Hairy Moment-Trach change gone bad

[nurseratchett29]

Just wanted to share----Had a hairy moment the other noc. Have worked for 6 years in peds homecare and have had my share of emergencies but this was new to me but I guess it happens:

Was changing trach the other noc on my wonderful 7yr old patient. He uses a Shiley 4.5 PDC. We always schedule this procedure when myself and his Mom are present to decrease his anxiety and make the procedure smoother. We usually work together with one of us removing the old trach and the other inserting the new one. I removed the old one and when Mom tried to insert the new one it would not go in. We are both very experienced in this and my little guy is used to it so it usually goes well but this time, it would not go in. We ended up having to temporarily insert a 4.0 non cuffed just to keep the stoma patent and called EMS. He has recently had a growth spurt and needs to have a stoma dilation because of his growth. It was a little hairy but all turned out well--Just wanted to share with others that this can happen after a growth spurt and that a seeminly routine procedure can always go south in a heartbeat. It reminded me of the importance of having backup plans and a back up trach tube of a smaller size to keep airway patient in case of emergency. It may sound redundant, but sometimes we are not mindful about these things when things are going great with our patients..