Tracheostomy Care: Precautions For Parents

Precautions For Parents

A child with a tracheostomy can do most things that other children do. Try to treat your child as normally as possible. It is important not to be overly protective. However, children with trachs must be watched very closely, since they may not be able to verbally indicate discomfort. Water represents a particularly serious threat, as drowning can easily occur if the tube is submerged in water.
Here are some precautions for children with tracheostomies. Remember that each child is different and that common sense goes a long way when caring for a child with a trach.

• Use extreme caution with baths. Use shallow water and prevent water from splashing into the trach. A trach mask, mist collar or moisture exchanger can be worn during baths for added protection. Never leave a child alone in the bathtub!
• For hair washing, lay the child back while supporting the head and neck. Pour water toward the back of the head, keeping the trach area dry. Have a dry towel handy for drips.
• No Swimming
• No Showering
• When holding a child with a trach, be sure the chin is up and that the tube opening is unobstructed.
• Check with the doctor before applying any salves or ointments near the trach.
• Avoid powder, talc, chlorine bleach, ammonia, aerosol sprays or perfumes near a child with a trach.
• Prevent foreign objects from entering the trach tube, such as water, sand, dust, small toy pieces, etc.
• Note that some types of HME’s are small enough or have filters that could be swallowed by young children.
• Avoid sandboxes and beaches
• Avoid chalk dust.
• Watch play with other children so that toys, fingers and food are not put into trach tube and that other children don‘t pull on the trach.
• No contact sports
• Avoid clothing that blocks the trach tube, such as crew necks, turtlenecks, and shirts that button in the back.
• No plastic bibs
• No necklaces
• No fuzzy or fur clothing or stuffed toys
• Avoid animals with fine hair or that shed excessively.
• Do not allow anyone to smoke near child.
• Keep the home as free from lint, dust and mold as possible.
• Limit the use of wood stoves and fireplaces, which dry the air.
• During cold weather, avoid allowing child to breathe freezing cold air directly into trach.
• Use a heat moisture exchanger (HME), gauze bandage, loose cotton scarf or surgical mask to protect the tracheostomy on dusty, smoggy or windy days.
• No Latex balloons, these are dangerous for all children. Latex over any airway will block breathing.
• There must be a trained person with the child at all times. At minimum, this person must be trained in CPR and know how to perform CPR on a child with a tracheostomy. They must be able to suction and change a tracheostomy tube. For school-age children, there should be a trained person (preferably an RN or LPN) with the child at school and on the bus to and from school.
• Avoid exposure to people with colds or other contagious illnesses.
• Be sure your child is up-to-date on all immunizations.
• Administer yearly flu shots if recommended by your doctor.
  

Emergency Plan for a Child with a Tracheostomy

• Post CPR instructions at the child’s bedside.
• Have emergency telephone numbers posted near each telephone.
• If possible, have a phone within reach of the child's bedside.
• A cordless telephone may be helpful to have access at all times.
• A mobile phone for travel if possible
• Notify electric, gas and telephone company that you have a child with a tracheostomy and whatever other medical issues he/she might have, so that your home is a priority in resuming service in the event of a power outage.
• Notify Police and Ambulance services that you have a child with a trach in your home.
• Notify the Fire Department if you have oxygen in your home.
• If snow is a problem in your area, notify your Department of Public Works for snow removal priority. Road repairs could also be a potential problem.
• Always have an extra trach tube with obturator, ties and scissors handy both at home and away from home. You may want to keep ties in place on the tube in order to save time in an emergency.
• Medic-Alert bracelet may be helpful.
• Develop an emergency plan and train all family members.
• Pack an emergency bag to take with you whenever you take your child away from home
  

Infection Control

• Hand washing, hand washing, hand washing! Hand washing is the single most important way to stop the spread of infection. Have antibacterial soap at every sink, as well as hand sanitizers where water is not available.
• Screen all visitors for colds, limit visit time and avoid crowds. Do not let strangers touch your child: be defensive, not paranoid.
• Use masks for family members with colds.
• Flu vaccines maybe recommended by your pediatrician.
• Open windows for 10 minutes each day, to ventilate house.
• Coal, wood stoves, or fireplaces may aggravate respiratory problems (they dry the air).
• Humidify air with cool mist, but remember to clean the humidifier each day with soap and water, disinfectant or bleach solution (1 part bleach to 10 parts water).
• Daycare is a leading risk factor for upper respiratory infections. It is not always possible for parents to be at home with their children, but this is helpful when possible. Also, a smaller day-care poses less risk of infection than a larger one.
• Parental smoking (second hand smoke) is a major risk factor for respiratory infections. Smoke must be avoided.
• Remember, cold viruses can survive several hours on objects such as toys, doorknobs, remote controls, and telephones. Disinfect these objects properly. (The dishwasher is useful for disinfecting many washable items.)
• A cold is contagious 2-4 days after symptoms appear.
• Keep tissues in every room of the house and dispose of them promptly and properly after use. No hankies, please.

What is RSV?

RSV stands for respiratory syncytial virus, the most frequent cause of serious respiratory tract infections in infants and young children. This is such a common virus that virtually all children have been infected by RSV by the age of 3. In most children and adults, RSV results in a respiratory infection that is not distinguishable from a common cold. However, for infants and children with underlying conditions, such as prematurity, lung, heart and immune deficiency diseases, RSV can be a very serious respiratory illness requiring hospitalization.
Avoid crowded places and avoid contact with people who have cold symptoms. When a family member is sick, extra precautions must be taken by washing hands often and preventing the spread of infectious secretions on tissues and objects.
Ask your doctor if Respigam would be helpful for your child. Respigam is an immune globulin that is given in injections throughout the RSV season for children at risk.

Source:  http://www.tracheostomy.com/care/precautions.htm