Difficult Tracheostomy Tube Insertion

Definition
Inability to insert the tracheostomy tube.

 

 

Cause	Prevention
Granulation tissue	Avoid trauma to stoma and seek medical care to remove granulation tissue
Poor positioning	Position child in prone position Use roll under shoulders to hyperextend neck Swaddle child or have second person help restrain child
Tube dry and not sliding in	Lubricate tube
Partially closed stoma	Pull down on stoma, calm child, wait for child to inhale

Signs & Symptoms

Trach tube does not go into stoma Increased heart rate Change in skin color – pale or cyanotic Increased work of breathing- retractions or nasal flaring Level of consciousness – restlessness to unconscious

 

Intervention
Assess child’s status and hyperextend the child’s neck to gain access to the trach site Continually assess the child for signs of respiratory distress If unable to determine cause for inability to insert trach tube, get the next smaller sized trach tube out and insert If unable to insert this trach tube, thread a suction catheter through the smaller sized trach tube and use it as a guide* If unable to get any tube in, and child is in respiratory distress and needs ventilation, cover stoma and use mask  over nose and mouth with manual resuscitation device to give breaths**

• Knowing the child's baseline will allow the nurse to better assess when there is a potential airway problem
• The emergency bag or “go-bag” has the equipment needed for problems with the tracheostomy and should be with the child at all times
• Keep up your skills in tracheostomy tube changes by participating in a change every 6 months; review the steps for emergency interventions for decannulation.
• The decision to call 911 for additional assistance is dependent on the child’s status. The primary value of emergency personnel is for additional assistance and transport to the nearest emergency department. Remember to take the “Go Bag” if the child is transported.