decannulation risk question

[Quailfeathers]

In reading a pt. chart in clinical I noted "High decannulation risk score = 14". Unfortunately I don't understand what is the actual risk and what I should be monitoring for. The pt no longer has a trach and my understand is the risk score is given to pt with a trach. Would appreciate some clarification. Why is a risk score given? How's at high risk? What nursing interventions/monitoring should be done?

[Daytonite, BSN, RN]

Decannulation is removal of the tracheostomy. I've never heard of a score being attached to this. My guess is that the facility must have some sort of scoring system for patient's that are, perhaps, likely to pull their tracheostomy tubes out. That would be a heads up to anyone taking care of the patient to be careful in making sure the patient can't reach the tube in order to pull it out. I would ask the nurses in the ICU where the patient probably was at the time he had the trach or one of the respiratory therapists about this. It may just be something that this facility came up with to identify and prevent problems that they've had before.

[augigi, CNS]

I agree with the above post. I've also never heard of a risk score for this, and assume it's facility-dependent. Maybe they had a problem with this happening.

In ICU, a high-risk pt for decannulation may be confused, disoriented, head-injured, waking up from anesthesia etc. It may also just be a noncompliant pt. If someone is a high risk for decannulation, you would monitor carefully, continue to grab their hands to stop the pulling, secure the tube carefully, sedate them if necessary, restrain them if necessary etc. You'd also make sure you had replacement cannulae/trach kit/forceps at the bedside (you do this for every trach pt).

If he no longer has a trach, it's irrelevant.