Everyday tips

Cardio Pulmonary Resuscitation (CPR): make sure that you and all persons responsible for your child’s care are trained. Consult your child’s healthcare team regarding referral to pertinent resources and the frequency of training renewal required.

Emergencies:

• All caregivers should be knowledgable and skilled in trachestomy care including suctioning, emergency cannula removal and replacement.
• Always have a telephone nearby in case of an emergency. Make sure your cell phone is charged at all times. When you go out, bring what you need to charge the phone, when necessary (cable with charger and portable Power Bank charger).
• Make sure that the company providing your home electricity is aware that a child with special (medical) needs resides in the home.
• Also inform your local fire station.
• Always keep emergency equipment required close at hand. This equipment must always be in your child’s room (eg, at his bedside) and brought along with your child to EVERY outing:
  • a replacement cannula the same size as the one in use
  • a tracheal cannula one size smaller than the one in use
  • one obturator the same size as the cannula in use and one smaller than the cannula in use
  • a water soluble lubricant
  • an inner cannula, if your child has a 2 piece cannula
  • tracheal cannula ties (Velcro® band or cotton ribbons)
  • scissors with rounded ends (if during an emergency, the ties or Velcro® band needs to be cut)
  • suction catheters
  • a fully charged portable suction device with connecting tubing and power cable
  • an extra connecting tube in the event that the one previously used becomes too saturated with secretions
  • a manual mouth suction catheter with mucus trap in the event that a suction device is not available
  • a self-inflating manual resuscitator with a tracheal cannula connector.
• Discuss with your child’s healthcare team whether your child requires monitoring by a trained and competent individual capable of intervening, as needed; during the day, night or at all times.
• With your child’s healthcare team, determine if a medical alert bracelet (eg, MedicAlert bracelet) containing key medical information such as is recommended.

Humidity:

• The air that enters the nose and passes through the throat (pharynx) is naturally filtered, heated and humidified before reaching the lungs. Since your child breathes through a tracheostomy, and these natural processes are bypassed, dry, cold, non-filtered air inhaled directly through the trachea to the lungs can cause irriation, couth, mucus plugs and thick, sticky secretions. Without proper humidification of the air your child breathes, secretions are more difficult to clear, increasing the risk of blocked airways and increasing the risk of lung infection.
• Avoid overheating the home in the winter and using an air conditioner in the summer to prevent excessively dry air.
• The recommended relative humidity in the home, measured with a hygrometer, should be between 40 to 50%.
• If your home air is too humid (55% and more), install a dehumidifier and clean it every week in order to prevent the presence of mold in the air that your child breathes.
• If your home air is too dry (less than 40%), the following daily habits can help increase the moisture in your home:
  • do not activate the exhaust fan when you cook or boil water,
  • avoid using an air conditioner in the summer,
  • keep the bathroom door open when you shower,
  • minimize the use of electric heaters, wood burning stoves and fireplaces during the winter,
  • eliminate carpeting and rugs in the home.
• During the day, extra humidity is generally not required unless the air in your house is very dry, in which case a portable humidifier filled with tap water can be used in the day, during naps and overnight. You must change the water and clean the humidifier regularly according to the manufacturer’s recommendations to prevent the proliferation of bacteria and mold in the air that your child breathes.
• The use of an artificial nose promotes inspiration of more humidified air and can be beneficial in some children with a tracheostomy, day or night.
• Delivery of humidity directly to the tracheostomy is possible by using a tracheal collar connected to a nebuliser powered by an air compressor. Since the equipment can limit the child’s movement, it is preferable to use it at night and during naps. This equipment must be well maintained and cleaned in order to prevent the proliferation of bacteria and mold that could cause your child to develop a lung infection. Refer to your child’s healthcare team and to the manufacturer’s recommendations regarding the frequency and the methods of cleaning the equipment.
• If your child uses a ventilatory assistance device, an integrated heated humidifier can increase the level of humidity as required during nightime and daytime use.
• With your child’s healthcare team, discuss ways in which the level of humidity can be optimised in the air your child breathes for comfort and to aid in secretion mobilisation and clearance.

Air quality:

• Air filtration protects the lungs from dust and other impurities.
• The air that enters the nose and passes through the throat (pharnyx) is naturally filtered, heated and humidified before reaching the lungs. Since the air that your child breathes goes directly to the lungs without being filtered, dust and other particles in the air can easily irritate your child’s lungs and affect breathing.
• Avoid all exposure to traditional or electronic cigarette smoke or vapour, especially at home.
• Clean and regularly change filters on air conditioners.
• In your child’s proximity, avoid:
  • use of products containing powder (eg, cleaning products, deodorants) or in aerosol form (eg, air fresheners, room fragrances),
  • presence of chemical products (eg, bleach, ammonia) or substances that give off strong odors (eg, paint remover, paint, nail polish, perfume).
• To prevent irritating particles from entering your child’s airways, avoid areas where there is:
  • accumulation of dust, presence of rugs, upholstered furniture and home accessories that are difficult to clean (eg, heavy drapery),
  • dust from renovations,
  • wood burning heating systems (stove or fireplace),
  • excessive pollution (eg, smog, heavy traffic, strong winds),
  • pets that shed fur or feathers (pieces can enter the tracheal cannula),
  • insects, leaves, etc.
• In your child’s room:
  • avoid the presence of toys and stuffed animals in your child’s bed,
  • use pillows cases, sheets, and blankets made of washable synthetic material (hypo-allergenic),
  • sheets that are very soft and fluffy with fibres (eg, flannel sheets) are not recommended: they attract dust and may release fine fibres that can enter your child’s tracheal cannula,
  • wash bedding in hot water every week in order to destroy dust mites,
  • dry bedding in a dryer if your child is allergic to pollen.
• Contact your child’s healthcare team for other suggestions regarding protecting and filtering the air your child breathes via tracheostomy (eg, using a scarf, artificial nose, etc).

