APLS TRACHY

Many children with an established tracheostomy will improve when the blocked tube is removed, allowing them to breathe through the stoma prior to replacing the blocked tube with a new one. However, there are risks in removing the tube from a newly created tracheostomy as, until the stoma track is established, attempted replacement of a tracheostomy tube may be difficult and a blind-ending false track could be created.

Parents who routinely care for their child's tracheostomy at home may be more familiar with tube suction and tube changing for their child than hospital staff in medical areas where this is rarely performed.

If you are unable to pass the suction catheter through the tracheostomy tube, then the tube must be changed immediately with the same size tube. If this fails to relieve the obstruction, or you cannot insert it:

• •Try a half size smaller tube.
• •If it is not possible to insert this, thread a lubricated suction catheter through the size smaller tracheostomy tube. Insert the suction catheter into the stoma and then attempt to guide the new tracheostomy tube along the catheter and into the stoma.
• •If this is unsuccessful then remove the tracheostomy tube.