[vssimpson]

We have had a rash of decannulations of fresh post operative tracheostomy patients in our PICU recently. I am wondering what protocols or policies are in place at other institutions regarding care of these patients. For example, are all fresh trachs paralyzed, vent circuits set up in certain ways, etc. We do not have an official protocol in place at this point, but would like to develop one. Please help!

[gwenith]

I will Pm you a copy of our PICU policy - hope it helps

[kc ccurn]

Are the trach's sutured in place or held with trach ties? I don't think we have a protocol re: trachs. By practice though they are routinely sutured in.

[vssimpson]

New tracheostomies are sutured in place AND held with trach ties. Weight of ventilator tubing has come up as one reason for the recent decannulations as well as the fact that the patients are no longer routinely paralyzed for 7 days as they were in the past.

[janfrn]

We're still paralyzing our fresh trachs for at least 48 hours, and often much longer. Our ENT surgeon is VERY particular about how "his" trachs are cared for. They are all sutured and tied, plus the circuit is anchored to the patient's chest on top of a folded receiving blanket the same height as the distance from stoma to circuit and tied in place with a length of burn net. Trach care is ONLY done by RTs, it's done q4h for the first two weeks at least and they all routinely have nystatin cream applied each time. We have a chronic patient whose trach is several months old already whom he is not allowing any p.o. intake for fear of aspiration... the kid is 15, intellectually intact and has all protective reflexes. Quite different from my last place of employment, where trached kids who were able were allowed to feed orally once they were ready, ventilated or not.

[Okiecruffler]

Our trachs come up on just a tad of sedation, sutured and tied of course, no bagging for the first 24 hours but nothing else. The only trach I've seen come out was one that a new nurse tried to bag about 6 hours out.

[UK2USA]

We tend to suture in our new tracheostomys in the UK, then paralise our patients for 3 days. Once the trache has had its first change (on day 7) the patient is discharged from PICU. I tried to find a protocol for this on our unit, but it appears that this is another one of those surgeons preferences.

Originally Posted by vssimpson

We have had a rash of decannulations of fresh post operative tracheostomy patients in our PICU recently. I am wondering what protocols or policies are in place at other institutions regarding care of these patients. For example, are all fresh trachs paralyzed, vent circuits set up in certain ways, etc. We do not have an official protocol in place at this point, but would like to develop one. Please help!

[blueinplaid]

Our kids have their fresh trachs sutured and tied. The ENT does the first tie change, but we are able to bag (gently) and our trach care is sterile water for the first two weeks post op, then 1/2 str hydrogen peroxide thereafter. We have had zero decannulations in our unit, and we do have many babies. I can't recall ever muscle relaxing them for safety purposes, but we do keep them sedated and sometimes using wrist restraints if necessary.