Changing trachs on adult vent pts in the home

Specialties Home Health

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I am a Pulmonary CNS and need more information re: home health nurses changing adult trach tubes in the home. Does anyone have a home health policy for this procedure? I have mixed thoughts about doing this in the home. Most of our home vent patients are sent home with no instructions about how the trach is going to changed, who is going to do it or the frequency. I haven't found any definitive answer in the literature.:banghead:

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Specializes in oncology, trauma, home health.
I am a Pulmonary CNS and need more information re: home health nurses changing trach tubes in the home. Does anyone have a home health policy for this procedure. I have mixed thoughts about doing this in the home. Most of our home vent patients are sent home with no instructions about how the trach is going to changed, who is going to do it or the frequency. I haven't found any definitive answer in the literature.:banghead:

Hey! I could do that, but this isn't the place to ask those questions. What you need to do is call the agency who is serving you, speak to a manager and ask all of your questions to them! Good luck!

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Thanks, but I am the one trying to write the policy for our agency. I am curious as to what other agencies are doing. Is there another place on this website that I could post this question?

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Specializes in Home Care, Hospice, OB.

you might want to check with briggs corporation..we purchased their p&p's and then tailored them to our agency in light of best practices and our population.

procedure depends on one vs two piece trach's, cuffed vs uncuffed, adult vs peds. the only universal we have is that an emergency trach one size smaller than current must be visible at the bedside for emergencies.

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Thank you for taking the time to respond. Do nurses in your agence change out the entire trach tube in the home?

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We were taught by a Dr to change entire trache unit uncuffed.

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Specializes in Vents, Telemetry, Home Care, Home infusion.

Did you check out the links in my thread Vent Information ?

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Specializes in Vents, Telemetry, Home Care, Home infusion.

Cared for vented Teens and adults for 15yrs in homecare and changed probably close to hundred trachs at home over the years.

You are absolutely correct that this is a neglected are of discharge planning! My experience this is an afterthought far too often. Choosing a homecare agency that has expertise in caring for this special population is in patients best interest.

Trach change orders initially come from the ENT inserting trach, then followup orders from pulmonologist caring for patient. I've had a few ENT make house calls for most difficult patients.

When accepting a vented patient for homecare, I would ask for trach change orders as part of admission orders and work with DME vendor re amount repiratory support they will provide patient. Length of time patient hospitalized, maturity of trach and previous trach change dificulites should guide trach change in the home.

Two scenerios seem to occur with my patients new to homecare:

a. Setup time for trach change when RT coming to home for vent checkup and change with their assistance.

b. When patient receiving shift care, trach changed by oncoming nurse with assistince RN who's leaving.

Once comfortable at home, I've changed trachs for patient without problems with assistance spouse, relative, aide and even devoted neighbor.

PSST: Have patients insurance checked that they have DME coverage prior leaving facility..... nothing like having supprise of "no coverage for medical equipment" once patents home.

Send letter to electrity company requesting priority service reconnection when electrical outage prior to patient discharge.... not nice when pole hit by car 2 hrs after pt first home from hospital, out in the country and battery backup not charged...2hrs later still hand banging patient as road blocked and no local ambulance service. ;)

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Not sure if you are still looking for answers here, but I am a home health nurse and I do change trachs in the home. This is however, decided if appropriate on a case by case basis. Our policy used to state that a respiratory therapist and/or doctor had to be present in the home with a RN. We have recently changed policy to allow for 2 RN's to collaborate together to change the trach. The last one I had, we changed monthly. My current patient's trach is changed weekly. She has a cuffed trach and is ventilator dependent. (I do not like doing weekly as the stoma stays irritated and it's traumatic for the patient) Prior to accepting in home health, which both of these patients had wonderful discharge planning and doctors willing to come to the home for emergencies), the caregivers were required to take an intensive course with respiratory therapy regarding equipment management and emergency interventions. The caregivers are definitely capable of being the second set of hands, however we don't allow it unless it's an emergency. I can probably get hold of our policy and let you see if you would like.

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Specializes in Peds/outpatient FP,derm,allergy/private duty.
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Send letter to electrity company requesting priority service reconnection when electrical outage prior to patient discharge.... not nice when pole hit by car 2 hrs after pt first home from hospital, out in the country and battery backup not charged...2hrs later still hand banging patient as road blocked and no local ambulance service. ;)[

:eek: I have very unpleasant dreams of this kind of thing happening!! Oh, BTW on a related note, have you or anyone else out there heard of a fold-up ambu bag that is small and easy to carry? A nurse I know told me that she got something like that at a seminar she attended but I looked online and I couldn't find anything like that. Thanks.

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Specializes in Home Care.

Thank you all for the information. I am a home health nurse who works as an independent provider and not with an agency. I have a client who was discharged from the hospital in late August after a trach placement in June. His trach had never been changed and the wife had been given no instructions of what to do in the home in an emergency. When I arrived (days later after a weekend with no nursing in the home) I asked the wife where the ambu bag was and she said she had not unpacked it yet from the hospital. I have had to do alot of teaching with the family and with the LPN who is the weekday shift nurse. If you have any other websites that would give me further instructional pieces for the family and/or the LPN that would be great.

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omg this scrares me.

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