Trach tubes popping out of patients

[Blackcat99]

I am hoping to work with children in the home with trachs. I am wondering how often these tubes pop out. It sure sounds scary to me. I have no trach experience. Have you ever had a tube pop out? How often does this actually occur? What's the best way to prevent this from happening? Any information would be greatly appreciated. Thanks:p

[Perpetual Student]

It happens, but not all the time. You will probably see it at least once if you do this kind of nursing for a while. If you remain calm and just focus on what you've got to do things will likely be fine, esp. if it's an older, established trach. You/someone else will have to change it routinely, too.

You can try to avoid it by making sure that ties are snug and secure. S--- still happens. More often than not I'd say dislodgement is associated with doing a dressing change and tie change.

Your orientation should ideally include doing a routine trach change. Even if you can't do one on orientation, review the procedure, fiddle with the equipment a little and be sure you understand it. It's generally pretty easy to change one, just a matter of sticking a tube in one obvious hole to put it simply.

Basically the key in this line of work is just stay COOL. You might not have any backup (until EMS arrives if you call them, anyway) and if you go to pieces there is a problem; if you continue to work the problem and think clearly things will almost certainly be fine.

This is a fun and rewarding area to work, esp. with kids. Kids are cool. I am going to miss it a little when I start my new job. Good luck, I hope you like it. :)

[caliotter3]

As previously stated, you have to check to see that the trach ties are secure. Almost all trach changes in the home are done with two people. The family should be at ease with this procedure and will let you help your first few times, then they will assist when you do it. With two people, the procedure becomes almost automatic and chances for dislodgement diminish.

[NotReady4PrimeTime, RN]

Trachs typically don't "pop out" or "fall out" - they're pulled out, either accidentally or deliberately. The part of the trach that sits in the trachea is curved and pivot at the insertion site. Older children will have a cuff on their tube that will make it harder to accidentally dislodge it. In the photo the item on the left is the obturator, a relatively inflexible stylet that sits inside the tube during placement and is then removed once the trach is in place. See the curve on it? The photo is of a neonatal trach tube, so it's as small as they come. It's possible to dislodge the trach during tie changes - I've done it myself, but by following a few simple rules you can minimize the likelihood greatly. The most important rule is not to remove the old tie until the new tie is in place and secure. You should be able to get one finger easily between the child's neck and the tie, but no more. If the child is a known trach puller, don't leave them unsupervised. Often they'll vomit when they pull their trach, but some manage to get them part way out.

[Blackcat99]

Thanks all so much. I am so glad to hear that there are usually 2 people doing the trach tube changes. I sure hope they don't give me a kid who is a known trach puller!!!! I would be afraid to get up to go to the bathroom thinking that maybe the kid will pull it out while I am in the bathroom. I am hoping that known trach pullers are very rare. I need to get a book on pediatric home care right away and start studying.

[ArwenEvenstar]

Just my late 2 cents. I took care of a trach/vent child for several yrs. When I was the full-time and primary nurse I never had any problems with the trach coming out or dislodging. I was always so careful with trach tie changes and made extra sure the ties were snug enough. Then I decreased my hours, and several nurses worked the case then. I soon learned that I had to immediately check the ties when I started the shift! I had several close calls where the trach almost came out....Other nurses were not making the ties snug enough! This child had an unusual fat, thick neck...trach care was a challenge and you did have to get the hang of it. So it was NOT that these other nurses were incompetent, but they were just not used to this child's unusual neck and getting the ties snug... So, my advice is carefully check the situation at the beginning of your shift.

[Blackcat99]

Thanks all for your words of wisdom. I will be starting my 1st day of orientation tomorrow. I will definately make sure that the straps are secure and snug.

[Up2nogood RN, RN]

I did take care of a pediatric trach puller, sometimes 3-4 times a day. She only did it with her parents for attention, never when a nurse was on duty. I did have to change her trach one noc because their was a leak somewhere in the cuff and wouldn't work on the vent without the cuff up. Try to change the trach with the parents there. They will be your biggest help because they know what techniques work for their child. The care you give in homecare isn't always textbook so ask the parents questions and it will go more smoothly.

I started out in peds private duty as a new LPN on noc shift and was scared to death of trachs/vents but found it to be fairly easy once you get the hang of it!

[Blackcat99]

Yikes!!!!!:eek: A trach puller!!!!! Glad to hear that she only pulled it out for her parents and not for you. As far as I know, I am only going to have trachs. They have discussed only trach training so far. I'm scared to death of vents. I sure hope they are going to wait awhile before they do any kind of vent training.

[Shanny246]

My son used to pull on his trach all the time! He was about 15 months when he pulled it out (only happened once). The scary part is that you cannot see the trach is out because the gauze covers it (his ties were still secure around his neck). I heard him making a noise, so I rushed over, realized it was out, and quickly put it back in. After him and I were both relaxed, I changed the trach and cleaned the site to make sure of no infection. As long as the ties are tight enough (you want to be able to fit the tip of your pinky in, you should be safe.

[Blackcat99]

I have been lucky so far with my patient. However, his Dad was not so lucky. I was told that Dad was busy cooking and was not able to give this spoiled but precious child his undivided attention. So he taught Dad a lesson by pulling out his trach tube!!!!! I am so glad it didn't happen on my shift.

[Not_A_Hat_Person, RN]

My client's trach tends to pop out when his head bends back, no matter how tightly the ties are tied. It usually happens during a diaper change. I just pop it back in.