Tracheostomy

Tracheostomy is performed for airway abnormalities such as subglottic stenosis or Tracheomalacia. Infants who required long-termassisted ventilation usually will have a Tracheostomy. 
Tracheostomy tubes can be cuffed of non-cuffed. A fenestrated tube has openings in the curve of the tube that allow air to be expired through the glottis (voicebox).
Suctioning is performed when the patient is unable to cough out secretions. The Tracheostomy tube is changed at intervals, usually every 2-4 weeks. Young children tend to be lying down with a towel behind the shoulder blades to make visualization of the neck easier. Older children may manage better sitting up for the change. Caregivers need to feel comfortable with Tracheostomy changes. If there is an emergency situation it may be from a blocked tube and caregivers need to be able to change the tube immediately. On occasions, if there is difficulty reinserting the tube, on size smaller should be used because it is easier to insert.