Patient education: Emergency care for infants and children with a tracheostomy (The Basics)

What is the purpose of this handout? — This handout is meant to serve as a quick reference to use if your child has an emergency problem with their tracheostomy.

The information here is a very brief summary of things you learned before your child was sent home from the hospital with their tracheostomy. It is meant to support, not replace, all of the hands-on training and detailed written information you received.

If you have any questions about the information here, or other questions about how to care for your child, ask your child's health care team.

What is a tracheostomy? — A tracheostomy tube, or "trach," is a tube that is placed through an opening in the windpipe or "trachea" (figure 1).

A trach can help keep the airway open and make it easier to remove secretions or "mucus" from the lungs.

What types of emergencies can happen with a tracheostomy? — Different problems can happen with the trach or other equipment. This can make it hard or impossible for the child to breathe.

Emergencies can include:

●The trach gets clogged with mucus. If the mucus is very thick, it can completely block the trach.

●The trach gets dislodged by accident and comes out.

●Problems with the ventilator (breathing machine), if the child uses one

Taking good care of the trach can help lower the risk of emergencies happening.

How can I prepare for an emergency? — Make sure that you fully understand how to care for your child's trach. You and at least 1 other caregiver will have been trained on trach care before your child went home from the hospital. In this training, you learned how to handle many types of emergencies.

Your child should always be cared for by someone who has been trained how to take care of a trach. If your child goes to school, there should be a caregiver there who can suction the trach and knows how to change the trach tube in case of an emergency.

Make sure that all emergency trach supplies stay with your child at all times (table 1). This way, you can get them quickly if needed.

If an emergency does happen, it is important to try and stay calm.

How can I tell if my child is having trouble breathing? — There are some things you can watch for that might mean your child is having trouble breathing.

Watch for symptoms like:

●Breathing is noisier than usual

●Not able to clear secretions from their trach

●Changes in skin color, such as lips or fingers that look dusky or darker in color

●Working harder to breathe or retractions (when you can see the chest pulling in with each breath)

●Agitation or restlessness

●Sweating

●Ventilator or pulse oximeter alarms

●Heart rate or saturations are lower than normal

●Chest is not moving with each breath

Noisy breathing and equipment alarms are common in children with trachs and are not always an emergency. It's important to know what normal and abnormal breathing with a trach sounds like, and what all of the alarms mean. Your health care team will give you training on these things before you leave the hospital.

What should I do if my child is having trouble breathing? — If your child is awake but having trouble breathing:

●First, check to make sure that the trach is in place. If not, replace it right away. If your child uses a ventilator or other machine to help them breathe, check that it is connected and working.

●Next, suction the trach. If you are able to pass the suction catheter and get rid of any secretions, your child's breathing might get better. If the trach is blocked (for example, you can't pass the suction catheter), change the trach.

●If your child is still struggling to breathe and has oxygen available, give oxygen. If they are already on oxygen, increase the amount.

●Some children use a "nebulizer" or get "breathing treatments" to get medicines into their lungs. If so, you can try giving an extra treatment to see if it helps their breathing.

If your child is still struggling to breathe after these steps, you might need to give rescue breaths:

●Call for emergency help (in the US and Canada, call 9-1-1).

●Start rescue breaths using a self-inflating bag (sample brand name: Ambu Bag). The bag connects to your child's trach.

●Look for your child's chest to rise and fall with each breath:

•If the chest does rise and fall, continue to give rescue breaths until help arrives or your child starts to breathe on their own.

•If the chest does not rise and fall, the trach might be blocked or in the wrong position. If you have not already done so, replace the trach now, and try giving rescue breaths again. If the chest still doesn't rise and fall, place a face mask over your child's nose and mouth, and use the bag to give breaths through the mask. You will need to have another person gently block the trach while you give breaths with a bag and face mask.

●If your child loses consciousness (stops responding) while you are trying to give rescue breaths, start CPR. Follow the steps in the section below.

What should I do if my child is unresponsive? — If your child is not breathing or responding to you at all, start CPR.

●Shout for help:

•If another adult is nearby, have them call for emergency help (in the US and Canada, call 9-1-1). If you are alone but have a cell phone, call for emergency help and put the phone on speaker. This way, you can start CPR at the same time.

•If you are alone and do not have a cell phone, do CPR for 2 minutes and then call for emergency help.

●Place your child on a hard, flat surface. If they are lying on their stomach, turn them over onto their back.

●Give 30 chest compressions to squeeze the heart and get blood moving again:

•For an infant younger than 1 year, you can do compressions using either the 2-finger or the 2-thumb method (figure 2 and figure 3). The 2-finger method might be easier if you are doing CPR by yourself.

•For a child 1 to 13 years old, you can do compressions using either the 2-hand or the 1-hand method (picture 1 and picture 2).

•For a teen older than 13 years, do compressions using the 2-hand method (picture 3).

●After giving 30 compressions, give 2 rescue breaths using a self-inflating bag attached to the trach. If breaths do not make the chest rise and fall:

•Replace the trach, if you have not already done so.

•If the chest still does not rise and fall after replacing the trach, use the bag with a face mask placed over your child's nose and mouth.

●Continue CPR. Repeat the cycle (30 compressions then 2 breaths). After 2 minutes of this, call for emergency help (in the US and Canada, call 9-1-1) if you have not already.

Keep doing CPR until help arrives or your child starts to breathe on their own.

More on this topic

Patient education: CPR for children (The Basics)
Patient education: How to care for a tracheostomy (The Basics)