The Paediatric Working Party of the National Tracheostomy Safety Project (NTSP) has issued new guidelines for the management of paediatric tracheostomy emergencies.
The paediatric recommendations come six years after the NTSP published its multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies in adults. The focus of both documents is on the management of postplacement incidents and the immediate management of potentially life‐threatening complications.
Recurrent themes that emerged on incident analyses have led to the NTSP making a number of recommendations that are common to both the adult and paediatric guidelines, including:
- Training for tracheostomy emergencies including recognition and management of blocked and displaced tubes;
- Hospital‐wide protocols and standardised training in tracheostomy care;
- Bed‐side information including details about the airway and tracheostomy tube; and
- Bed‐side tracheostomy boxes containing essential equipment for each patient.
The principles of providing emergency oxygenation and limiting the number of unnecessary airway interventions are retained from the adult guidelines, but key differences include the recommendation for bespoke paediatric bedhead signs reflecting paediatric tracheostomy indications and pathologies. The NTSP says bedhead signs should be mandated as part of the theatre sign‐out process following tracheostomy surgery.
The NTSP also advises that blocked or partially displaced tracheostomy tubes can be considered as a foreign body in the trachea and emergency tracheostomy tube change is recommended in the absence of tube patency.
The full guidelines are published in the Anaesthesia, the journal of the Association of Anaesthetists of Great Britain and Ireland.