Does anyone have a video clip of how to reinsert a trach if in an emergency?

  1. If available thanks
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    Joined: Sep '06; Posts: 298; Likes: 105


  3. by   NurseyBaby'05
    I never knew there was a proper way to reinsert except to get in as fast as possible so it doesn't close up. I was always told we can treat an infection or other skin issue later. If the pt's not breathing, all the techniques/treatments in the world aren't gong to be doing him any good in the grave.
  4. by   Daytonite
    i worked with many trach patients. reinserting a trach is not hard. you insert the obturator into the trach tube you are going to use as the replacement and just gently insert the unit through the tracheostomy opening. you can use some water soluble gel if you like to make the insertion smooth and less irritating for the patient. you remove the obturator once the trach tube is in place and replace it with an inner cannula. place the ties.

    this is not as much as an emergency as you would think. usually, when a patient pulls out their trach, or someone else accidentally removes it, there is a gaping wound that remains open and does not close as easily as you might think it would. mostly it's just messy with the patient possibly coughing out sputum. - changing a tracheostomy tube. this web page is part of this website:
  5. by   NRSKarenRN
    Above website great resource and has 2 videos of procedure.

    With advent of velcro trach ties, change little easier as can more quickly secure tube in place. First video shows trach insertion without any trach ties attached. I find it easier if using velcro tie to have it attached to one side of trach flange as shown in video #2, can quickly place behind neck and attach second side preventing patient from moving head or coughing out tube.

    ALWAYS insert obturator into cannula to aide in inserting and preventing scrapes to airway, immediately remove then focus on securing ties. Occasionally inserting airway with flange at 12 & 6 o'clock position then rotating 45 degrees to 3 & 9 o'clock position will get past any fibrous trach tissue....along with using dab of surgical lubricant.

    Insert inner cannula, inflate cuff if needed, reattach to oxygen source if used and complete! Can be done in less than 1 minute if no bucking broncho.....just have everything opened and preped prior to start of procedure.
    Rarely need to have neck hyperexteneded in bedbound patient.

    Good Luck mastering this skill!

    PM if needed as respiratory my specialty.
    Last edit by NRSKarenRN on Dec 31, '06
  6. by   whm33
    I copied this from another forum just for educational purposes

    04-19-2009, 10:57 AM
    So the scenario of the dislodged trach. Meaning a fresh trach (before the first trach change) becomes dislodged or falls out. When reinserted, it enters the pretracheal space, causing bilateral tension pneumothorax, and eventually the patient goes into cardiac arrest if the problem is not recognized.

    I was taught in medical school that should a fresh trach become dislodged, you do not reinsert it, you intubate the patient. This is because a fresh trach has not formed stoma yet, and if it is reinserted, it may not be obvious if it is in the trachea or the pretracheal space.

    So, I know of 4 cases since 2006 between 3 of the academic centers in my city. Of those cases, many of the staff were not aware that you should never reinsert a fresh trach. After some investigating, it seems that not many people outside of ENT, CCM, and pulm know about this potential disaster.

    This has become my soapbox. During one of the cases stated above, I was on the code team. An ancillary staff member (just to leave at that, so no knocks on anyone) outright argued with me during the code because he wanted to reinsert the trach. After the code was finished, I discussed the case with him, and he had said that he never heard of that. I've started asking around, and I have come to realize that it is not a well-known complication. Now I give a monthly lecture to educate on the complications of dislodged trachs. Maybe hoping to save a patient or two...

    I was interested to know if any of you have encountered this problem or even seen a few cases.