Background
Paediatric tracheostomies are performed for many reasons, usually in children with multiple comorbidities.1,2 Tracheostomy tube displacement can have disastrous implications, including death.3 To minimise this risk, stay sutures are placed intraoperatively either side of the vertical tracheotomy. These sutures assist reinsertion of a dislodged tube, pulling up and presenting the open tracheostomy. Stay sutures are secured to the chest with tape and marked ‘Right’, ‘Left’ and ‘Do not remove’. On discussion with the nursing team, a part-task trainer was developed to support the maintenance of paediatric tracheostomy care competencies.
Technique
The paediatric tracheostomy part-task trainer is produced using readily available equipment (Fig 1). A plastic box is covered with adhesive tape and padded with gauze. A suction tube is secured with tape to the middle of the box (Fig 2). Gauze is used to pad around the tube, leaving a small 1.5 × 1.5 cm opening, simulating a tracheostomy stoma (Fig 3). 4.0 Prolene sutures are then sutured to the tube, either side of a vertical incision. These stay sutures are secured on each side with labels (Fig 4). A tracheostomy tube is then inserted into the tube incision. Preparation time is around 15 minutes.
Figure 1.
Equipment needed to develop the paediatric tracheostomy part-task trainer.
Figure 2.
Suction tube secured in the middle of a plastic box.
Figure 3.
Gauze padding around the tube with a 1.5 × 1.5 cm opening, simulating a tracheostomy.
Figure 4.
Stay sutures are secured on each side with individual labels marking each side and also ‘do not remove’.
Discussion
We have described a simple, easily reproducible trainer which could be used to improve paediatric tracheostomy care. The stay sutures in the trainer provide the learner with a sensation of the safe required tension to open the airway. Through simulation, this could reduce the incidence of emergency calls in the event of displaced tracheostomy tubes.
References
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