Considerations:
Attempt to provide the student with as much privacy as possible, given the urgency of the situation
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 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
- Stethoscope
Additional needed supplies:
- Oxygen source with appropriate tubing (if ordered)
- Manual resuscitator
- Adaptor for tracheostomy tube
- Stethoscope
- Personal protective equipment
- gloves
- goggles
- mask
Procedure:
- 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
- Connect the bag to the tracheostomy tube
- If 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
- 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 has oxygen ordered, use it when hand ventilating the student at the flow of 4 to 6 liters per minute
- Remove resuscitator bag from tracheostomy tube
- Wash hands
- Document assessment, procedure, and outcomes in student’s healthcare record
- Report any concerns to parents/guardian and healthcare provider
References:
Children’s Hospital of Wisconsin. (2012). Health Facts for You. Manual Resuscitator Bag. Available at: http://www2.chw.org/applications/TeachingSheets/1119EN.pdf
Tribby, R. & Dreier, C. (2010). Oxygenation and Manual Ventilation. Available at: http://www.uwppc.org/educational-resources/trach/section4/L4_OxygenationManual.pdf
Acknowledgment of Initial and Update Reviewers:
Cynthia C. Griffith, RN, BSN
Nurse Clinician
Tracheostomy/Home Ventilator Program
Children’s Hospital of Wisconsin
Cecilia Lang, MSN, CCRN, PNP-BC
Tracheostomy/Home Ventilator APN
Children’s Hospital of Wisconsin
Page last updated: September 15, 2021
Page last reviewed: September 15, 2021
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.