Ventilator pt chokes on food

Nurses Safety

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This is prob a very stupid question so I'm sorry. If you have a vent pt and they are able to eat, are you able to perform the Heimlich?

Specializes in Case Management, ICU, Telemetry.
Hmmm...my pt is vented and he is 22. He eats everything,including milk duds candy.

He doesn't have a cuffed trach either.

Many ENT's in my area are actually doing away with cuffs on all trach pts.

One told me the cuffs cause tracheal erosions and that they are extremely hard to treat.

So any pt that comes to her with a cuff is instantly decuffed,including peds pts.

Totally off topic but I find this interesting. I was aware that they create erosion but I didn't think that just giving everyone an uncuffed trach was an option. Good to know.

Specializes in Pediatrics.

Thank you. I appreciate this response. I'm thinking that the Heimlich would be appropriate in a situation where the obstruction was unable to be removed. I always think of complications that could occur in my pts so I can always be prepared for the worst. I was unable to find anything about this situation online or in txt.

Specializes in CICU.

Certainly not an expert, but I am thinking the trach can be replaced if dislodged by abdominal thrusting... Patent airway is most important.

This question is commonly asked by parents. Home care nurses should receive the same instructions and information about the trach the parents did for home situations.

For the Heimlich, there is a trach in the trachea. A piece of whatever is not going to shoot out through the small cannula of the trach nor will it be able to pass the trach to make it through the larynx.

The Heimlich may also not be effective since you have the stoma as another opening besides the upper airway so creating enough pressure might not be possible with both opening. It also depends on why the trach was placed such as stenosis or vocal cord paralysis as to where something will go. I would also have to be a very small piece to get past the curve of the trach in the trachea and pass the trach within the trachea. If it does not go down to the lung fields a physician in ER (Pulmonology, ENT) can easily scope the particle out. That is one advantage of the trach. I would not recommend doing this in the field since they will not have the appropriate equipment and once the piece of whatever is in the lung fields it is there until the hospital and can cause more problems.

If the patient is still breathing, you have time to get them to the appropriate physician for retrieval as long as you stay calm and keep others that way as well as not doing something impulsive to put the piece of matter in a bad spot.

Cuffed trachs create problems. The old days of inflating to eat are long gone and can cause aspiration. Placing a speaking valve in line helps equalize the pressure to facilitate swallowing.

Look up the education videos on this website and you will learn what talking and eating with a ventilator are all about.

The Passy-Muir® Valve | www.passy-muir.com

Specializes in Pediatrics.

Thank you so much!

Specializes in retired LTC.

To OP - I found your question very interesting. It's not something I have ever thought about, so your question is an eye-opener for me. I've said it before here on AN that I'm always learning something new, even though I've been doing nsg since the Dark Ages.

Thank you and don't ever be afraid to ask questions - that' s how we ALL learn.

Specializes in Pediatrics, Emergency, Trauma.
To OP - I found your question very interesting. It's not something I have ever thought about so your question is an eye-opener for me. I've said it before here on AN that I'm always learning something new, even though I've been doing nsg since the Dark Ages. Thank you and don't ever be afraid to ask questions - that' s how we ALL learn.[/quote']

:yes:

...although to me, moral of the story is...ALWAYS watch the airway....

Let's take a look at the anatomy of how that tracheostomy is constructed.

If it's for a post-laryngectomy patient, there is no more connection between the pharynx and the trachea, it's been surgically removed. The only way for air or anything else to enter the trachea is through the stoma. Therefore there's no way that any food in the pharynx can go anywhere but the esophagus. Therefore there would be no need to do a Heimlich maneuver for an aspirated piece of food, because there's no way to aspirate it. Cuffed or uncuffed tube makes no difference here.

If the airway between the pharynx and trachea is open then it is possible to aspirate into the trachea, with the possibility of it completely occluding the trachea below the level of the tube. However, this is very unlikely, because the tube itself would probably prevent anything big enough to occlude a trachea from getting down below it to do that, even if uncuffed. A cuffed tube, if in use, would prevent aspirating anything that big for sure.

A cuffed tube, if in use, would prevent aspirating anything that big for sure [/QUOTE]

But then as a general rule, if the cuff has to be inflated, the patient probably should not be taking anything by mouth. The exception would be total vent dependency where getting the full benefit of a required tidal volume and PEEP. A swallow study should have been done with those parameters by a qualified SLP.

Specializes in Critical Care.

The common wisdom these day is that the cuff should be deflated or a cuffless trach should be used if the patient is takes food by mouth (a normal swallow utilizes positive pressure in the trachea created by the lungs to prevent food from entering the airway), so it's certainly possible for small food particles to pass the trach cannula, although they shouldn't be big enough to occlude the entire trachea. In general, it's hard to "choke" with a trach cannula in place since the airway is already occupied by a foreign object that allows the free flow of air. If it were to pass the trach cannula and then come back up into the cannula and occlude it then shouldn't occlude the entire airway assuming the cuff is deflated or there is no cuff. If the inner cannula become occluded it should be easy to change out.

The common wisdom these day is that the cuff should be deflated or a cuffless trach should be used if the patient is takes food by mouth (a normal swallow utilizes positive pressure in the trachea created by the lungs to prevent food from entering the airway), so it's certainly possible for small food particles to pass the trach cannula, although they shouldn't be big enough to occlude the entire trachea. In general, it's hard to "choke" with a trach cannula in place since the airway is already occupied by a foreign object that allows the free flow of air. If it were to pass the trach cannula and then come back up into the cannula and occlude it then shouldn't occlude the entire airway assuming the cuff is deflated or there is no cuff. If the inner cannula become occluded it should be easy to change out.

Just cuff deflation alone does not equalize the pressure. The deflated cuff prevents esophageal pressure from the trachea and a one way valve (PMV/Speak Valve) helps to achieve some normalization of a swallow.

I posted a link earlier to the PMV website which has excellent free CE videos which explains this in detail.

But, if the cuff is deflated and a PMV (speaking valve) one way valve is in place, airflow around the trach could be impeded by a foreign object. This will cause a suffocation of sorts of a different type if the patient can not exhale effectively while the ventilator continues to give mechanical breaths. A pneumothorax can also occur. This is a source of serious injury and death when people forget or don't notice a patient has a one way valve inline. This is of importance to note for those caring for ventilator patients in LTC who have speaking valve trial. You should be very careful about delegating cuff inflation to someone else.

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