The nose and mouth provide warmth, filtering and moisture for the air we breath. A tracheostomy tube by-passes these mechanisms. Humidification must be provided to keep secretions thin and to avoid mucus plugs. Children with tracheostomies do best in an environment of 50% humidity or higher.
- Air compressor
- Nebulizer bottle
- Aerosol tubing
- Trach mask
- Sterile water
- Saline ampules (bullets)
- Heat Moisture Exchanger (HME) Also known by several other terms including: Thermal Humidifying Filters, Swedish nose, Artificial nose, Filter, Thermovent T.
- Room humidifiers
Humidity should be delivered while sleeping. Attach a mist collar (trach mask) with aerosol tubing over the trach with the other end of tubing attached to the nebulizer bottle and air compressor. Sterile water goes into the nebulizer bottle (do not overfill, note line guide). Oxygen can also be delivered via the mist collar if needed.
Illustration courtesy of the Department of Otolaryngology, Cincinnati Children's
Hospital Medical Center, Cincinnati, Ohio
Heated mist may be ordered. Heated mist is accomplished by an electric heating rod that fits into the nebulizer bottle. Extra care should be taken to be sure the bottle does not go dry, which could melt plastic. Many of these heating elements do not have automatic shut-offs and this could be a potential fire hazard. Also, more moisture will accumulate in the aerosol tubing with heated mist. Moisture that accumulates in the aerosol tubing must be removed frequently to prevent occlusion of the tube and/or accidental aspiration. Disconnect tubing at the trach end, empty into a container and discard. Do not drain fluid into the humidifying unit. Fluid traps (or drainage bags) are helpful in preventing occlusion and aspiration. These collection devices also need to be emptied frequently. Position the air compressor and tubing lower than the child to help prevent aspiration from moisture in the tubing. A mist collar can also be worn during the day when mucus is thick or blood tinged. Sterile saline drops can be instilled into the trach tube if secretions become thick and difficult to suction. A saline nebulizer treatment is also helpful to loosen secretions if the child has a nebulizer machine. Additional fluid intake can also helps to keep secretions thinner.
Secretions can be kept thin during the day by applying a Heat Moisture Exchanger (HME) to the trach tube. An HME is a humidifying filter that fits onto the end of the trach tube and comes in several shapes and sizes (all styles fit over the standard trach tube opening). There are also HMEs available for portable ventilators. Bedside ventilators have built-in humidifiers. HMEs also help prevent small particles from entering the trach tube. Change HME daily and as needed if soiled or wet.
Aaron wearing a thermovent T (HME)
Although room humidifiers are also helpful, it is vital that these machines be cleaned regularly to prevent bacterial growth. Warm mist humidifiers are especially prone to bacterial growth. Bacteria, mold and mildew grow best in warm, wet environments. Use caution with ultrasonic humidifiers because they can produce white dust, which can be harmful when inhaled. The higher the mineral content (the harder your water is), the greater the potential for white dust. Using distilled water can help prevent white dust. The regular cool mist humidifiers are often the best choice, unless otherwise directed by your doctor. Clean and refill room humidifiers daily.