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Indi
cate
on
this
dia
gram
an
y su
ture
s in
pla
ce
This
pati
ent h
as a
New
TRA
CHEO
STO
MY
UPP
ER A
IRW
AY A
BNO
RMAL
ITY:
Yes
/ N
o
Doc
umen
t lar
yngo
scop
y gr
ade
and
note
s on
upp
er a
irway
man
agem
ent o
r pati
ent s
peci
fic re
susc
itatio
n pl
ans
Due
1st tr
ache
osto
my
chan
ge:
___
/ __
_ /
___
(by
EN
T O
NLY
)
Patie
nt L
abel
/ D
etai
lsP
ati
en
t ID
:
Tra
che
ost
om
y:
Su
ctio
n:
Add
tube
spe
cific
ation
in
clud
ing
cuff
or in
ner t
ube
____
__m
m ID
, ___
___
mm
dis
tal l
engt
h
____
__ F
G C
athe
ter t
o D
epth
___
___
cm
In a
n Em
erge
ncy:
Cal
l 222
2 an
d re
ques
t the
Res
usci
tatio
n Te
am a
nd E
NT
surg
eon
Follo
w th
e Em
erge
ncy
Paed
iatr
ic T
rach
eost
omy
Man
agem
ent A
lgor
ithm
on
reve
rse
Basi
c Re
spon
seAd
vanc
ed R
espo
nse
IS THE PATIENT BREATHING? - Look, listen and feel at the mouth and tracheostomy/stomaIS THE PATIENT BREATHING? - Look, listen and feel at the mouth and tracheostomy/stoma
EMERGENCY TRACHEOSTOMY TUBE CHANGE
Emergency Paediatric Tracheostomy Management
Remove any attachments: humidifier (HME), speaking valve and change inner tube (if present)
Inner tubes need re-inserting to connect to bagging circuits
Remove any attachments: humidifier (HME), speaking valve and change inner tube (if present)
Inner tubes need re-inserting to connect to bagging circuits
Yes
SUCTION TO ASSESS TRACHEOSTOMY PATENCY
YesRESPONDS:
continue oxygen, reassessment
and stabilisation
Plan for definitive airway if tube change failure
RESPONDS:continue oxygen,
reassessmentand stabilisation
Plan for definitive airway if tube change failure
NTSP (Paediatric Working Group) Sep 2014
The tracheostomy tube is patentPerform tracheal suction Consider partial obstructionConsider tracheostomy tube change
CONTINUE ASSESSMENT (ABCDE)
The tracheostomy tube is patentPerform tracheal suction Consider partial obstructionConsider tracheostomy tube change
CONTINUE ASSESSMENT (ABCDE)
5 RESCUE BREATHS – USE TRACHEOSTOMY IF PATENT
SAFETY - STIMULATE - SHOUT FOR HELP - OXYGEN
SAFE: Check Safe area, Stimulate, and Shout for help, CALL 2222 (hospital) or 999 (home)AIRWAY: Open child’s airway: head tilt / chin lift / pillow or towel under shoulders may helpOXYGEN: Ensure high flow oxygen to the tracheostomy AND the face as soon as oxygen availableCapnograph: Exhaled carbon dioxide waveform may indicate a patent airway (secondary responders)
CHECK FOR SIGNS OF LIFE ? – START CPR
15 compressions : 2 rescue breathsEnsure help or resuscitation team called
Patent Upper Airway – deliver breath to the mouthObstructed Upper Airway – deliver breath to tracheostomy/stoma
Tracheostomy STOMA ventilation Paediatric face mask applied to stoma LMA applied to stoma
Tracheostomy STOMA ventilation Paediatric face mask applied to stoma LMA applied to stoma
Attempt intubation of STOMA 3.0 ID tracheostomy tube / ETT‘Difficult Airway’ Expert and Equipment**
Attempt intubation of STOMA 3.0 ID tracheostomy tube / ETT‘Difficult Airway’ Expert and Equipment**
Standard ORAL airway manoeuvres may be appropriate. If so cover the stoma (swabs / hand). Use: Bag-valve-face mask Oral or nasal airway adjuncts Supraglottic airway device e.g. Laryngeal Mask Airway (LMA)
Standard ORAL airway manoeuvres may be appropriate. If so cover the stoma (swabs / hand). Use: Bag-valve-face mask Oral or nasal airway adjuncts Supraglottic airway device e.g. Laryngeal Mask Airway (LMA)
ORAL intubation may be appropriate with a downsized ET tubeUncut tube, advanced beyond stomaPrepare for difficult intubation‘Difficult Airway’ Expert and Equipment**
ORAL intubation may be appropriate with a downsized ET tubeUncut tube, advanced beyond stomaPrepare for difficult intubation‘Difficult Airway’ Expert and Equipment**
Secondary emergency oxygenation Primary emergency oxygenation
**EQUIPMENT: Fibreoptic scope, bougie, airway exchange catheter, Airway trolley**EQUIPMENT: Fibreoptic scope, bougie, airway exchange catheter, Airway trolley
Deflate cuff (if present). Reassess patency after any tube change1st – same size tube, 2nd – smaller size tube
* 3rd – smaller size tube sited over suction catheter to guideIF UNSUCCESSFUL – REMOVE THE TUBE
Can you pass a SUCTION catheter?Can you pass a SUCTION catheter?
