Trach and secretions

[703bird]

This may be a dumb question but I would like to know why people with trachs have a lot of secretions? What causes the lungs to produce so much secretion that a person would have to be suctioned?

[GreyGull]

If you've ever know anyone who has gotten dentures you will probably know that at first the amount of mucus their mouth created was large and constant when wearing the dentures. After awhile it calms down usually. Same thing; the body is reacting to a foreign object in it.

Our bodies also adapt quite well to some objects as evidenced by stents, pacemakers, Blom-Singer valves, IUDs, spinal rods, artificial this and that.

However, when it comes to body piercings I wish I could effectively use that argument on some young people.

I always do a normal saline lavage first (breaks up the secretions so the pt. can cough them up more easily), then go down til the patient coughs, go a little further, then suction outward intermittently. Having pink/blood tinged secretions is not a bad thing. I always say better out than in.

I rarely use saline unless the secretions are really thick or the person does not want a suction catheter introduced usually due to being traumatized.

If the secretions are thick enough to require saline I look for a solution to the problem or take it as a sign of something more serious.

If you ever get the opportunity to see (bronchoscopy) the carina of patient who has an ETT or trach for any length of time, it is a learning experience and you'll have a new respect for suctioning. The damage done can lead to serious inflammation and even necrosis.

Checking the patiency of a trach qshift is advised but that does not mean you have to draw blood doing so. Also, if the patient's trach has an inner cannula, it can tell you alot about the secretions and of course patency. If the patient is a quadriplegic, I encourage a cough with the cough inexsufflator or quad coughing before suctioning. They are probably the most difficult patients to determine a suctioning need just by listening to breath sounds due to the paralysis.

[NeoPediRN]

On the wee ones we have orders to suction q4h, whether or not there is evidence of any secretions. We end up with lots of granulomas and worsening stenosis. There are suction guides on their vent sheet above the crib that are followe as to not extend beyond the tip of the trach, but regardless they end up with the above mentioned.