Monthly Archives: June 2008

Complete Tracheostomy Care – Part 2 of 3

  By admin | June 16, 2008 - 2:53 pm | NBN Respiratory, Newborn Nurses
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Tracheostomy Tie Change

Purpose

Tie changes are done to prevent the tracheostomy tube from falling out, and to prevent skin breakdown and rashes on the neck.

When

Ties are changed at least daily or when ties are wet or dirty.

Supplies

You will need the following supplies for suctioning your child’s tracheostomy tube:

  • Scissors
  • Hemostats
  • Extra tracheostomy ties
  • Optional self-fastening ties

How to Change Twill Ties

Here are the steps you need to know for changing the twill tie for your child’s tracheotomy tube:

  • Ask a second person to help with tie change. The second person will hold the tracheotomy tube in place while the first person is changing the ties.
  • If possible during the tie change, do not cut the old ties until the new ties are secured. Slide the soiled ties up or down to allow you to put the new ties on the flange at the same time.
  • Cut two pieces of cotton twill tape long enough to fit around the neck and be tied.
  • Cut at an angle to prevent fraying. Fold the angled end over about 1/2 inch and poke a small hole into the doubled end about 1/4 inch from the fold.
  • Thread the tape through the hole of the tracheotomy tube flange from back to front. Pull the other end of the tie through the hole using the hemostats’ or tweezers. Pull tightly while holding the tube. (This secures the tie to the tube without using knots and does not tug the tracheotomy tube from the child’s neck.)
  • Repeat the process for the other side of the tube. Bring both pieces of tie together and tie a square knot
  • Check the new ties and see that only one finger can slide under the ties. The location of the knot should be moved each time it is tied to prevent skin breakdown. Flex the child’s head slightly while tying to ensure the ties are secure in all positions. If irritation is noted on the neck, protection can be applied. This involves either placing a gauze pad at the point of rubbing or using different ties.
  • Cut the old ties and remove them. Re-check the new ties to be sure that only one finger can slide between the ties and the neck. The second person must hold the tracheotomy in place as the first person secures the new ties. Secure the ties by tying three square knots.

Self-Fastening Ties

Some children are switched to self fastening ties following their tracheotomy tube change on the 5th POD, because they are easier to use and less irritating to most necks. However, they are not for every child. Style and fit is very important for safe use. Some children’s skin is sensitive to the material in the neck tape. They are expensive, and some insurances limit the number used. If your doctor permits you child to use them, a prescription will be sent to your equipment company. There are several brands from which to choose that may help fit your child’s needs.

How To Change Self-Fastening Ties

Here are the steps you need to know for changing the twill tie for your child’s tracheotomy tube:

  • Remove the old ties, while the second person holds the flange of the tracheotomy tube.
  • Slip the self-fastening tab through the opening of the tracheotomy flange, folding it back onto the cloth material to fasten it securely.
  • Repeat this step on the other side.
  • With the child’s head flexed forward slightly, bring the two ends together, fastening the third self-fastening tab to the material.
  • Check that self-fastening ties are secure, only allowing one finger to fit between the tie and the neck.

    • Tips

  • If using self-fastening ties you must check the self-fastening ties often throughout the day to make sure the Velcro is secure.
  • If cleaning and reusing Velcro ties, the ties must be checked to see that the Velcro hold is still strong. They can only be washed in mild soap and water, and line dried.

    • Your Child Should Have Emergency Equipment With Them At All Times!

    • Same size tracheotomy tube with ties already in place
    • One size smaller tracheotomy tube with the ties already in
    • Suction machine (unit should be fully charged)
    • Suction catheters
    • Breathing bag, with adaptors if indicated
    • Normal saline
    • Extra tracheotomy ties
    • Scissors
    • Hemostats
    • Water-based lubricant
    • Phone list

    New Behavioral Wrap Around Program

      By admin | June 12, 2008 - 10:45 am | New Behavioral Network
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    What is the Wrap Around Program?

    New Behavioral Network offers community-based services that assist children (ages 3-21) and families to address behavioral and mental health needs. These services consist of strength-based individualized treatment plans that address specific behavioral and mental health concerns of the child and family. All services are performed in the child’s home, school and other community settings. Families are active participants from the development of the treatment plan to the achievement of goals.

    What are the program’s objectives?

    • To provide dependable, reliable, well-trained therapeutic mentors.
    • To plan and implement therapeutic activities which carry out the therapeutic treatment plan.
    • To ensure all goal oriented activities are clinically sound and provide services based on the most up-to-date information provided by the Comprehensive Intake Process.
    • To provide continuous communication among all members of the therapeutic treatment team to ensure the success of the program.
    • To help parents develop skills and maintain habits to raise intelligent and emotionally stable children.

    What methods will be employed?

    The intake process allows New Behavioral Network to review all necessary referral information and will then contact the family to schedule the initial visit. The initial home visit will usually take place in the client’s home. This allows New Behavioral Network to obtain additional information about the community and environment, and introduces the family to the agency and services provided. During this visit the process and all components of the program will be explained. Visiting sessions are then set up with a Therapeutic Mentor, carefully selected based on the client’s needs and behaviors, as well as compatiability with schedules.

    Who will provide these services?

    The Clinical Manager (LCSW) oversees all clinical aspects of the program and supervises the Case Manager weekly. The Bachelor and Masters prepared Child Mental Health Case Manager has experience in moderate to high risk children/youth mental health programs, and will supervise the Therapeutic Mentors weekly. The Therapeutic Mentors provided each meet specific qualifications and experience necessary for moderate to high risk children/youth mental health programs.

    Our mission at New Behavioral Network is to provide services that utilize a multi-systemic perspective, services that are strength based, and services that empower families with the ability to maintain change. Our Wrap Around Program works to unite an intricate network of systems, including family and community organizations, that are involved with the client. New Behavioral Network is dedicated to providing comprehensive treatment across all settings. We place value in identifying and building the client’s strength, and utilizing these assets to facilitate change.