What is it?
- The air we breathe enters through the nose or the mouth, descends down the throat (pharynx) and is directed to the voicebox (larynx) where the vocal cords are located. Once past the vocal cords, the air descends down the trachea to the lungs.
- A tracheostomy is a small opening (surgical incision), made at the front of the neck and into the trachea, that allows air to go directly into the lungs rather than passing through the nose and mouth.
- When we swallow, a small valve (epiglottis), blocks the trachea so that foods and liquids go towards the digestive system (esophagus and stomach) rather than into the lungs.
- Certain medical conditions require that a tracheostomy be in place, for example to:
- facilitate the passage of air: allows air to get to the lungs even in situations of partial or complete blockage of the upper airway,
- facilitate the suctioning of secretions in children who are unable to cough and/or clear secretions effectively,
- prevent foods, liquids and saliva from getting into the lungs (aspiration) and to prevent lung infections (pneumonia) caused by aspiration,
- connect to a respirator for children that require this type of support.
- A small tube (tracheal cannula), is placed into the tracheostomy in order to keep it open (patent).
- Depending on the child’s condition, the tracheostomy can be temporary or permanent.
How does it work?
- Three different types of tracheal cannulas exist (ex: Bivona®, Shiley®, Portex®). The type of cannula selected depends upon the age, size and medical conditions of the child. Your child’s health care team will provide you with information regarding the type of tracheal cannula best suited to your child’s condition.
- A simple tracheal cannula is most frequently recommended in children. It is composed of one single tube (cannula) that is inserted into the trachea.
Simple tracheal cannula and components
|Body of the tracheal tube, commonly called “cannula”||
|Flanges or neck collar or trach plate||
- Other types of tracheal cannula’s can be used in children.
Other types of tracheal cannulas
|Two piece cannula: inner cannula and outer cannula||
|Fenestrated tracheal cannula||
- The tracheal cannula is held in place by tracheostomy ties (cotton ribbons or Velcro® band) that circle to the back of the neck.
- Specific care must be provided to children with a tracheostomy:
- cleaning of the skin around the tracheostomy and replacement of the tracheostomy dressing,
- replacement of the tracheal cannula,
- replacement of the inner cannula, if a 2 piece cannula is in place,
- suctioning of secretions,
- administration of medication via a tracheostomy,
- invasive ventilation, if needed,
- manual ventilation, if needed,
- cough assistance.
- Depending on your child’s condition, different types of equipment can be used to increase the level of ambient humidity in order to allow your child to make sounds or speak, to deliver solutions and medications to his tracheostomy or to manually assist his breathing.
|Artificial nose (or filter exchanger or heat and moisture exchanger)||
|Air compressor for humidity delivery||
|Heated humidifier (or heated humidifier plate)||
|Speaking valves (ex: Passy-Muir®, Shiley®)||
|Small volume nebulizer (or mini nebulizer)||
|Metred dose inhaler (MDI) (or pump or puffer) with a spacer (Aerochamber® or air chamber)||
- The connection and disconnection of these medical devices to the tracheal cannula must be performed with care so as to avoid unnecessary pull or tension on the cannula itself.
- With adequate observation and good daily care, breathing through a tracheostomy is comfortable and safe for your child. Do not hesitate to ask your child’s health care team any questions you may have regarding your child’s care needs.
Methods of care
Tracheostoma skin care, changing the tracheostomy dressing, changing the inner cannula of a tracheostomy (if present)