Tracheostomy Tube Obstruction

Definition
A trach tube obstruction is a trach that is partially or totally occluded and compromises the integrity of the child's airway.  

 

 

 

Cause	Prevention
Mucus build up on the wall of the tracheostomy tube	Adequate humidification, frequent suctioning, change the trach tube at regular intervals
Inadequate humidity	Increased use of heated humidification May not be able to use HME as long as usual
Increased thickened secretions with respiratory infection	Increased use of heated humidification Increase fluid intake
Humidification system malfunction or incorrect temperature	Troubeshoot the humidification system or alter the temperature settings
Child not adequately hydrated	Increase fluid intake

Signs & Symptoms

Signs of need for suction – mucus in trach tube, coughing Dry whistling sounds from trach tube Coarse breath sounds or decreased breath sounds on auscultation Increased heart rate Change in skin color – pale or cyanotic Increased work of breathing- retractions or nasal flaring Level of consciousness – restlessness to unconscious Decreased chest movement Alarms of cardio respiratory monitor – high heart rate, low heart rate, apnea Decreased oxygen saturation as measured by an oximeter High pressure alarm if volume ventilated Inability to pass the suction catheter the entire length of the trach tube Inability to get chest to rise with the resuscitation device

 

Intervention

Assess child’s status and hyperextend the child’s neck to gain access to the trach site Establish a patent airway Intervention can include suctioning, instilling normal saline, giving breaths with manual resuscitation device and/or changing the trach tube Choice of intervention is based on the child’s status and degree of respiratory distress Provide manual ventilation as necessary Proceed with CPR as indicated.

• 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.
• When there is a change in therapy, such as the use of a speaking valve or the humidity moisture exchanger (HME), the amount of humidification can change which can cause thicker secretions and plugs.
• Keep up your skills in tracheostomy tube changes by participating in a change every 6 months; review the steps for emergency interventions for obstructed airway.
• 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.