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View Full Version : Trach care/infection.


bryantem
04-15-2009, 05:34 PM
Well, it looks like we have some irritation around the stoma. ENT told us to do Nystatin during the day. What do you clean your kiddoes stoma with? I have been using saline bullets (because it is sterile) and a Q-tip- which isn't sterile because home health doesn't give those to me. Any tips on how to help her? We stopped with the dressin because home health doesn't give us those either.
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Gretchen(Celia's mom)
04-15-2009, 06:22 PM
We always used sterile water applied with a q-tip(you can buy the packaged kind at the pharmacy) Then put bactroban around the stoma and used 2x2 split IV gauze(also bought from the pharmacy). We did this as daily care 4x a day for the first 3-4 years, only using the gauze when it was irritated or had gran tissue.

drct1245
04-15-2009, 08:16 PM
For the trach we always used 1/2 peroxide/sterile water mix along w/ the sterile cotton tip applicators.

When Ayden started teething, we had to use 2x2 split gauze to absorb and not cause irritation, which lead to yeast infection. B/c of the plastic, it's probably a yeast infection, which is what the nystatin is for. Very common. How come they won't give you sterile cotton tip apps? Will your ENT write you a letter of medical necessity to get them?? We have gotten them from day one for both g-tube and trach. Much easier to clean w/ .

TommysDad
04-15-2009, 08:19 PM
We got Tommy's pediatrician to write us a letter of medical necessity to get hydrophilic foam dressing. We get the 4"X4". There are 10 to a box. So our Dr. wrote the script for 30 sheets a month, 3 boxes. We take each 4"X4" square, cut it in half, make our own slit down the middle and round the edges and put that under Tommy's trache for about a year because regular gauze 4X4's were still causing break down even if we did trache care 4 times a day.

If Tommy got break-down in the hospital, we were always told to use 1/2 strength solution by taking 5 mls hydrogen peroxide and mixing it with 5 mls sterile water. Otherwise, we just use baby shampoo/wash with the sterile water. Then we always rinse, and then we dry (using new cotton swabs for each application).

If breakdown is bad enough, our TCU nurse practicioner will prescribe Triamcinalone cream (AKA: Kenelogg cream), but we are very carefully not to get it IN the stoma!!!

Around the trache ties where Tommy gets red & near break down, we got Calmoseptine ointment from Cincinnati Children's Hospital to apply around the neck, but we don't use this around the stoma site.

Some times around Tommy's stoma, it gets rather red & irritated looking. He's very prone to having things grow in his trache. The pulm & family are tyring to decide if these bugs are colonized or active infections. Once we start antibiotic drops into the trache, his stoma redness goes away. Someone told us to try Tea Tree oil (available in your homeopathic stores) for trache infections instead of always going with antibiotics. We've tried tea tree oil several times when we think Tommy's getting trache germs and his stoma gets red and inflamed. It works to the point where we don't call Pulm and ask for a trache culture many times! But again, we do not put that into the stoma area. Just around the outer part of the stoma.

There are lots of options as you can see from this site. You just have to find what works best for your child. And unfortunately, sometimes the hardest part is finding a doctor who will advocate for your child and take the time to write letters of medical necessity, but if they do that, I do not think state aid would refuse to supply such items.

Good luck!

~Maggie

Niff
04-15-2009, 08:24 PM
Do they supply you with "Trach Kits"? Our DME doesn't supply seperate trach care items (like sterile q-tips and split gauze) because they carry Trach Kits which have them prepackaged.

llwilliams8
04-15-2009, 10:41 PM
We just use the bullets of saline with the cotton-tip applicators and the already split IV sponges. We only do trach care once a day. We've been doing it this way for 6 months and they was one time she started getting a little greenish tint so we used bacitracin (sp) to apply around the stoma and it cleared up after 10 days. We've never had any issues since.

bryantem
04-16-2009, 12:42 AM
Thanks! We don't get the Q-tips or 2x2's because they are considered to be feeding supplies, and we don't have an enteral feeding account since we got off the NG tube.
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JWorthington
04-16-2009, 04:48 AM
We use soft swabs and saline to clean around the trach. We dont use anything under the tapes as Sam's stoma is always clean and dry. We get dressing packs from the pharmacy that contain the swabs.

Julie

sarah78
04-16-2009, 05:43 AM
Hi,

We use cooled boiled water (in a sterile pot) and gauze swabs which we get on prescription from pharmacy. We also use trachy dressings underneath the tapes which we also get on prescription.

S

saywhatyouwill
04-16-2009, 07:31 AM
we just use saline and non-sterile swabs. if her neck gets stinky trimovate usually fixes the problem. to be honest we are lax about cleaning the stoma :-(

Mom2TwinsPlus1
04-16-2009, 07:37 AM
We either use 1/2 peroxide/sterile water or a unscented diaper wipe. Yes, a diaper wipe. But our doctor told us we could use anything we like, just not plain soap and water since soap leaves a reisude on the neck and could irritate it. But Emma's neck is usually pretty clean to begin with, just sweaty. The stoma rarely looks dirty at all, with gunk or anything, but we do clean it daily anyway of course

Hospitals have used sailine, which I find can irriate Emma and make her kind of raw or red.

