Does anyone use cloth under/around the trach?

[Shauna]

I use cloth g-tube pads for my DD. I want to use them for her trach as well, and have tried them a couple of times, but I'm nervous about switching from the hydrosorb pads we currently use. I asked the training nurse at the hospital what his advice was about using cloth and he said he'd never been asked that question but he didn't think it was a good idea because it wasn't sterile. He said if we do try it, we should wait a couple of months for the stoma to completely heal.

Thing is, they don't give us enough hydrosorb pads and we have to wash and reuse them anyway. So they aren't sterile all the time either. Aside from that, we aren't using a sterile method at home anyway, just "clean". We only use sterile for deep suctioning, which we only have to do like once a day.

DD really does need *something* under the trach because her skin is sensitive and she gets marks where the trach rubs.

Her stoma has been looking absolutely beautiful since the stitches fell out several weeks ago. No granulation tissue or anything!

Her trach was placed a little over 2 months ago.

So is it ok? Not ok?

Here's a pic of her with the adorable pad underneath.

[LKN]

We never used anything under the trach. My son's skin is very sensitive and everything was irritating to the stoma and area around it. The rubbing of the gauze or other material to the skin caused much redness. We left the hospital without orders for any kind of stoma or trach padding materials.

Also, I was nervous about anything thick under the trach for fear it would push out the actual trach tube.

If you like to use cloth, and it doesn't bother her then go for it. I sort of understand where the nurse/dr is coming from though--cloth is thicker and seems like it would be more abrasive than the thin materials that are designed to go under trachs.

[IzzyB]

We do double 2x2 split gauze. We get plenty of them monthly to use for the trach and g-tube site. Unlike the previous poster I don't think thickness would be an issue since we use double the pads and what we use is probably thicker than the material. If we don't use 2 our son flips out and it gets red.

Since I do use sterile gauze I would not like the fact it is not sterile. But then again we use still the peroxide to clean it and bactroban around the stoma. But I know we are just extra careful because we have had no infections and I fear changing anything.

You can try and see what happens, it is really up to you.

[Kate]

I'm with Kristy, we didn't use anything. I did at first and then we got our 2nd opinion-the ENT showed me with the scope the difference even the 2x2 made-it was so thin and yet it moved the trach just enough to rub and cause problems inside! I was shocked! (and mad) SO, ever since that we didn't put anything under the trach. Just our experience

[Shauna]

Well the hydrosorb is really thick and does make the trach pull out more. I hadn't thought of that. The cloth is quite thin and I can get a snug fit. She really does have to have something because it's bad enough she'll eventually have skin break down, I suspect. We do everything we are supposed to, I even change her trach ties twice a day instead of once. The gauze isn't wide enough to cover the whole area. I suppose I could stuff extra pieces up under the sides, but by that point I'm using 2 or 3 packages each time and we don't get enough of those either.

She's not as goopy as she was in the beginning. Her stoma tightened up a bit (it was like gaping in the beginning ) so I think there's just less secretions dripping out and we're suctioning them up instead. But she still gets pretty wet some days.

[Ainsley's Mom]

Personally I think the trach stoma oozes too many secretions to use cloth. I'm not concerned that it's not sterile, but that it will get damp with secretions and harbor bacteria at the stoma site. I suppose if you change them frequently. The other thing is laundering. The first time they are used they'll be pretty clean, but after having been used around the stoma I'd worry they would be difficult to fully clean. Particularly if there was pseudomonas or something like that in the secretions. But I suppose you could boil them or something but I think my first choice would be something disposable.

FYI when the stoma matures I think they usually outgrow the need for a dressing under the trach. Back in the beginning we used Exu-dry. They are thin and wick away moisture.

[kadiera]

We've been debating it. We use cloth off and on around Bethany's g-tube, and did for Alexander too. Bethany's skin is highly reactive, and I worry that the gauze we're using isn't quite soft enough (she's clearly better with gauze than without, and her g-tube looks loads better with the cloth than before we used it).

I'm still thinking. We may at least trial it and see - this kid is so darn reactive to so many things.....

[IzzyB]

I totally understand the reactive skin thing. Johnny's diaper rash was so bad he was bleeding for a month. We had tried everything including three different prescription stuff. We changed diapers, tried herbal methods, even went with no diaper during the day (used pads underneath him) for a week. Nothing worked. We finally had to get wound consult at the hospital when he went on the vent and they gave us these special wipes that put a barrier on his skin along with special cream. The cream is not too pricey, but the wipes can be .20 a piece depending what sale I get, but well worth a non-broken down bottom.

We tried awhile back to go without gauze at the g-tube site because he didn't flip out with no gauze, but no luck. It started to break down, so we were back to gauze. If we go without gauze on his trach he literally flips out. We were in the hospital and he woke up from being out for an MRI and didn't have a gauze on. They had him on continuous venting from his g-tube while he got used to the air from his vent going into his stomach from his leak. Well he was so mad he pushed everything out of his stomach into the syringe. I called someone in to put the gauze under there because there was none in the room. The minute the gauze was under he stopped flipping out and the food went back in. I truly think all kids are different when it comes to their needs.

I do agree that you would have to boil the cloth to make sure it got sterile enough from what was coming out of the stoma and I would keep an eye on any irritation build up from the cloth. You know your child the best, so no one can tell you the right or wrong way to do things.

[kadiera]

I'm less concerned about cleaning, but then again, we have cloth diapers and kids who puke daily, so we're always trying to get gunk out of clothes, blankets, diapers, the couch, everyone's hair.....

[IzzyB]

Janet - I feel for you. Just the puking alone causes a lot of laundry and the daughter who is a messy eater causes laundry too. Cloth diapering was something we almost tried with Johnny's diaper rash, but before putting the money out we realized the diapers were not causing diaper rash since he didn't wear diapers 12 of the 24 hours of the day for a week and the rash got worse - lol With twins it was not an adventure I was looking forward too and either were our nurses