Golisano Children's Hospital / Tracheostomy & Ventilator Program / Tracheostomy / Symptom Management Symptom Management If your child is having trouble breathing, the trach tube falls out or becomes blocked, and you cannot immediately solve the problem, call 911. Secretions: Yellow, green or colored secretions; or bad odor to secretions Why is this happening? Infection What to do... Contact your doctor’s office and report symptoms If your child has a fever or an increase in difficulty breathing, contact your doctor immediately If breathing becomes severe, call 911 Blood-tinged secretions Why is this happening? Not enough humidification Irritation to respiratory tract from suctioning too vigorously What to do... Increase humidification Stay well hydrated Assure you are gently suctioning to the appropriate depth If it persists or becomes worse, contact your doctor’s office Frank bleeding/bright red blood Why is this happening? Irritation and injury to airway Active bleeding from a blood vessel What to do... At times, there may be some oozing around trach after a trach tube change. If oozing does not decrease, contact doctor’s office. For unexplained bright red or frank bleeding, contact doctor or call 911 Thick secretions Why is this happening? Dehydration Not enough humidification What to do... If not fluid restricted, increase fluids Increase humidification If prescribed, give nebulizer to help loosen secretions Suction trach Blocked or plugged trach Why is this happening? Thickened or dried secretions Obstruction by a foreign body What to do... Attempt to suction. If little or no improvement, change trach or inner cannula. If still little or no improvement, call 911. May repeat suctioning. If child stops breathing, begin CPR. Trach tube falls out and another is available What to do... Replace trach tube of same size. If unable to replace trach tube of same size, attempt to place trach one size smaller. If unable to replace, immediately call 911. Trach tube falls out and another is NOT available What to do... Call 911. If child is having trouble breathing, give rescue breaths with resuscitation bag with mask covering mouth and nose. (Cover stoma with gauze and tape.) Food coming out of trach Why is this happening? Possible aspiration Fistula What to do... Stop child from eating and drinking, or turn off tube feed immediately. Suction trach. Contact doctor immediately for instructions. If child is having trouble breathing, call 911. Trouble breathing or change in breathing Why is this happening? Many possible reasons What to do... If there is a change in breathing and it is not causing immediate distress to the child, call the doctor. For severe trouble breathing, high-pitched wheezing, or shortness of breath with or without sweating, fever, agitation, anxiety and/or drowsiness, call 911. Be prepared to give rescue breaths or start CPR if child’s condition gets worse. Skin around stoma is red Why is this happening? Irritation Possible infection What to do... Increase frequency of skin care, making sure to keep area clean and dry. If stoma remains red and is associated with colored drainage or fever, contact the doctor. Granulation tissue at stoma Why is this happening? Too much movement of the trach tube What to do... Alternate position of ventilator tubing. Make sure trach ties are tight enough. Call ENT to make them aware. Your child may need a cream for the site. Ventilator is not maintaining pressure (for children who are ventilated) Why is this happening? Leak within system Deflated cuff on trach What to do... Check balloon on trach for inflation. If leaking or cannot inflate, replace trach. Check ventilator tubing. If there’s trouble breathing, call 911. Be prepared to give rescue breaths or start CPR if child’s condition gets worse.
