Trach change disagreement with Case manager

[zook1065]

Being an LPN I need reviews from my case charge RN for my PDN PT. Prior to starting my demonstration on changing a trach, I asked my client if they wanted the trach ties changed. The PT doesn't like them messed with and just had a shower with tie change the day prior. The PT refused and it was explained that ties should be changed daily.....with still, a refusal. The charge stated she was going to do it or have it done anyway. So to fast forward, after the change, and respecting the PT wishes, I was told I couldn't be checked off because ties weren't done, and was done incorrectly because of that. The RN was very upset I didn't change them

By the way the PT is 18 with no guardianship.

So was I wrong in honoring the PT wishes, not that it was a past problem with skin breakdown on the neck, and respecting their rights. I did argue my point but it seemed useless.

I'm just frustrated and needed to vent. Did I do this wrong?

[SDALPN]

You were changing the trach but asked if they wanted the ties changed? Why? That's when it's the easiest to change it and you were already doing a procedure. Have the new tie ready to go on the new trach fasten and done.[/quote']

That doesn't matter if the patient refused.

[4give&4getoften]

I think OP asked if he wanted then changed because she knew prior that "he doesn't like them messed with". Am I right? Is that why you asked him?

[ventmommy]

I'm confused by this post and it may just be because my experience is with children. Does your patient have a tube with an inner canula? If not, the ties have to be messed with when you change the tube because even the old ties would have to be re-attached to the new tube.

If the patient doesn't change the ties every day, the care should be coordinated so that they are changed after every shower and that the weekly tube change falls on a shower day.

[systoly]

well, it's kinda like asking a pt. who is rsistive

to personal care, "do you want a shower today?"

of course the answer is "no"

and of course we don't drag them into the shower room

by their ankles, but to invite a "no" ...