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.
    leslie :-D likes this.
  2. 20 Comments so far...

  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. 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
  11. 0
    Thanks for the info! You definitely are a teacher and are right on! Nursing could use more nurses like you!


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