June 28, 2012

Trach Handbook Part 3 - Skin Care & Tie Changes

It is necessary to keep the skin clean and dry and ensure the tracheostomy tube is secure. Wet or dirty ties can lead to rashes and other skin problems. Ties that are to loose increase the risk of accidental dislodgement of the trach tube and formation of granulation tissue. Ties that are too tight cause serious breakdown of the skin. Skin care and ties should be done AT LEAST once per day. A good time to do them is after a bath because the ties usually get wet in the bath. Change the ties and clean the skin more often if the ties are wet, dirty, too loose/tight, or neck is irritated.

Special Considerations
  • Each time you change trach ties, check for signs off redness, riughness or rashes. Persistent rashes need to be seen by a doctor
  • Do not use powder or lotions around the stoma or neck unless prescribed by a doctor
  • spare trach's
  • Check the tightness of ties throughout the day to make to sure the trach tube remains secure.

Equipment needed for Trach change:
  • Pre made ties
  • Scissors
  • Tweezers
  • Two clean cloths one wet one dry

Emergency equipment to have near you for EVERY tie change
  • 2 spare Trachs (1 normal size and 1 one size smaller)
  • Suction catheter and machine 
  • Manual ventilator/Bagger
  • lubricant

Prepare the child for tie change by either laying flat or sitting. In small children it is necessary to place a roll under the shoulders to expose the neck. 

Procedure for skin care and tie changes
  • Two person job for small children
  • Everyone starts by washing hands
  • Have one person stabilize the tracheostomy tube using two fingers.
  • Cut and remove old ties
  • Use wet cloth to clean neck and stoma, always wipe away from stoma
  • Pat neck dry using dry cloth
  • Secure new ties
  • Test for tightness. Should be able to place the tip of index finger under tie. 
  • Triple knot ties on each side for security

How to make Hannah's Trach tie:

 Measure Hannah's neck to no how long to cut the molskine. Right now she's 14.5'

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