By the end of this chapter, you will be able to:
- identify the items you should keep in your child's emergency tracheostomy kit at all times
- understand how to prepare tracheostomy cleaning supplies
Your child should have an emergency tracheostomy kit with them, wherever they go. You may have multiple kits (in the stroller, car, bedroom, etc.). The tracheostomy kit contains back up tracheostomy tubes in case you need to perform an emergency tracheostomy change if your child’s tracheostomy tube becomes blocked or is accidently removed.
The emergency tracheostomy kit should be checked daily and after each tracheostomy tube change. A checklist attached to the kit box helps to ensure all emergency supplies are present. A part of your daily safety checks should include ensuring that products have not gone past their expiry dates and that tracheostomy tubes are in good condition (not broken, discolored, not overused and the obturator slides in/out of the tube with ease).
You may also hear the emergency tracheostomy kit and tracheostomy related equipment and supplies referred to as the "Go kit".
Tracheostomy kit contents
An emergency tracheostomy kit contains the following supplies:
- tracheostomy outer cannula with ties attached and obturator of the same size that your infant/child currently has in place
- tracheostomy tube one size smaller with ties attached and obturator (store in a small, well-labelled clear bag)
- Please note: Ensure you have suction catheters that fit both the same size and one size down tracheostomy tubes.
- Exception: A 2.5 mm inner diameter tracheostomy tube is the smallest size available. If your child has a 2.5 mm tracheostomy tube, their health-care team will inform you how to manage emergencies.
- normal saline nebules (small, sealed tubes that are filled with saline)
- water soluble lubricant
- round-ended/blunt scissors
- clean tracheostomy gauze (dressing) and/or pre-cut gauze
- manual suction setup: 20 mL syringe with feeding tube attached that is the same size as the suction catheter your child uses for their main tracheostomy tube (in case the suction machine malfunctions)
- Please note: Ensure you have a feeding tube that is one size down if the one size down backup tracheostomy tube is smaller in diameter.
Important
- Always keep spare heat and moisture exchangers (HMEs) or other needed tracheostomy adjuncts, especially when travelling outside the home.
- Routinely check supplies for expiry dates.
If your child has a cuffed tube, then your emergency tracheostomy kit will require some additional items:
- syringe
- sterile water nebule (if your child has a water filled cuff)
- a small cup
Other items that may need to be in the emergency tracheostomy kit include:
- spare obturator for size of tube that is in the child
- spare inner cannula, if your child has an adult-sized tube
- one size down manual suction setup
- This is in the event that the one size down tracheostomy tube needs to be placed and it requires a smaller sized suction catheter (a smaller sized manual suction setup, i.e., one size down feeding tube).
- specialty gauze or stoma medication, if prescribed
- cotton swabs and extra gauze
- wire cutters, if there are beaded tracheostomy ties (although the use of beaded tracheostomy ties is not recommended)
Preparing tracheostomy cleaning supplies
You will need the following cleaning supplies in your child’s emergency tracheostomy kit:
- saline nebules
- sterile water nebules
- saline-soaked cotton swabs (single use, medical grade) or gauze
- dry gauze (regular and/or precut)
- wet facecloth
- dry facecloth
- disposal tray
Additional tracheostomy equipment and supplies
Additional equipment and supplies needed to perform a tracheostomy change:
- wound care supplies, if needed (e.g., specialty gauze, prescribed medication for stoma)
- suction machine, suction catheters/adjuncts and tubing
- sterile water and container for rinsing
- oximeter, cable and probes. This is an oxygen and heart rate monitor. Your health-care provider will prescribe this if your child needs it and will instruct you on when and how to use it.
- small towel or blanket to place under child’s shoulder’s
- blunt plastic tweezers (optional) to help reinsert gauze
- manual resuscitation bag with tracheostomy adaptor and the appropriately sized face mask and stoma mask (if prescribed)
- oxygen, if prescribed
- good light source, such as a head lamp, which is important when visualizing the tracheostomy site