*THIS PROCEDURE IS TYPICALLY PERFORMED BY A REGISTERED NURSE
The use of this procedure guideline assumes that the registered nurse has the nursing education and skills to perform this task. This procedure guideline does not replace nursing clinical judgment.
Considerations:
When caring for a student who has a tracheostomy, the nurse should always know the reason for the tracheostomy, the student’s underlying health conditions and whether the student needs the tracheostomy to breathe.
Attempt to provide the student with as much privacy as possible, given the urgency of the situation.
There should always be a “GO BAG” (Emergency Travel Bag) accessible when completing any tracheostomy procedure.
If the student’s “GO BAG” contains a battery charged suction machine, the school nurse should check the battery charge level daily to ensure that it is fully charged.
The school nurses should establish a schedule to periodically check the “GO BAG” to ensure all necessary supplies are available, not expired, and are in working condition.
When using a resuscitation bag to provide assisted breaths or manual ventilation you must call 911.
Supplies:
“GO BAG” (Emergency Travel Bag) Equipment:
The essential equipment to be kept with the student at all times is as follows:
- gloves
- portable oxygen (if ordered) 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
- battery should have a full charge
- sterile suction catheters
- sterile saline vials
- water-based lubricant
- distilled or sterile water
- 4×4 gauze
- split gauze dressing (if student uses)
- unscented and dye free soap
- syringe, if needed for tracheostomy tube cuff
- sterile water for cuffed trach filled with water
- 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
- Stethoscope
Additional needed supplies:
- Oxygen source with appropriate tubing (if ordered)
- Manual resuscitator
- Adaptor for tracheostomy tube
- Stethoscope
- Accessible phone
- Personal protective equipment
- gloves
- goggles
- mask
- Individualized Healthcare Plan (IHP)
- Healthcare provider’s order
- Parent/Guardian authorization form
Procedure:
- Call for assistance
- Ask that another school staff personnel call 911 or emergency medical services and notify parent
- Remove other students from the area, as necessary
- Reassure student
- Explain procedure to the student at a level that he/she will understand
- Wash hands, if student’s condition permits
- Assemble equipment as student’s condition permits or utilize equipment in emergency travel bag
- If ordered, place pulse oximeter on student’s finger, toe or ear lobe during and after the procedure
- Check function of resuscitator bag
- Function test one
- Squeeze the bag to ensure that it deflates and inflates
- Function test two
- Place finger over the patient port
- Squeeze air out of the bag
- Check for movement of the pressure pop off
- Function test three
- Place finger over the patient port
- Occlude the pressure pop off
- Squeeze the bag, no air should escape
- Function test one
- If student is on a ventilator, remove ventilator. If using heat moisture exchanger (HME), speaking valve, or trach mask, remove prior to connecting to bag
- Connect the bag to the tracheostomy tube
- Attach oxygen, if ordered
- Turn on the oxygen per the manufacturer’s instructions and healthcare provider’s order
- If student is able to breathe on their own, squeeze the resuscitator bag as soon as the student begins to inhale
- IIf student is able to breathe on their own, squeeze the resuscitator bag as soon as the student begins to inhale
- If the student does not breathe on his or her own squeeze the bag at the same rate as the ventilator or at least 8-10 breaths per minute
- As you squeeze the bag, watch student’s chest rise
- As soon as your student’s chest rises, release the bag
- Repeat this cycle of squeezing and releasing until the student is back to their baseline
- If the student is not breathing on their own and loses consciousness, you will need to begin CPR
- Continue to assist the student with breathing and/or perform continuous CPR until help arrives
- If the student stabilizes and returns to baseline, remove resuscitator bag from tracheostomy tube
- Wash hands
- Document assessment, procedure, and outcomes in student’s health care record
- Report any concerns to parents/guardian and health care provider
References:
Children’s Mercy Kansas City. (2018). Office of evidence based practice (EBP) – Critically appraised topic: Tracheostomy emergency supplies. Retrieved June 8, 2023 from https://www.childrensmercy.org/contentassets/878a471901cd4e858cc27ae0d82f441e/trach-go-bag-cat.pdf
Children’s Mercy Kansas City. (n.d.). Tracheostomy tube. Retrieved June 7, 2023, from https://www.childrensmercy.org/siteassets/media/departments-and-clinics/otolaryngology/tracheostomy-care-parent-card.pdf
Children’s Mercy Kansas City. (n.d.). Bagging: Manually ventilating a child with a tracheostomy. . Retrieved June 8, 2023, from https://www.childrensmercy.org/departments-and-clinics/otolaryngology-ear-nose-and-throat/tracheostomy-program/tracheostomy-videos/
Children’s Wisconsin. (n.d.). Checking the resuscitator bag. . Retrieved June 8, 2023, from https://childrenswi.org/medical-care/tracheostomy-home-ventilator/educational-resources
Children’s Wisconsin. (n.d.). Connecting oxygen to the manual resuscitation bag. . Retrieved June 8, 2023, from https://childrenswi.org/medical-care/tracheostomy-home-ventilator/educational-resources
Pediatric Home Services. (2007). Using a resuscitation bag (Bolsa de reanimación). . Retrieved June 8, 2023, from https://www.pediatrichomeservice.com/tips-how-tos/using-a-resuscitation-bag/?play=1
Page last updated: February 28, 2025
Page last reviewed: February 28, 2025
The information and materials presented in this Website are intended for informational purposes only and are not designed to diagnose or treat a health problem or disease, or assist in diagnosis or treatment of the same. The information is not intended to substitute for, supplement or replace clinical judgment. If there are any concerns or questions about or relating to a nursing or medical procedure, contact the individual’s healthcare provider. The information provided on this Website is not intended to be a substitute for medical orders and persons without the proper education, training, supervision and/or licensure should not perform the procedures.