Considerations:
- Attempt to provide the student with as much privacy as possible, given the urgency of the situation
- Should always have Emergency Travel Bag accessible when completing any tracheostomy procedure
- Two people should be present during the procedure in the event of accidental decannulization
- Some children have disposable inner cannulas and do not need to re-clean and reuse their inner cannula, if the child does not have a spare inner cannula in the emergency travel bag, their inner cannula should be cleaned and re-used
Supplies:
Emergency Travel Bag Equipment:
The essential equipment to be kept with the student at all times is as follows:
- gloves
- portable oxygen with appropriate sized Ambu-bag
- appropriate size Ambu-bag facemask (for emergencies when unable to reinsert a new tracheostomy tube
- portable suction machine that can operate with battery or electricity
- sterile suction catheters
- sterile saline vials
- water-based lubricant
- two spare tracheostomy tubes- one the size the student currently uses and one that is a size smaller in the event that the tube needs to be changed and there is difficulty passing it through the stoma
- obturator, if applicable
- spare tracheostomy ties
- blunt scissors
- emergency phone numbers
- pulse oximeter — may be optional if student is not on oxygen or mechanical ventilation
Additional needed supplies:
- Student’s individual health plan/Healthcare provider’s order
- Stethoscope
- Sterile water
- Hydrogen peroxide
- Sterile pipe cleaners
- Basin for cleaning
- Personal protective equipment
- gloves
- goggles
- mask
- Assembles supplies and place on a clean surface
- Review student’s individual health plan/health care provider’s order
- Position student providing as much privacy as possible
- Explain the procedure at a level the student will understand
- Wash hands
- Assess student’s respiratory status to ensure it is appropriate to change tracheostomy cannula at this time
- Put on clean gloves
- Check emergency travel bag for disposable inner cannula
- If disposable inner cannula is available remove the inner cannula as per manufacturer’s instructions
- Reinsert the inner cannula by turning it 90 degrees from its usual position, introduce the tip into the outer cannula, slowly rotating it back 90 degrees to its final position
- If the student does not have a disposable inner cannula in emergency travel bag, follow the steps below for cleaning and re-inserting inner cannula
- Have person assisting with procedure wash hands and put on clean gloves
- Mix equal parts of sterile water and hydrogen peroxide in a clean basin
- Remove the inner cannula as indicated per manufacturer’s instructions
- Soak the inner cannula in a the basin of half-strength hydrogen peroxide solution
- Using sterile pipe cleaners, remove any dried secretions from inside the cannula
- Thoroughly rinse the cannula with sterile water
- Reinsert the inner cannula by turning it 90 degrees from its usual position, introduce the tip into the outer cannula, slowly rotating it back 90 degrees to its final position
- Lock the cannula in place per manufacturer’s instructions
- Assess student’s respiratory status
- Remove gloves
- Document assessment, intervention and outcomes in student’s healthcare record
- Follow up with parents/guardian and healthcare provider, as needed
References:
American Thoracic Society. (2000). Care of the child with a chronic tracheostomy. American Journal of Respiratory & Critical Care Medicine, 1, 297-308.
Bowden, V. R., & Greenberg, C. S. (2012). Pediatric nursing procedures (Third Edition). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Connecticut State Department of Education. (2012). Clinical Procedure Guidelines for Connecticut School Nurses. Available at:
http://www.sde.ct.gov/sde/lib/sde/pdf/publications/clinical_guidelines/clinical_guidelines.pdf
Acknowledgment of Reviewers:
Marcia Creasy, BSN, RN
Retired School Nurse
Cynthia C. Griffith, RN, BSN
Nurse Clinician
Tracheostomy/Home Ventilator Program
Children’s Hospital of Wisconsin
Mary Kay Kempken, RN, BSN, NCSN
School Nurse
Randall Consolidated School
Cecilia Lang, MSN, CCRN, PNP-BC
Tracheostomy/Home Ventilator APN
Children’s Hospital of Wisconsin
Carole Wegner, MSN, RN
Clinical Nurse Specialist
Tracheostomy/Home Ventilator Program
Children’s Hospital of Wisconsin
Page last updated: November 11, 2015
Page last reviewed: November 11, 2015