obturator placed in trach stoma?

  1. 1 One of my co-workers told me she was told not to replace a trach if a pt. de-cannulates herself. Instead, we are to call 911, and in the meantime, she said, "we are supposed to place "this" (she showed me an obturator in a plastic bag) into her stoma."

    HUH???? I told her that didn't seem right to me, but she said "well, management says we need to protect the airway"

    I don't understand how placing an obturator into a stoma will protect it. Am I being obtuse or are my managers way off here?


    At my part time job, I do homecare for a trach pt. and had to go through additional training to work with him. Never, ever we were taught to do this, it was always an emergency trach change--period.
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  3. Visit  SunnyAndrsn} profile page

    About SunnyAndrsn

    Joined Nov '07; Posts: 576; Likes: 454.

    20 Comments so far...

  4. Visit  leslie :-D} profile page
    4
    your managers are 100% wrong.
    if a pt decannulates, you replace it- period.
    if a new one isn't on hand, you use the one that expelled.

    either way, never use the obturator.
    oh gawd, no.

    leslie
    AprilRNurse, Nursebarebari, TrishJK, and 1 other like this.
  5. Visit  GilaRRT} profile page
    1
    Unless it was a new trach with the obturator in place? I simply cannot see placing an obturator without taking any steps to secure any type of airway. Additionally, there is a chance that the EMT or PM will not be able to manage the trach.
    BBFRN likes this.
  6. Visit  NRSKarenRN} profile page
    9


    obturator picture on the left., inner canula, middle, outer canula right.


    the obturator is part ot tracheostomy tube with handle at proximal top end and bullet pointed distall end used to pass the trach into your windpipe. it is inserted inside trach tube to give it rigidity/ support with bullet shaped end easing tube passage in trachea. it is immediatly removed and inner cannula inserted then trach ties used to hold trach in place. if left in place will cause airway obstructrion.
    trachs mature usually in 7-10 days with rn's capable of changing after first doctor change (provided education and supervised practice occurs).


    medscape:tracheostomy management
    free registration required


    understanding ventilation &respiratory assessment

    types of tracheostomy tubes

    living with a tracheostomy

    tracheostomy as a passey muir valve

    tracheostomy and laryngectomy stoma care

    video: changing tracheostomy tube
    noyesno, Blindsided, SunnyAndrsn, and 6 others like this.
  7. Visit  Christen, ANP} profile page
    2
    If a trach comes out, you may need to use the obturator to make the trach firm enough to replace it - most trach's are too flexible to reinsert without the obturator. However, the obturator results in an occluded trach / airway, therefore it must be removed after the trach is reinserted.
    SunnyAndrsn and BBFRN like this.
  8. Visit  PageRespiratory!} profile page
    7
    Quote from SunnyAndrsn
    One of my co-workers told me she was told not to replace a trach if a pt. de-cannulates herself. Instead, we are to call 911, and in the meantime, she said, "we are supposed to place "this" (she showed me an obturator in a plastic bag) into her stoma."

    HUH???? I told her that didn't seem right to me, but she said "well, management says we need to protect the airway"

    I don't understand how placing an obturator into a stoma will protect it. Am I being obtuse or are my managers way off here?


    At my part time job, I do homecare for a trach pt. and had to go through additional training to work with him. Never, ever we were taught to do this, it was always an emergency trach change--period.
    >
    LOL! Your managers appear to be confusing "protecting the AW" with "occluding the AW".......
    nursel56, Altra, SunnyAndrsn, and 4 others like this.
  9. Visit  melz34} profile page
    1
    you should replace it straight away with a new trach I don't see how obturator in a plastic bag is going to help protect the airway infection could easily enter the trach stoma and cause the patient harm they are definetley wrong
    SunnyAndrsn likes this.
  10. Visit  GOMER42} profile page
    8
    If you were to stick the obturator in the airway until EMS arrived, your patient would be dead.
    Occluding the airway like that would be equivalent to throwing a plastic bag over your head until help arrived.
    JeanettePNP, Medic2RN, marilynmom, and 5 others like this.
  11. Visit  nanciepaul} profile page
    0
    you sure it is your hospital's rule?please make sure bc it sounds crappy..It is not the right way to keep the airway open. apply O2 to save the life
  12. Visit  LockportRN} profile page
    0
    Thanks for the info! You definitely are a teacher and are right on! Nursing could use more nurses like you!
  13. Visit  BBFRN} profile page
    2
    I am 100% with everyone else in this. An obturator alone would be nothing more than a foreign body purposefully placed into someone's airway. She really, really needs to know that she is giving dangerous instructions there.
    SunnyAndrsn and leslie :-D like this.
  14. Visit  SunnyAndrsn} profile page
    3
    Quote from leslie :-D
    your managers are 100% wrong.
    if a pt decannulates, you replace it- period.
    if a new one isn't on hand, you use the one that expelled.

    either way, never use the obturator.
    oh gawd, no.

    leslie
    Thank you, thank you, thank you, for re-inforcing what I already knew. A little more information was forthcoming today, very little of it good.

    Currently this pt. is at a psych unit, and I told my manger if she expected me to work with her once she came back, that all proper equipment would be in place in her room or I would 1. refuse to work as charge RN, and 2. Refuse to work with that pt. I used the word "liablity", which is usually something management seems to understand.

    I brought in the training packet I had for my home care job, showed them the obturator (still in her room) and asked for an explanation on how this was supposed to help maintain an airway (as a solid object). I got a puzzled look and was told that the last time she decannulated, she was sent down the street to the hospital and this is what they sent back to manage the airway.

    I asked her if it was possible they sent the obturator so that we, at our facility, could re-insert the trach itself, since the nurse who sent her in didn't have a clue how to re-insert the trach? It appeared that small (but dim) light bulb came on over this manager's head. She said she would bring it up at the morning meeting (management meeting)...

    I just don't know why the heck we are taking pts. that 1/2 the nurses and none of the managers know how to care for.
    GilaRRT, BBFRN, and leslie :-D like this.
  15. Visit  SunnyAndrsn} profile page
    0
    Quote from GilaRN
    Unless it was a new trach with the obturator in place? I simply cannot see placing an obturator without taking any steps to secure any type of airway. Additionally, there is a chance that the EMT or PM will not be able to manage the trach.
    Nope, it was just the obturator, period. I talked to management about this today. Right now she's not with us, she was sent to a psych unit.

    I was taught that if a pt. decannulates, always, always, always 1. have O2 available, 2, have the same size trach and one size down to re-insert ASAP. If for some reason, the current trach size can't be re-inserted, then have a size down to try.

    So all of this crap with the obturator did NOT make sense to me. This is not even a critical thinking issue, this is just plain use your brain.


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