surgical
tracheostomy.
sutures removal after 7-10 days
or depend on ENT Team
Decision
 TRACHEOSTOMY TUBES

• Surgical Types of Tubes • Shiley

All types of Tracheostomy tube there is  neonatal • Tracoe
cuff and non cuff  Pediatric • Bivona

Cuff tube usually use with new Pediatric size

Neonatal size patients
(Tracoe) And patients
start from size
(Tracoe)
start from size
on Mechanical ventilator • 3.0 mm
• 3.5mm
• 2.5 mm • 4.0mm
• 3.0 mm Tube length of the tracheostomy tube may also vary • 4.5mm
• 3.5 mm • 5.0mm
• 4.0 mm
between tubes for different size and manufacturers • 5.5mm
(i.e. size 3 neo length 34 size 4.0 length 36) • 6.0mm
 typet uses pediatric

tracoe

shiley tube bivona tube

 Changing a Tracheostomy Tube
1
BEFORE
• lab results (INR, HGB, PLAT)
• Tow person to do tube change.
• Keep pt NPO for 2 hours
maximum
• Extend neck of the pt. Flat
position at least 15 degrees
• Do suction through tube and
use Lubricating Jelly
2
DURING
3
AFTER
• check stoma side. • check the tube on place.
( granulation tissue) • Check o2 sat.
• One person for removing • Do auscultation of
next one for insertion. breathing sound. Use
• If pt. On cuff tube need to stethoscope
• You can do x-ray
do deflation. • scope thru
tracheostomy tube
 TROUBLESHOOTING
TRACHEOSTOMY TUBE
ACCIDENTALLY TUBE OUT
• oxygenation the patient.
• Call for help. ENT physicians and tranche team.
• Try to inserted the same tube if can not try with
smaller size.
• Use dilator to keep stoma open until ENT or
tracheostomy team came.
DISPLACEMENT TUBE
consider the patients new tracheostomy
• check when you are suction resistances and no secretion
• Patients desaturation
• Tracheal emphysema when you doing ambu bag.
• Action plan remove the tube and try to inserted again if
still you can use ( bougie or suction catheter ) as guide.
• Keep stoma open(dilator ) until ENTor trache team
around
 Troubleshooting Tracheostomy
Tube

Tube blockage Tube blockage

you Find tube blockage
during suctioning the
patients Or he Start desating
with difficulty of breathing
you must change the
suctioning and cleaning
tracheostomy tube
Cuff rupture
usually happen with over
happen for new inflation
patients. Or patients Cuff patients during first tube
he/she thick secretions cut usually happen during
tracheostomy care,
or poor caring of
The sing and symptoms leack
on mv, sound through oral.
( inner cannula )
Need to change the tube
immediately
Stoma closed Stoma closed
happen with new need to do intubation if
failed insertion and
change or routine tube covered the stoma side.
change.
Inform the ENT physician
Action plan ambu bag
to do inserted on OR
the patients . monitor o2 sat
Try to open the stoma
with dilators
 Complications

Granuloma(s) (i.e. granulation tissue)

stage IV
posttracheotomy
wound.
Mucus plugs
Tracheostomy care

stoma site care to Avoid granulation tissue

stoma care for short neck cases ( wound )

check with one finger secured to avoid

accidentally tube out

Tracheal suction use formula (size of the tube

×3 = ÷2 )
 Weaning process

Our decision
Weaning base on consultant decision usually after DLP under GA +
full assessment for upper airway and after making sure if no other
issues effects weaning such as neurological disease or congenital
syndromes respiratory diseases