Cleaning - It's best to clean the trachey site each time you change the inner tube, so the dry crusty secretion build up is kept to a minimum.

ET tube & not breathing - If the inner tube blocks & your child is not breathing, remove the inner tube immediately & insert the ET tube down to 7cm, attach the one way breathing valve , hold in place, breath into the valve & call 111. The ET tube & breathing valve should always be in your emergency kit.

Suctioning - Do not suction down more than the 7cm marks on the cathida as this can cause unwanted granulation tissue.

Crusty secretions - To clean dry crusty bits that are on the outside of the trachey, soak them with a wet gauze to loosen them, then wipe dry. If they are still hard to remove use a fine brush or the end of a cotton bud.

Inner tube cleaning - To clean the inner tubes use warm soapy water. Clean with a small fine brush or pipe cleaner, wipe excess off with a gauze then shake dry then put back into an airtight container. Cytology brushes are great if your home care nurse can get them.

Emergency change - If you are out & don't have any water to clean the tube & it needs changing. Try using the inside of a 1ml saline syringe, it works really well.

Humidification - Always use humidification at night to stop the secretions drying up.

Clothing - Watch out for clothing that is too high. V necks or button up shirts are best.

Dust & sand - Keep away from dusty or sandy places {beach} as these metal trachey's don't have the advantage of using a swedish nose like plastic trachey's. If you are in a dusty place try putting a loose fitting bandana around your child's neck.