Airway Maintenance During Seizure w/Trach

[MILakeGal]

Hello,

I recently got a position as a home care nurse for a patient with a Trach and seizure disorder. I know that in patients without a Trach, after ensuring a patients safety, we can turn them on their side so they do not aspirate secretions, but what do we do for patients with trachs? Do we suction during a seizure if necessary? I feel like this goes against the practice of never putting something in their mouth - but ensuring airway patentcy is our priority too? Thank you for your help in advance!

[brownbook]

There is not a black or white, right or wrong, answer to your post.

Seizures can be, are, as different as snowflakes. No two are alike.

Yes the airway is important to focus on.

You need to get "report" from who ever was caring for the patient prior to your being assigned to them.

How do the seizures usually present themselves? Does the patient have frequent seizures? How long do they usually last? Does the patient have a lot of secretions irregardless of their seizure disorder, requiring frequent suctioning?

Can you get a history, and answers, from your agency? Read over the notes from their prior care givers or actually talk to their prior care giver?

[JKL33]

On 2/16/2020 at 5:38 PM, MILakeGal said:

I feel like this goes against the practice of never putting something in their mouth

How is that?

What is the rationale for not putting anything in the mouth?

[RNNPICU, BSN, RN]

There used to be a belief that you should put a tongue depressor in the mouth of a seizing patient to prevent the tongue from obstructing the airway. However, because during a seizure the person often clamps down with extreme force that the tongue depressor or anything in the mouth would break off and then they would aspirate on that.

[RNNPICU, BSN, RN]

As brownbrook stated, you should get report on frequeny, duration, and type of seizures as well as what is the plan to do in the event of a seizure... some may need bagging, some may need oxygen on the ventiltor (if they are on home mechanical ventilation), etc.. In other words, follow what the order say. If patient is cyanotic - call 911, you may need to give them breaths.

OP: as you stated airway patency is always important in trach patients. You may need to suction as well.

[JKL33]

I asked the question so as to possibly get some critical thinking going regarding why the situation of suctioning a trach is not the same as sticking something into the mouth of a seizing patient.

But it occurs to me that the OP was possibly referring to oral suctioning of secretions. The answer there would still be that in active seizure the suctioning would be limited to the cheek pocket/outside the teeth and not to put a yankauer between the teeth during a seizure, if that were even possible.

[RNNPICU, BSN, RN]

4 minutes ago, JKL33 said:

I asked the question so as to possibly get some critical thinking going regarding why the situation of suctioning a trach is not the same as sticking something into the mouth of a seizing patient.

But it occurs to me that the OP was possibly referring to oral suctioning of secretions. The answer there would still be that in active seizure the suctioning would be limited to the cheek pocket/outside the teeth and not to put a yankauer between the teeth during a seizure, if that were even possible.

Sorry JKL33: I was just trying to be helpful

[Defibn', RN, EMT-P]

Luckily, the pt with a patent trach & cuff has a protected airway. I would not worry about suctioning the mouth until the seizure stops. If they have copious secretions coming from the trach, sure, you could suction it. Likely, the secretions coming from the trach can be dealt with after the seizure. Unless, of course, the seizure was hypoxic in nature from an occluded trach. Like RNNPICU said, you may need to ventilate the pt.

[MILakeGal]

Thank you everyone for your comments. I have learned a lot. I will be sure to inquire about their care plans and history and now feel more safe in handling this kind of situation should it arise. Thank you!