No
No
*3-smaller size tube sited over suction catheter to guide: to be used if out of hospital
This
pati
ent h
as a
TRAC
HEO
STO
MY
UPP
ER A
IRW
AY A
BNO
RMAL
ITY:
Yes
/ N
o
Doc
umen
t lar
yngo
scop
y gr
ade
and
note
s on
upp
er a
irway
man
agem
ent o
r pati
ent s
peci
fic re
susc
itatio
n pl
ans
Patie
nt L
abel
/ D
etai
lsP
ati
en
t ID
:
Tra
che
ost
om
y:
Su
ctio
n:
Add
tube
spe
cific
ation
in
clud
ing
cuff
or in
ner t
ube
____
__m
m ID
, ___
___
mm
dis
tal l
engt
h
____
__ F
G C
athe
ter t
o D
epth
___
___
cm
In a
n Em
erge
ncy:
Cal
l 222
2 an
d re
ques
t the
Res
usci
tatio
n Te
am a
nd E
NT
surg
eon
Follo
w th
e Em
erge
ncy
Paed
iatr
ic T
rach
eost
omy
Man
agem
ent A
lgor
ithm
on
reve
rse
Basi
c Re
spon
seAd
vanc
ed R
espo
nse
IS THE PATIENT BREATHING? - Look, listen and feel at the mouth and tracheostomy/stomaIS THE PATIENT BREATHING? - Look, listen and feel at the mouth and tracheostomy/stoma
EMERGENCY TRACHEOSTOMY TUBE CHANGE
Emergency Paediatric Tracheostomy Management
Remove any attachments: humidifier (HME), speaking valve and change inner tube (if present)
Inner tubes need re-inserting to connect to bagging circuits
Remove any attachments: humidifier (HME), speaking valve and change inner tube (if present)
Inner tubes need re-inserting to connect to bagging circuits
Yes
SUCTION TO ASSESS TRACHEOSTOMY PATENCY
YesRESPONDS:
continue oxygen, reassessment
and stabilisation
Plan for definitive airway if tube change failure
RESPONDS:continue oxygen,
reassessmentand stabilisation
Plan for definitive airway if tube change failure
NTSP (Paediatric Working Group) Sep 2014
The tracheostomy tube is patentPerform tracheal suction Consider partial obstructionConsider tracheostomy tube change
CONTINUE ASSESSMENT (ABCDE)
The tracheostomy tube is patentPerform tracheal suction Consider partial obstructionConsider tracheostomy tube change
CONTINUE ASSESSMENT (ABCDE)
5 RESCUE BREATHS – USE TRACHEOSTOMY IF PATENT
SAFETY - STIMULATE - SHOUT FOR HELP - OXYGEN
SAFE: Check Safe area, Stimulate, and Shout for help, CALL 2222 (hospital) or 999 (home)AIRWAY: Open child’s airway: head tilt / chin lift / pillow or towel under shoulders may helpOXYGEN: Ensure high flow oxygen to the tracheostomy AND the face as soon as oxygen availableCapnograph: Exhaled carbon dioxide waveform may indicate a patent airway (secondary responders)
CHECK FOR SIGNS OF LIFE ? – START CPR
15 compressions : 2 rescue breathsEnsure help or resuscitation team called
Patent Upper Airway – deliver breath to the mouthObstructed Upper Airway – deliver breath to tracheostomy/stoma
Tracheostomy STOMA ventilation Paediatric face mask applied to stoma LMA applied to stoma
Tracheostomy STOMA ventilation Paediatric face mask applied to stoma LMA applied to stoma
Attempt intubation of STOMA 3.0 ID tracheostomy tube / ETT‘Difficult Airway’ Expert and Equipment**
Attempt intubation of STOMA 3.0 ID tracheostomy tube / ETT‘Difficult Airway’ Expert and Equipment**
Standard ORAL airway manoeuvres may be appropriate. If so cover the stoma (swabs / hand). Use: Bag-valve-face mask Oral or nasal airway adjuncts Supraglottic airway device e.g. Laryngeal Mask Airway (LMA)
Standard ORAL airway manoeuvres may be appropriate. If so cover the stoma (swabs / hand). Use: Bag-valve-face mask Oral or nasal airway adjuncts Supraglottic airway device e.g. Laryngeal Mask Airway (LMA)
ORAL intubation may be appropriate with a downsized ET tubeUncut tube, advanced beyond stomaPrepare for difficult intubation‘Difficult Airway’ Expert and Equipment**
ORAL intubation may be appropriate with a downsized ET tubeUncut tube, advanced beyond stomaPrepare for difficult intubation‘Difficult Airway’ Expert and Equipment**
Secondary emergency oxygenation Primary emergency oxygenation
**EQUIPMENT: Fibreoptic scope, bougie, airway exchange catheter, Airway trolley**EQUIPMENT: Fibreoptic scope, bougie, airway exchange catheter, Airway trolley
Deflate cuff (if present). Reassess patency after any tube change1st – same size tube, 2nd – smaller size tube
* 3rd – smaller size tube sited over suction catheter to guideIF UNSUCCESSFUL – REMOVE THE TUBE
Can you pass a SUCTION catheter?Can you pass a SUCTION catheter?
No
No
*3-smaller size tube sited over suction catheter to guide: to be used if out of hospital
