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The University of Chicago Medicine - Comer Children's Hospital

Emergency Care

Preventing Problems

To help your child breathe easier, keep him or her away from smoke, strong chemical fumes from cleaning solutions, burning leaves, small fires, and baby powder. Also, keep small toys--such as plastic blocks, beads, charms, and game pieces--away from your child. If these enter the trach or airway, they could block the air going into the lungs.

Being Prepared

Children are active and curious and sometimes problems do occur. The best thing for you to do is be prepared.

When the Tube Falls Out

If the trach tube falls out, don't panic. The stoma does not close completely so you have time to insert a new tube. Always keep an extra tube near your child. Some parents tape a trach tube set to the child's bed, stroller, or humidifier. Always keep one in the car or diaper bag for traveling. If you have a two-story home, consider keeping one set upstairs and one downstairs.

  1. Insert a clean tube into the stoma using the obturator.
  2. Hold the tube in place with your fingers and pull out the obturator.
  3. Replace the ties.

When a clean tube is not available, use the old one and secure it with ties. If the old tube is not usable and there is not a clean tube available, place a hollow item--such as a suction catheter--into the stoma until a new tube can be located. Hold the item in place until you can insert a new trach tube.

Difficulty Breathing

When the tube becomes blocked with mucus, your child will have trouble breathing. You need to watch for these signs:

  • Breathing is at a faster rate than usual.
  • Your child has a restless or frightened look or is pale and sweaty.
  • The skin on the chest and neck are pulling in.

When you notice these signs, suction immediately. If the mucus in the catheter if very thick, put a few drops of sterile saline from a saline dropper into the stoma and suction immediately. The saline might loosen and thin the mucus plug. If you cannot remove the mucus, change the tube. Call your child's doctor if the symptoms continue.

If Your Child Stops Breathing

If your child does not breathe when the trach tube is clear of mucus, begin cardio-pulmonary resuscitation (CPR). Your child's nurse will teach you the procedure and have you practice until you feel comfortable performing it.

When to Call Your Child's Doctor

Call your doctor if your child has any of these symptoms:

  • Difficulty breathing after he or she has been suctioned
  • Temperature higher than 101.5 degrees Fahrenheit
  • Color change in the mucus from white to yellow or green
  • Foul odor from the secretions
  • Redness around the area of the stoma or skin on the neck
  • Tube cannot be reinserted when changing the trach tube
  • Blood from the tracheostomy site or blood in the secretions