I think its diffrent for ech kid. If I were worried about infection I would go with the 1/2 peroxide/sterile water though.

Nate's Ma
04-16-2009, 02:37 PM
Ok... after reading all of you guys I feel like the odd man out. I use a clean wet (warm tap water) washcloth and a little Baby Aveeno soap. I take Nates trach out, clean the stoma and wipe the goopies away, wash his neck, put some triamcinolone, nystatin and mupirocin around the area, change the ties, then pop the trach back in. Nate's trach was placed Dec 22. I found that the peroxide and water mix burned Nate's skin and it hurt when we did his trach care. He has no problem with what we do now.

bryantem
04-16-2009, 04:18 PM
I have always been afraid to take her trach out longer than putting a new one in. Anything to deal with her trach is a battle. How long can Nate (and the other kids) handle the trach being out? We went to the pediatrician today and she gave me a bottle of sterile water to clean it with since home health is a pain. They did a culture too, just to make sure it isn't anything other than a yeast.
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kirafaesmom
04-16-2009, 05:07 PM
Well, I wasn't going to reply to this post, but alas, we just got back from the pediatricians....thankfully, it's irritation NOT an infection. They consulted with our ENT and he wants us to STOP using the gauze dressings and only use the Lyafoam. We are to keep cleaning with sterile water only. He felt/and has seent that the gauze itself is causing irritation. If it doesn't improve in the next several days of using the foam, then we may have to (get!) to switch away from the Shiley.

kirafaesmom
04-16-2009, 05:11 PM
I have always been afraid to take her trach out longer than putting a new one in. Anything to deal with her trach is a battle. How long can Nate (and the other kids) handle the trach being out? We went to the pediatrician today and she gave me a bottle of sterile water to clean it with since home health is a pain. They did a culture too, just to make sure it isn't anything other than a yeast.
Kira was trached for aspiration issues and has the seperation. She doesn't need the trach in place to breath, so we can have it out for however long we need for trach care. I would suggest maybe hooking Addisyn to her oximeter for trach care so you know what she can tolerate.

Baby1107
04-16-2009, 06:52 PM
I have always been afraid to take her trach out longer than putting a new one in. Anything to deal with her trach is a battle. How long can Nate (and the other kids) handle the trach being out? We went to the pediatrician today and she gave me a bottle of sterile water to clean it with since home health is a pain. They did a culture too, just to make sure it isn't anything other than a yeast.


Austin cannot be without his trach for as long as the care would take, so trach ahnges take only a few seconds. For daily care we change out the ties, 2X2 split & nystatin. The area around the trach is washed in his bath and we have never had an infection. We use the gauze everyday or we do get redness.

drct1245
04-16-2009, 07:14 PM
Thanks! We don't get the Q-tips or 2x2's because they are considered to be feeding supplies, and we don't have an enteral feeding account since we got off the NG tube.

Which is kinda back wards b/c the g-tube just has to be clean b/c it's the tummy and the trach area is supposed to be sterile b/c it's the lungs. (?) I think you need to set the DME straight. :D

bryantem
04-16-2009, 09:08 PM
Which is kinda back wards b/c the g-tube just has to be clean b/c it's the tummy and the trach area is supposed to be sterile b/c it's the lungs. (?) I think you need to set the DME straight. :D

What makes it even worse is that they sent me this stuff and she never even had a g-tube. When they sent the q-tips, they sent me a total of 6...not 6 boxes; 6 q-tips. On Monday, they wanted to bring 1 HME and 1 suction catheter.
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kirafaesmom
04-16-2009, 09:31 PM
What makes it even worse is that they sent me this stuff and she never even had a g-tube. When they sent the q-tips, they sent me a total of 6...not 6 boxes; 6 q-tips. On Monday, they wanted to bring 1 HME and 1 suction catheter.
Oh for pete's sake......Let me know if you need either q-tips or gauze. I have OODLES of both and we won't be using the gauze anymore,

lynn
04-16-2009, 11:11 PM
Joseph hates his trach out-he really freaks and actually "holds"his breath and looks blueish -- he can breathe without it has done several times when sedated -- docs think it is just so diff feeling and he doesnt like it. So we only clean the area around stoma (sometimes in bath w/clean water, sometimes baby wipe, usually dont use anything special: peroxide ect) and change out ties nightly. I have stopped using gauze for the last couple of days, and it seems neck is ok.- still waiting to see if I should start using again. (he is trying to eat and it got to be a pain changing it 5times a day just cause it looked gross)

Let me know if you need any gauze also-- I have tons DME messed up and sent 50 boxes once instead of 50pkg of gauze. I have both 2x2 and 4x4 split iv drain gauze.
Perhaps you need to look into diff supplier- dont they know you need at least one hme/cateter per day? also can your dr write an script for sterile water for inhalation if that is what she wants you to use to clean- we get 24 500ml bottles each month for the humidifier.