Prevention of infections:

• A tracheostomy is an open door for entry of bacteria that may be present in the environment. Since the air that your child breathes bypasses the natural protective structures such as the nose, mouth and pharynx, the risk of your child contracting a lung infection is increased. It is important that you do everything possible to reduce this risk like controlling the humidity, the temperature and the quality of air that your child breathes.
• Always wash your hands before providing care to your child and have your child wash his hands before and after all meals and frequently during the day.

Prevention of respiratory infections:

• If you have a cold, the flu or another respiratory infection, use non sterile gloves and wear a mask when providing care to your child.
• Avoid exposing your child to anyone that has a cold, the flu or other respiratory infection with or without a cough.
• In accordance with your child’s healthcare team’s recommendations and depending on your child’s condition, avoid high traffic areas (eg, shopping centres, daycares) to reduce the risk of exposure to bacteria and viruses.
• The annual flu vaccine and vaccines which provide protection for pneumonia are also good prevention methods for the child and family members; discuss this with the healthcare team.

Disinfection of working surfaces:

• Table and counter tops used as working surfaces during the care of your child must be disinfected before each procedure.
• Here are some solutions recommended for disinfection of working surfaces:
  • rubbing alcohol 70%,
  • household chlorine bleach diluted ½ tsp bleach (the less concentrated) in 1 cup of tap water,
  • acetic acid household white vinegar diluted to a 1.25% solution: mix 1/3 cup of vinegar 5% with 1 cup of tap water,
  • other home cleaning products (check with your child’s healthcare team for specific products).
• Do not use sprays because the aerosol particles dispersed in the air can affect your child’s breathing.
• Rinse and dry all surfaces thoroughly before using.
• If you decide to use a clean towel for the workspace, make sure to regularly clean all working surfaces at least once a week.

Maintenance and cleaning of medical supplies and equipment:

• Equipment should generally be cleaned once per week or more frequently if soiled.
• Clean according to the manufacturer or your healthcare team’s recommendations specific to your child’s condition, comfort, safety, and environment.
• Below is a suggested method that can serve as a guide:
  • Always wash your hands, before starting.
  • Prepare the sink: wash it, disinfect it with bleach and then rinse thoroughly with running tap water or use a large dishwater bowl reserved only for the cleaning of your child’s medical equipment.
  • Disassemble all the equipment (according to the manufacturer’s recommendations) so that all the parts can be cleaned thoroughly.
  • Rinse all the parts under warm tap water so as to remove any debris (eg, secretions, blood).
  • Soak all parts in a sink or in a dishwashing bin filled with warm water and non-perfumed, non-antibacterial dish soap (eg, Sunlight), for 10 to 15 minutes.
  • Follow the manufacturer recommendations for the soaking of certain parts, if required.
  • Never use bleach, alcohol or non-diluted hydrogen peroxide to clean equipment; these products may damage the equipment.
  • If needed, brush the interior and exterior of the parts that remain soiled with a soft baby bottle brush.
  • Rinse all parts with warm/hot water.
  • Allow all parts to dry on a clean towel placing them in such a fashion that will allow water to drain away from them.
  • Reassemble all components once thoroughly dry.
  • Store the equipment that is not in use in a bag used only for this purpose (eg, cotton pillowcase) or in a clean container with a lid that will protect the equipment from dust and dirt, according to your child’s healthcare team recommendations.

Communication:

• Sounds and voice are products of the passage of air coming from the lungs as it passes through the larynx where the vocal cords are found. Since a tracheostomy is just below the vocal cords, your child exhales the air from his lungs without it passing through the vocal cords.
• The capacity of a child with tracheostomy to produce sounds will vary depending on the child’s condition. It is therefore possible that your child may be unable to speak, make sounds or cry.
• Learn to observe your child’s non verbal behaviors and facial expressions to better understand what your child is trying to communicate.
• Depending upon the abilities and capacities of your child, alternate forms of communication may be used, including: hand signals, symbols on a card or screen, communication board, writing, sign language, etc. A speech-language specialist can help identify the methods that suit your child best.
• During your child’s naps or at night, different methods of communication can be used to alert you rapidly to a problem:
  • a bell attached to your child’s foot or wrist can tell you that your child is moving (if young and not independent),
  • an infant monitor, with or without a camera, at the bedside,
  • a bell next to the bed, if your child is capable of activating it independently.
• Depending on the underlying medical condition, some children may benefit from a type of tracheal cannula or equipment that will allow them to make sounds or speak:
  • a speaking valve,
  • a fenestrated cannula: used in adolescents,
  • a smaller size cannula in younger children that allows leakage of air around the vocal cords when the child exhales.
• Communication with your child is essential; discuss the best strategies to optimize your child’s language skills and capacities with the healthcare team.

Daycare and school:

• Your child’s healthcare team will evaluate your child’s needs and will support you in the planning of integration to daycare or to school.
• Advise school staff of the treatment and care that your child requires.

Living with a tracheostomy: As with other types of complex care, living with a tracheostomy is an adjustment for both the child and the family. Review the topics in Prepare your child, Prepare yourself and Prepare your home for many more suggestions to help you, your child and your family cope and thrive.