Deep tracheostomy suctioning for 5 years

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Hi everyone,

I am part of an in-home nursing team for a ventilated quadriplegic. Her quadriplegia is a result of a brainstem erniation as opposed to a spinal injury so she is a ball game all of her own.

For 5 years she has been deep suctioned and in the last year she has requested staff not to pull back once resistance is met but to try and make her cough every time. I have been with this client for over 2 years and the difference in results form suctioning are obvious.

She constantly has thick, green mucous which is very hard to suction, although blood tests have shown no sign of infections. The chest specialist has suggetsed she come off her fluid tablets as this may be drying her chest up, but our team have noticed the difference far before her starting on the fluid tablets.

One of her lungs has deflated partially also.

Could this be due to loss of cilia and and increase in mucous? I have done some research but can't find a lot on the outcome of such a thing.

Any help would be greatly appreciated.

Thanks guys!

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Ooops *herniation*

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One of my clients also has her way of doing suctioning. She won't let me clear the suction tubing with water and wants "marathon" sessions. The other night she had me suctioning her for over 20 minutes. I tried to tell her that this is not a good practice, but everything I say goes right past her. It is no wonder to me that she suffers frequent infections. She only takes her meds if she wants to, including antibiotics. There is no getting through to her. I'm afraid that if your RT makes some valid suggestions, that your client will probably be resistent to change. The best thing to do as I see it, is to provide the teaching with mild encouragement, and to document the response. You can't force anything on these people.

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Thanks for your response. I definitely always encourage and document, but, similarly to your client she requests endless suctions and vibes. She hasn't responded to anti-biotics which either means there is no infection or she has taken that many she is resistant. Her suctions are so thick it is almost impossible to get anything up, even after boundless amounts of chest physio. I am wondering if the damage has been done, so to speak.

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Specializes in Critical Care.

:offtopic: I have to ask. I was under the impression that brainstem herniation was a bad thing. Everytime I encountered it in the PICU, the patient was declared brain dead. yet this patient is not only alive, but able to communicate to the extent that she directs her own care.

Please explain how this is possible.

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It is definitely a bad thing. It left an otherwise healthy 30 something woman in a quadriplegic, 24-hr ventilated state. She can mouth words to get her requests across. The only part of her body she can control are her eyes and lips.

Apparently she is the only known case in the world, which is why it is so hard to get medical advice. It all originated from a simple ear infection.

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It all originated from a simple ear infection.

WHAT!?!

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It is definitely a bad thing. It left an otherwise healthy 30 something woman in a quadriplegic, 24-hr ventilated state. She can mouth words to get her requests across. The only part of her body she can control are her eyes and lips.

Apparently she is the only known case in the world, which is why it is so hard to get medical advice. It all originated from a simple ear infection.

you may want to consider modifying or even deleting some parts of your post.

to me, there is unique information that could potentially identify who your pt is.

leslie

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She actually requested that I ask on the forum as I told her I found it and we are all looking for answers as to why her chest suctions have changed. She is totally ok with details being given. :)

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To add to my above post...she is ok with details being given if they assist in obtaining productive advice. Thanks guys! :)

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Specializes in ICU.
:offtopic: I have to ask. I was under the impression that brainstem herniation was a bad thing. Everytime I encountered it in the PICU, the patient was declared brain dead. yet this patient is not only alive, but able to communicate to the extent that she directs her own care.

Please explain how this is possible.

The only brainstem herniation I have encountered followed traumatic brain injury and in every case the patient died ... once they have coned there isn't much can be done.

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What can I say...that's what happened and she is still with us. She is an absolute medical mystery, having had many professors, neurologists, doctors and specialists try and come up with an answer to no avail. If they have no explanation for her then I doubt us, as nurses, could shed any further light on the situation. Howerev, my question is relating to her deep suctioning which is definitely something a nurse could offer advice on.

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