Mission Consolidated Independent School District
Health Services TRACHEOSTOMY OVERVIEW
Purpose:
The following is to be used to refresh the RN & LVN on the purpose and overall use of Tracheostomy Care.
In addition, the following Trach procedure/guidelines obtained from the West Virginia Public Schools Manual
have been modified to meet the Texas BNE requirements and have been adopted by MCISD. They will be
used to serve the respiratory health needs of students while at school.
What is a tracheostomy?
A tracheostomy is a surgical opening in the neck into the trachea (i.e.,windpipe), which allows air to go in and
out of the lungs. The opening in the neck is called a stoma. A plastic or metal tube called a tracheostomy tube
may be inserted through the stoma into the trachea. Some students may not need a tracheostomy tube. There
are different types of tracheostomy tubes that are held in place with a tie around the neck. A tracheostomy is
performed because of an injury or condition that requires bypassing the normal breathing passages or because
of neurological, muscular, or other conditions that make it difficult to breathe effectively or to clear secretions
or mucus out of their breathing passages without assistance. A tracheostomy allows for long-term use of a
ventilator or respirator (i.e., breathing machine) and provides an easy way to clear the trachea of mucus. Many
students with tracheostomies are able to speak. Most are able to eat and drink by mouth but some may need
dietary modifications.
It is vitally important that equipment accompany the student at all times, including transport and
classroom activities. A backpack or other carrying device could serve as a travel bag. This equipment
should be checked daily by the school nurse or other designated caregiver.
Definitions:
• Tracheostomy: a tracheostomy is a surgical opening into the windpipe bypassing the upper airway.
• Tracheostomy tube: a tracheostomy tube is a plastic or metal tube inserted through a hole (stoma) in the
neck and is held in place by ties around the neck. There are various types of tracheostomy tubes but all
serve the same purpose. Tracheostomy tubes cause no discomfort to the student.
• Obturator: a small plastic device which is used as a guide for insertion of the tracheostomy tube.
• Ambu-bag: This is sometimes called a resuscitation bag. It is a device that allows for the manual
introduction of air directly into the stoma. An adapter is needed that fits over the tracheostomy tube. It is
necessary that the Ambu-bag be with the student at all times should it become necessary to perform
rescue breathing for the student.
• Sims Connector: a small plastic tube that fits on the end of the tubing of a portable suction machine. The
Sims Connector allows the trach to be suctioned, but prevents the catheter from going too far into the
trach. This piece of equipment is essential in the school setting. Only a registered or licensed practical
nurse may suction the tracheostomy tube without a Sims Connector.
Type: There are many different types of tracheostomy tubes each having various features needed by the
individual student. Check with the school nurse, physician, or parent to determine what features are required
for each student. There are a number of different procedures that are required when caring for a student with a
tracheostomy, these are:
•
•
•
•
Tracheal suctioning routine (with Sims Connector) and deep suctioning
(with suction catheter)
School Health Special Procedures
Manual resuscitation
(Tracheostomy Overview) Page | 1
•
•
Emergency changing of tracheostomy tube and/or ties
Administration of supplemental oxygen
Suggested:
• Settings: There is no restriction on where a student may receive tracheostomy care. Students with
tracheostomies should avoid areas with a lot of dust or other airborne particles (i.e., chalk dust, sand,
glitter, etc.). The air the student breathes enters the lungs directly without being filtered, humidified,
and warmed by the nose and mouth. Regular tracheostomy care prescribed to maintain the student’s
health and function should be done at home. In an emergency, care should be given wherever the
student is. It is imperative that a complete set of equipment for tracheostomy care be available for the
student at all times.
•
Equipment needed includes:
Ambu or resuscitator bag with adapter
Extra tracheostomy tube with ties and obturator (1-same size and 1-one size smaller)
Syringe (3 cc)
Saline vials
Portable suction machine (battery operated)
Back-up power source for suction machine
Bulb syringe
Suction catheters
Sims Connector
Blunt scissors
Tissues
Pipe cleaners
Gloves
Tracheal sponges
Emergency phone numbers
Supplemental oxygen (if needed)
Restrictions:
All tracheostomy care, such as: suctioning, medication administration, oxygen administration, cleaning, and
changing (except in cases of an emergency) require a current order from a physician on the Authorization for
Health.
Procedures/Treatment form paying particular attention to:
• Student’s care requirements (e.g. suctioning)
• Student’s ability to request assistance
• Student’s proneness to emergencies
• Accessibility to equipment and back-up equipment
• An alternate means of warming and moisturizing the air and preventing mucus from becoming too thick.
• Signs and symptoms of respiratory distress
• Type of tracheostomy tube used (e.g., inner cannula, cuffed)
• Personnel and equipment needed for transportation (e.g., travel bag)
• Availability of caregivers
• Means of communication used by student (if applicable)
• Means of communication among different areas of the school (e.g., walkie-talkies, intercoms,
telephones).
• Latex allergy alert
Do not use powders; aerosols (i.e., room deodorizers, etc); small particles, such as sand, glitter, lint, chalk
dust, and animal hair; small pieces of food and water; or glue or chemicals with strong fumes near a student
with a tracheostomy. Students who may have accidental contact with any of these potential hazards should
have a protective covering for the tracheostomy.
(Tracheostomy Overview) Page | 2