Pediatric Tracheostomy Tubes
Tracheostomy Tubes
Overview
Tracheostomy tubes are medical devices inserted through a surgical opening in the trachea (tracheostomy) to maintain a patent airway in pediatric patients requiring long-term ventilation or airway support.
Key Components
- Outer Cannula: Main tube inserted into trachea
- Inner Cannula: Removable tube for cleaning (if present)
- Obturator: Guide for tube insertion
- Neck Flange: Stabilizes tube position
- Securing Straps: Holds tube in place
Size Selection Criteria
- Age-based sizing:
- Neonates: 2.5-3.0 mm ID
- Infants: 3.0-3.5 mm ID
- Toddlers: 3.5-4.0 mm ID
- School-age: 4.0-5.0 mm ID
- Adolescents: 5.0-6.0 mm ID
- Anatomical Considerations:
- Tracheal diameter
- Neck thickness
- Stoma maturity
Types and Components
Common Tube Types
- Cuffed Tubes
- Air-filled cuff for ventilation
- Better seal for positive pressure
- Reduced aspiration risk
- Regular cuff pressure monitoring needed
- Uncuffed Tubes
- Most common in pediatrics
- Allows air leak around tube
- Permits vocalization
- Lower pressure on tracheal wall
- Fenestrated Tubes
- Opening in upper curve
- Facilitates weaning
- Enables speech
- Not for initial placement
Material Types
- Polyvinyl Chloride (PVC)
- Disposable
- Cost-effective
- Becomes rigid over time
- Silicone
- Softer and more flexible
- Longer lasting
- Better tissue compatibility
- Metal (Silver)
- Reusable
- Durable
- Higher initial cost
Care and Maintenance
Daily Care Protocol
- Stoma Care
- Clean with sterile saline
- Assess for signs of infection
- Change dressing as needed
- Document skin condition
- Tube Care
- Suction as needed
- Clean inner cannula (if present)
- Check securing straps
- Verify tube position
- Humidification
- Maintain adequate humidity
- Monitor secretion consistency
- Adjust humidification as needed
Equipment Requirements
- Essential Supplies
- Spare tracheostomy tube (same size)
- Smaller size tube
- Suction catheters
- Sterile saline
- Clean gloves
- Emergency kit
Complications and Emergency Management
Early Complications
- Hemorrhage
- Monitor bleeding
- Assess coagulation status
- Apply gentle pressure
- Tube Displacement
- Verify position
- Check securing straps
- Reassess frequently
- Infection
- Monitor temperature
- Assess discharge
- Culture if indicated
Late Complications
- Granulation Tissue
- Regular assessment
- Treatment options
- Prevention strategies
- Tracheal Stenosis
- Monitor breathing pattern
- Assess for stridor
- Regular tube size evaluation
Emergency Management
- Tube Obstruction
- Attempt suctioning
- Change inner cannula
- Change entire tube if needed
- Accidental Decannulation
- Stay calm
- Call for help
- Attempt reinsertion
- Provide bag-mask ventilation if needed
