Tracheostomy 101 . .

Over the last year a lot of you have asked a lot of questions. Very few of you have actually met Parker face to face, and you wanted to know what it was like . . . caring for a child with a trach. The truth is that our experience with the trach has been much like our experience raising children: as soon as we think we have “it” the target moves and we start all over again.

 Some questions and some answers.

What exactly is a tracheostomy tube? The tube itself is a small plastic tube with two flanges. The part that goes into Parker’s trachea is 3.5mm inner diameter and 5.2 mm outer diameter. The length is 6 mm. That’s it. My son’s airway depends on a piece of plastic with a 3.5mm hole in it.

How does it stay in? The tube is tied around the neck by the flanges. We use a spongy velcro strip to hold it. Others use more of a ribbon and still others make creative beaded necklaces.

Can it come out on accident? Yes. Thankfully, we’ve never had that happen.

How often do you change it? To begin with, we changed Parker’s tube twice a week. Now we do it just once a week. We sterilize and reuse the tubes for a month. Rotating between two. To change it we literally pull it out, clean the stoma area with a bit of saline and pop the new one in. The whole thing takes less than 15 seconds start to finish.

What is suctioning? Trachs cause a lot of secretions. These need to be removed to keep the airway clear. When Parker was first trached we suctioned him about every 5-10 minutes around the clock. With time, his secretions have decreased and he’s become capable of clearing them himself so we suction far less often. There are two types of suctioning: going into the tube itself with a suction catheter and tip suctioning which is just clearing the “trach snot” from the outside part of the trach. Because Parker has a productive cough that is all we really do anymore.  We have two suction machines. One stays put by all of his equipment and the other is a portable and very, very loud!

How do you keep bugs and cheerios from ending up inside his trach? In the best of times, the trach is always covered by either an artificial nose or a speaking valve. The “nose” acts as a filter and also provides humidity and heat to the air passing into his lungs. The speaking valve is a one way valve that passes air in through the trach and forces the exhale out through the mouth and nose (therefore making speech easier). I am sure no one reading will be surpised to hear that Parker is often found without either of these on his trach. His lastest pleasure in life is to chew the sponge from his “nose” like chewing gum. I’m sure the flavor rivals that of anything Wrigley’s has ever conceived.

What happens if something does end up in the trach? Potentially, Parker could cough or sneeze it out (stand back!) if not, we could change the trach. If it is “trach snot” that is blocking it we can suction or add a few drops of saline to loosen it up. Thankfully, we’ve never really been in an emergency situation like this.

What happens at night? The Ontario government provides all trach patients with 40 hours a week of nursing care. Our insurance provides quite a bit more. So, each night Parker has a nurse that watches him sleep. Monitors his blood oxygen, heartrate, breathing, etc. She suctions, feeds, changes diapers, and anything else that he needs done during the time that she is here. I can’t say that I love having someone else in our house all the time but I like it more than the thought of being exhausted all the time. In the end, it has been a very good thing.

Is Parker limited in his activity? That would be NO! Ok, he can’t swim or take a shower and we have to be extra careful that he doesn’t fall in the potty, but other than that he is just like any other 15 month old that you’ve ever met. Nothing slows him down. I will admit that while I’m not really one of those faint at heart moms that hovers over their child’s every move, I do at times worry that his 100 mph tears through the house or flying leaps off of whatever he’s climbed onto are going to result in a crash of the neck. So far so good.

These are my answers to those questions. There are lots of different ways of doing things in the trach world. If you would like to know more about trachs and trach care I recommend Aaron’s Tracheostomy Site: www.tracheostomy.com

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