OK, here is my question. I opened a case last weekend, a young man with a trach, a plastic Shiley type, placed for sleep apnea. So he says, I got a very poor history, and on the weekend, it is hard to speak with anyone who knows anything about his case.
The HMO sent twill "tapes" to tie his trach with. Now I have a critical care background, and I remember the days when that was the only choice anyone had, but why would that cheap HMO send something so difficult for even many nurses to do properly? I put in a request for the foam/velcro type of ties.
I have not had many trach's in home care, and none in my own caseload, so I am wondering, are we suypposed to tecah the pt to change the ties themselves? I have one pt who I am in e-mail contact with, she was a nursing school instructor, and she has had a trach for quite some time. She agreed with me that this would be nuts to teach a pt. I also felt that no one should be alone when an airway is changed, heck, I am sure someone else is nearby when I change trach ties in the ICU for heavens sake. Is anyone out there teaching pt's to do this for themselevs? If not, how often do you change the ties? My other pt/rn says q 2 weeks or prn.
And where the heck is everyone?? No posts in this forum for a while, wake up HH nurses!!!
Sep 20, '01
by NRSKarenRN, BSN, RN
From the "Respiratory Expert" (LOL):
Things to consider re deciding type of trach tube anchoring device:
1. New trach vs old.
2. Medical DX: Any change for trach edema/neck swelling??
3.Availability and willingness of caregiver to assist with trach tie change.
4. Condition of skin around trach/neck and ammount of secretions.
6. Payor source: willing to pay for velcro?
7. Patient will remain long term agency client vs. teach and discharge.
The answers to these questions will lead you decide type of trach anchoring device.
If insurance will pay for velcro holder e.g. Dale tracheostomy holder, I say request that type. 2 per month is usual amount needed. Change q 3-5 days new...can leave on up to a week to 2wks. older; more frequent change if excessive secretions. HAND wash in warm soapy water and air dry-dries over night.---quickly dries with handheld hair dryer if needed. I have even bleached them if needed ( bloody open areas etc).
Letter of medical necessity demonstrating why velcro holder only needed sometimes will get that product covered:
eg: patient lives alone, dominent arm weakness; unable to change himself and caregiver unwilling to assist; patient with neck tumor that is increasing size and risk strangulation overnight--need quick adjustment etc.
Re twill ties:
1. Always try to teach care giver how to do if available.
2. if new trach, prefer two pieces with bowtie on side vs one piece that is knotted.
3. if no infection control/swelling concerns, ok to leave on as long as not soiled--- encourage cleaning beneath area q day.; otherwise do q three days.
4. DOCUMENT and get DRS order that its OK for patient living alone to change trach ties himself---use stand mirror to visualize if unable get to BR mirror----even had one patient's family go to auto junkyard and buy side door mirror that sits flush--- he could swivel it easily!
Newest anchoring device---Plastic IV tubing!!!!!!! Can be cut to size, easily cleaned, blends in with skin tones, not needing change for up to a month or more, softer even on neck for patients with long term older trach...LTC/extended rehab units using (seen in a nursing magazine).
Edited for spelling.
Last edit by NRSKarenRN on Sep 22, '01
Sep 21, '01
by NRSKarenRN, BSN, RN
Needed a little time for finger clicking...google.com search found these great sites re tracheostomy and respiratory care:
1. Adult CEU article in Advance for nursing- Tracheostomy Patient Care :
2.TRACHEOSTOMY CARE :An Introduction
3. The tracheostomy tube change: a review of techniques
4. Trach tube diagram + info on Passy-muir speaking valves
5. Trach tube suppliers:
6. Pediatric and TONS trach info @ Aaron's Tracheostomy page
7. Size chart comparison for trach tubes + trach changing procedure
8. Laryngectomee Stoma Care
9. Vent users support page
10. Respiratory resources @ Brownson's Nursing Notes
Hoolahan---add these respiratory resources to your web site please, so I can find them again! ANA standards address nursing educational requirements and practice standards not care techniques.
Last edit by NRSKarenRN on Sep 21, '01