Definition

• According to Mayo Clinic, a tracheostomy is "a surgically created hole at the front of your neck going into your windpipe (trachea)." For an infant, a blockage in the windpipe that does not allow enough air into the lungs can lead to a tracheotomy, a surgical procedure that puts a tube through the stoma (hole in the neck) and down the trachea to keep the windpipe open. A ventilator, a machine that breathes for the baby, attaches to the trach tube, if needed.
  
  

Precautions

• In the "Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses," Elizabeth Fiske, RNC, MSN, NNP, states that hand washing before infant trach care is imperative, to keep germs out of the stoma. She also warns that, as oxygen does not enter through the nose or mouth, there is no moisture in the air breathed, which increases the risk of mucus in the airway. Devices such as a heat and moisture exchanger can help keep the infant's air moist. Fiske also advises keeping the surrounding air free from smoke, chemicals and dust.
  
  

Care

• Cleaning around the stoma properly reduces the chance of bacteria entering the airway. When bathing, Fiske says, shallow tub baths or sponge baths keep water from getting into the stoma. Changing the trach tube according to your doctor's instructions is essential, and listening for airway obstructions and suctioning to remove a blockage is also necessary for your baby to continue breathing.
  
  

Complications

• According to Fiske, stoma infection--one of the complications with infant trach care--is indicated by redness, bleeding or drainage. Antibiotic ointment usually clears up the infection. A more serious complication is narrowing of the airway, which warrants emergency help if the airway constricts so much that it will not allow anything to keep it open.
  
  

Considerations

• When you first bring your baby home, Friske recommends using the services of a home care nurse to help you "identify unanticipated challenges in the home environment," confirm your baby's health status and remind you of follow-up care practices.