Deep tracheostomy suctioning for 5 years

[heato77]

Hi everyone,

I am part of an in-home nursing team for a ventilated quadriplegic. Her quadriplegia is a result of a brainstem erniation as opposed to a spinal injury so she is a ball game all of her own.

For 5 years she has been deep suctioned and in the last year she has requested staff not to pull back once resistance is met but to try and make her cough every time. I have been with this client for over 2 years and the difference in results form suctioning are obvious.

She constantly has thick, green mucous which is very hard to suction, although blood tests have shown no sign of infections. The chest specialist has suggetsed she come off her fluid tablets as this may be drying her chest up, but our team have noticed the difference far before her starting on the fluid tablets.

One of her lungs has deflated partially also.

Could this be due to loss of cilia and and increase in mucous? I have done some research but can't find a lot on the outcome of such a thing.

Any help would be greatly appreciated.

Thanks guys!

[heato77]

GRRR..typos. I really should edit before posting.

[jstbreathe]

Have you tried instilling a few cc's of Normal Saline down trach, then suctioning?

Or 5 CC's of Isotonic Hc03? doing the same, instilling down trach, bagging for a few deep breaths, then suctioning. It may be a bit uncomfortable, but it works. The Hc03 thins the secretions. But, if used too much it can turn secretions frothy and over flowing.

If the secretions are as thick as you say, she has the potential to plug off, then you will have major issues!

Try the normal saline first, if that is not helpful then as MD about Isotonic Hc03.

Good Luck!

[heato77]

Thanks for that advice. :) We have tried normal saline a few times, which hasn't proved helpful. Unfortunately on a couple of occasions we have not been able to suction the saline back up let alone the mucous necessitating the original suction! Now she is very wary of any liquids being put down the trach. I haven't heard of the latter suggestion, so that might prove very useful.

[MaryAnn_RN]

I found that acetylcysteine (mucomyst) nebs work well.

[iwanna]

I have had trachs, myself. Mucomyst before suctioning was very helpful in expelling the plugs.