Sharing some helpful info here.
What should You look for if you think your patient is in trouble?
Although your patient has an airway, there are still possible threats that may prevent adequate breathing.
Respiratory Distress
- Flared nostrils
- Rapid breathing or change in breathing pattern
- Noisy breathing
- Clammy and sweaty skin
- Restlessness
Mucus Plug
A mucus plug is a collection of mucus that has clogged the airway.
- May have symptoms of respiratory distress if unable to breathe easily
- Can be prevented through adequate fluid intake, proper suctioning, and coughing
- A mucus plug may be removed by suctioning the airway and loosening the secretions with saline
Bleeding
It is not unusual to have occasional blood-tinged or pink colored mucus. However, bright red blood may be a sign of serious damage to the airway.
Causes of bleeding may include:
- Dry airway
- Frequent suctioning
- Infection
- Excessive coughing
- Irritation from the tracheostomy tube
- Trauma to the tube
- Foreign body aspiration
How to Prevent Bleeding
- Suction when necessary and avoid frequent deep suctioning
- Use appropriate methods of humidification
Bright, Red Bleeding
- If you see bright red bleeding from your child’s tracheostomy it is important to contact your provider or call 911
Blood-tinged or Pink Mucus
- Provide gentle suctioning
- May use saline to loosen secretions
- Notify provider if it continues
Accidental decannulation
If the tracheostomy tube is not secured properly then it is easy for your child to cough, pull, or have the tracheostomy fall out. If the tracheostomy comes out partially or completely, your child may have difficulty breathing.
Prevention
- Make sure the tracheostomy ties are secure, dry, and intact
- If the ties are showing signs of wear such as thinning of the tie or tears, it is time to replace the ties.
- Do not allow anyone or your child to pull at the tracheostomy
Complications
- Symptoms of respiratory distress
- If the tracheostomy comes out, then replace the tube as you would perform a tracheostomy tube change.
Aspiration
This occurs when secretions or food particles from the stomach or esophagus enter the airway.
Signs of Aspiration
- Drooling
- Coughing or choking with swallowing
- Food contents in the secretions from the tracheostomy
- Frequent lung infections
Prevention
- Thickening liquids with artificial thickener or foods such as puddings, baby foods, yogurt, cereal, or jello
- Have your child sit upright during and after feedings for 30 minutes
- Encourage slow eating and small bites
What to Do If Aspiration Occurs
- Carefully watch your child’s eating and drinking
- Suction the tube until the secretions are clear of the liquid or food particles
- Change the tube if it is clogged
- Notify your provider if your child is showing signs of breathing difficulties
- Work with a speech therapist as recommended
Remember your child can also aspirate if they vomit. It is best to turn your child’s head to the side and suction as needed.
Infection
Since air inhaled through a tracheostomy is not filtered by the body, your child is at an increased risk for infections.
Signs of Infection
- Fever
- Foul odor
- Yellow or green secretions
- Redness or bleeding at the stoma site
- Fast breathing or change in breathing pattern
- Lethargy
If you feel that your child’s tracheostomy may be infected, please call your provider.
http://www.musckids.org/ent/tracheostomyhandbook/trouble.htm
