Changing out trach tubes

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I am trying this question a second time from a different perspective. I have been asked to change out the trach tubes for adult ventilator dependent pts. ( new cuffed tubes every month). I am a little uncomfortable doing this in the home with the minimal support available. The RT from the DME company is not authorized to change out the tube. How many of you have changed out trach tubes as part of your home health nursing practice? Any feedback will be greatly appreciated!

Signed,

A reluctant home health nurse

:bow:

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Hi i am lisc RT and i have never heard of routine trach tube changes done under 6mos. You might want to find out why the company feels this should be done. You can also consult the NBRC the National Board of Respiratory Care as to what they recommend. I am saying this because I to work with long term adult ventilator patients and frequent trach tube changes can be more harmful than helpful. We routinely change trach's every 6mos. I hope this is a little more helpful good luck to you.:)

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Specializes in Vents, Telemetry, Home Care, Home infusion.

Depending on the type of trach used, q month trach change has been the norm. However, with newer type trachs, patients can go for longer periods of time. You should only be going this IF you are comfortable. More times you change trach on your client more comfortable one becomes.

Coming from a resp/telemetry unit, I was still leary first time changed trach @ pts home.

a. If there is shifts of nurses, perform change at shift change.

b. Have supervisor/ clinical specialist present while perform change.

c. Agency inservice by ENT doc/ RT.

Links to help: Tracheostomy and Vent Information

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Specializes in Home Health/PD.

we have children that we do trach changes on, because the insurance would rather have us do it then the parents. we also recently had one of our adult clients trached, hes getting 3x a day changes! i couldn't believe it, but that's what we are told to do. luckily with the children, the parents normally do it and we assist, but there are a few that we do the change on. just ask for help from a co-worker at shift change, or ask to be oriented with someone for the trach change.

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Specializes in pedi, pedi psych,dd, school ,home health.

I have done many trach changes on home care pts. I do agree with pp it is nice to do it when there is someone to bag while you change; the extra set of hands helps.

reasons for changing

it does get a little less scary when you routinely change the trach on the same pt...you get to know their little idiosyncrasises such as placement, position etc.

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Thank you for your responses. They were all very helpful. I just wonder how common it is for nurses to do this procedure in the home. I suspect that home mechanical ventilation is not that common. We currently have 5 patients. One family does the trach change. The primary nurse and I have changed the tube for one pt. I'm not sure what is going on with the others.

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