Nursing Care of Infant With Tracheostomy

Caring for an infant with a tracheostomy can be both scary and reassuring. On the one hand, there is wide open access to the trachea, leading to the possibility of aspiration from increased secretions or foreign objects. On the other hand, under most conditions, you have a reliable airway. The good news is that with proper nursing care of the infant with a tracheostomy, the outcome is a safe and stable baby.

Protecting the Airway

Toys and equipment that are small or have small parts should be stored away from the infant's crib to prevent anything from getting into the tracheostomy opening. The climate should be moderate. Extremes in temperature can irritate the lungs of an infant with a tracheostomy since air is not warmed and moistened in the upper airways first. (In the hospital setting, this is not usually an issue.)

Adequate humidity is essential and additional mist must often be provided to keep secretions loose. Keep the site free from any loose clothing and the head positioned for optimal airway patency. In any position, unless someone is holding the baby, an electronic monitor should be in use. Unless the tracheostomy is brand new or the infant is being fed, shut off the monitor when the primary family caregiver is holding the baby so as not to undermine her confidence (using nursing judgment, of course).

If the infant is breast or bottle fed, a breathable fabric cloth should be placed over the tracheostomy to prevent milk or formula from entering. Suction before feeding since 20-30 minutes should elapse after feeding before suctioning again. It can induce vomiting. An identical new setup should always be kept at the bedside or near enough to be instantly available.

Cleaning the Tracheostomy Site

Clean the tracheostomy site daily. Clean it twice if it looks irritated. The ties should be changed at the same time or more frequently if soiled. Daily care prevents skin breakdown and obstruction of the tube. The University of Kentucky Health Information Library recommends using half-strength hydrogen peroxide and mild soap and water to clean the site. Please check your facility's policy and procedure recommendation.

If the tube has an inner cannula, it can be removed and placed in a bowl of the half-strength hydrogen peroxide while the skin is cleaned. A clean and healthy site should be washed with mild soap and water and dried thoroughly. If the site is irritated, draining or rashy, use half-strength hydrogen peroxide and cotton tipped swabs. The inner cannula, if present, should be washed using a pipe cleaner to scrub the inside. A new pipe cleaner is used to dry the inside of the cannula. A second person should be available to stabilize the tube while the ties are changed. Ties or hook and loop closure should be snug enough that your little finger can just slip under the ties.

If the Tube Comes Out Accidentally

If the infant's tracheostomy tube comes out while you are cleaning or changing it, do not panic. Even if it comes all the way out, the hole will not close up. Call for assistance and replace the tube. If the tube has slid out only part of the way, see if you can slide it back in. If it has come all the way out, use the new one you have ready to replace it with.

If the tube will not go in, gently reposition it and try again. In the home setting, if the tube will not go in, call 911. Feel for air movement at the site. If the baby is not breathing, perform mouth-to-tracheostomy rescue breathing. Remember to cover the nose and mouth.