Trach dislodged

[MendedHeart]

I was called into a non vented trach patients room by another nurse on the floor....neither of us knew the patient except his pulse ox was 83%. His cuffed trach was lying on his chest. It was covered with mucous and blood and still inflated . I grabbed the first clean trach I could find and placed in back in the stoma. The patient recovered sats after that. So problem is that the one I reinserted was a size bigger than the one he had prior. I had no idea what size he had..the primary nurse was hanging blood down the hall and didnt know whay was going on, happened so fast. His trach size had just been downsized that day. Now the Doctor is very mad. He wanted my name etc... Im pretty sure I did the right thing. Thoughts? How do I handle this so I dont get in trouble. Thanks

[GrannyRRT]

Did you do a formal event reporting so that this situation could be reviewed by others who do have more control over P&P?

A sitter is not a solution to lack of equipment and proper training. I also know patients can be quicker than most sitters.

Someone commented earlier about having only milliseconds to replace a trach. If that is the case, this patient needs to be on a floor capable of handling high maintenance airways where equipment and well trained personnel are available. Typically a nonvented trach patient is stable. Their preexisting lung disease may cause them to be oxygen dependent and may desat quickly just like pulmonary patients do when they take off their nasal cannula. Chances are this patient might have been at least on at least 28% oxygen if the humidifier was attached to wall oxygen flowmeter.

Haste makes waste. On most stable non vent trach patients you can provide O2 by mask or nasal cannula while you prepare the new trach and assess the stoma for damage. If there is tearing, care must be taken on reinsertion. If you false tract (go outside the trachea into the neck tissue), your chances of properly reinserting another trach properly become slim to none. Even in nursing home and subacutes with established older trachs this becomes a deadly event if you are not prepared. If you look up the adverse events for LTC you will see this is not all that uncommon. At least in the hospital setting we can orally intubate which is why some type of code is sometimes called to get the people at bedside (MD and/RT) who can replace the trach which might require equipment to grab or visualize the trachea or to intubate so the repair can be made in the OR.

Even if not that extreme, if there is bleeding, an assessment must be done as for any other wound.