When Isaac was in the hospital, the respiratory therapists told me that I would be responsible for his trache care everyday. They would ask me what time was convenient for me to do it and I would make sure I was in the hospital at that time. They were very good at working around my schedule.  I also saw how each one of them did the procedure differently. I formed my own way of doing it based on the styles I saw from them. I learned from my private duty nurses that children whose parents did their trache care seldom got any infections and those children also got used to trache care that they don’t give their parents a difficult time. Anyway, in the interests of sharing, here are my own steps to do trache care.

Materials you will need:

Two sterile water small bottles ( I use the one I had from the hospital) one bottle is for sterile water that I use for the cuff (I do not dip applicators in this bottle) and the other bottle is dipping the applicators in and has colored tape on it for marking, 8 sterile applicators (4 wet, 4 dry), trache tie cut to size,  1 packet of 2×2 excillon gauze, 2 4×4 gauze (one damp, one dry), mupirocin ointment, sterile water for cuff inflation, two luer lock syringes (one for deflating the cuff and one for inflating the cuff, nystatin powder to sprinkle on the trache tie and rub so that there are no loose particles that can go in the stoma, gloves and hand sanitizer.

1. Cut the trache tie to fit around the neck of your child. I usually have a template or sample I use to measure against. This template would have to be changed from time to time especially when you think your child is outgrowing it.
2. Use hand sanitizer on your hands and put your gloves on. Proceed to remove the old gauze around the stoma and clean using the sterile applicators. Use the wet applicators first then the dry.
3. Place the new trache tie at the back of your child’s head behind the old one that is still attached. Slowly remove the velcro fastening of the old trache tie closest to you and wipe the neck with the damp gauze and dry with the dry gauze. Attach the new trache tie on that side.
4. Hold on to the old trache tie and move it towards the other side of the neck where the side furthest from you is still fastened. Hold on to it because it holds the trache in place right now.
5. Wipe the other side of the neck with the damp gauze and follow through with the dry. Remove the old trache tie while holding on to the trache. As soon as the old tie has been removed, fasten the new trache tie.
6. Deflate the cuff of the trache and check if you got the same amount as you put in the day before. Inflate the cuff with the prescribed amount of water.

After trache care I usually change the in line suction catheter as well. At the beginning we only changed it every 3 days. A simple request from my doctor and the DME company gives me 30 catheters so I can change it everyday. This sometimes takes time because they have to course it through insurance. So make sure you request for 30 before you come home.