EMERGENCY SUPPLIES tube same

size /
smaller size

It is essential need to be beside each Tracheal

CATHETER
SUCTION
patient to be ready for the worst when Dilator
( CORRECT
caring for a patient who has a SIZE )
tracheostomy. Tracheostomy situations
fall into three categories: occlusion,
dislodgement, and bleeding. pulse
AMBU
oximeter
BAG ( OXYGEN )
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 q neonatal • Tracoe
there is cuff and non cuff q Pediatric • Bivona

Cuff tube usually use with new Pediatric size

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

tracoe

shiley tube bivona tube

 Changing a Tracheostomy Tube

1
BEFORE 2
• lab results (INR, HGB, 3
PLAT) DURING
• Tow person to do tube AFTER
• check stoma side.( • check the tube on
change.
granulation tissue) place.
• Keep pt NPO for 2 hours
maximum • One person for • Check o2 sat.
removing next one • Do auscultation of
• Extend neck of the pt.
breathing sound.
Flat position at least 15 for insertion.
Use stethoscope
degrees • If pt. On cuff tube
• You can do x-ray
• Do suction through need to do deflation. • scope thru
tube and use tracheostomy tube
Lubricating Jelly
 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 Tube
Cuff rupture Stoma closed Stoma closed
blockage blockage
usually happen with
you Find tube happen for new over inflation happen with new need to do
blockage during patients. Or Cuff patients during first intubation if failed
suctioning the patients he/she cut usually happen tube change or insertion and
patients Or he Start thick secretions or during tracheostomy routine tube covered the stoma
desating with care, change.
poor caring of side.
difficulty of breathing The sing and symptoms Action plan ambu
suctioning and Inform the ENT
you must change the leack on mv, sound bag the patients . physician to do
cleaning ( inner through oral.
tracheostomy tube Try to open the inserted on OR
cannula ) Need to change the
stoma with dilators monitor o2 sat
tube immediately
 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