Changing a trach cannula...?

[EGVnurse]

Hi everyone! I was taking care of a patient with a #8 portex trach and the doctor told me later I needed to change the cannula every shift, even though there was no order for it. What is the deal with changing trach cannulas? Trachs make me so, so nervous.

I'm confused about the difference between metal and plastic.

The difference between inflated and deflated. What does it really mean? Its significance?

When, why, and how to change the inner and outer cannula.

What is the difference between the inner and outer cannulas?

I don't see many trach-ed patients so I have lots of questions. Thanks!

[ilikesharpthings]

The inner cannula is changed regularly to maintain the patency of the trach without having to change the whole thing as often. Secretions can build up inside the inner cannula, even with suctioning and humidification.

Trachs with cuffs are often used when a patient is ventilated so that the whole tidal volume is being forced into the lungs rather than escaping out of the upper airway around the cannula. The cuff forms a seal between the trachea and trach cannula. This also prevents air from going past the larynx so speech is nearly impossible with a cuffed trach that is properly inflated. Cuffless trachs allow for movement of air in the upper airway and can allow speech, a better sense of smell, and can help with appetite if the patient is eating by mouth. It depends on the indication for the trach what type of trach a patient will have.

[TraumaSurfer]

Are you in a homecare setting or a facility? Facilities will have trach care policies. Home care will have orders sets. The frequency of actually changing the cannula will vary but it still must be checked routinely and prn. You should be very well trained if you are caring for a trach. You must know how to remove the inner cannula which is first line in case of plugging.

Aaron's Tracheostomy Page has tons of info including metal teach.

[OneDuckyRN]

The floor that I work on has a protocol for trach care, which includes changing disposable inner cannulas every shift. Non-disposables get removed and cleaned every shift with care. I've never seen a metal trach still in use, but one of my pts has a non-disposable plastic Shiley.

[TraumaSurfer]

The floor that I work on has a protocol for trach care, which includes changing disposable inner cannulas every shift. Non-disposables get removed and cleaned every shift with care. I've never seen a metal trach still in use, but one of my pts has a non-disposable plastic Shiley.

Metal trachs are for long term care. You will find them in acute rehab and home care. Many ENT physicians also prefer them for the neck surgery patients during recovery. The stainless steel, comfort and cost effectiveness make them very popular.

[systoly]

every trach patient i've had, had the inner cannula changed every shift, even if it wasn't new

based on 12 hour shifts

[flipflopsNsweetTea]

We change inner cannulas q8h