Cough assist with uncuffed trach?

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Specializes in Pediatric Home Health.

Background...peds home health, 7yo with uncuffed trach, on vent as needed (sleeping or low RR), anoxic brain injury documented as "brainstem only" but retains the tiniest bit more than that. Mouth open with large protruding tongue, unable to close manually. No swallow or cough reflex.

Client has a respiratory regimen that includes cough assist via trach, but obviously most of the pressure escapes through nose and mouth. I am new to this home and want to come up with a suggestion before I'm like, "Umm... this isn't working," because the caregivers and other nurses have been doing it this way forever. BUT IT'S NOT WORKING.

The only suggestion I can find is to plug the trach and use the cough assist with a mask. This is a bad option for this client. Why are uncuffed trachs?! Just... why are they even? 

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