What is a Tracheostomy?
A surgical (artificial) opening directly into the trachea (windpipe) to establish an airway. A tracheostomy tube is inserted and connected to a mechanical ventilator or another oxygen delivery device. The tube is inserted through a cut in the neck below the vocal cords. This allows air to enter the lungs.
Tracheostomy Care Includes:
Inspecting the stoma daily (every 12 hours or per facility policy) and PRN.
Assessing for irritation, infection or inflammation.
Removing the inner cannula for inspection and cleaning. Dirty cannulas should be cleaned and left to air dry.
Assessing for odor.
Check for secretions, noting color, quantity, & consistency (e.g. thick, white, clear, copious, scant, etc.).
Assessing the need for suctioning.
Providing daily oral care.
Changing the exu-dry dressing Q 12 hours & trach ties Q 3 days + PRN (when visibly soiled). Avoid dressings that trap moisture as this can cause maceration.
Why do NICU babies receive tracheostomies?
There are a variety of reasons why an infant may need a trach, ranging from a narrow airway to the need for long-term mechanical respiratory support from a ventilator. The most common reason is to relieve severe breathing difficulties due to chronic respiratory failure, bronchopulmonary dysplasia, and/or chronic lung disease from long term ventilator support.
Can babies with a trach eat?
In most cases, a baby with a tracheostomy can eat and drink without any trouble once they have recovered from the surgery. A speech pathologist and/or occupational therapist should assess the baby’s ability to swallow before he/she is given any food or drinks.
Can babies talk/vocalize with a trach?
Babies may have a speaking valve attached to the end of their tracheostomy tube. This one-way valve directs exhaled air through the trachea and upper airway, helping the baby to coo and cry.
Will my baby develop appropriately with a trach?
During your baby’s development, he will begin to make mouth shapes and early sounds like kisses and blowing raspberries. These sounds should be encouraged and will lead to the development of more speechlike sounds over time. Babies communication options will depend on the airway and the reason for the trach.
DISCHARGE
Before a baby is discharged, it is important for parents to be fully confident and competent with trach management. NICU nurses are trach gurus and are responsible for teaching and educating parents about EVERYTHING including:
Trach care & skin care around the trach
Trach suctioning
Trach changes
Home ventilator management
Safety and emergency situations (e.g. dislodgement)
Organizing family needs and supplies
Easing the home transition