How do I protect airway when trach gets pulled out?

getoverit, BSN, RN, EMT-P · Apr 15, 2010

The best way to protect their airway is to reinsert the Shiley and you don't need a doctor to do it. If you're unfamiliar with this, no big deal...I'm sure anyone of your co-workers or RTs could help you learn how.

Of course you should have sterile gloves, suction kits, French caths, BVM, etc in the room for every patient with any kind of airway adjunct.

TakeBack · Apr 15, 2010

Agreed....anyone taking care of a trach pt needs to be able to emergently reinsert the airway.

Place the obturator back in the trach and insert at 90 deg, then turn. Get the RTs to show you.

All trach pts should have the equipment near the bedside- traditionally taped to the wall above the bed.

meandragonbrett · Apr 16, 2010

You need to insert a new trach (which should be at the bedside....one the same size and one the next size down) or the obturator. If you cannot place a new trach or obturator the next best thing is to take an ETT and place so that you can ventilate the patient until you get an appropriate clinician to the bedside.

RescueNinja · Apr 17, 2010

Ditto what everyone else said. It is your responsibility as the pt's nurse to ensure all emergency equipment is in the room (this includes back-ups for trachs).

ahicks · Apr 17, 2010

Thanks for all the replies. I guess I was under the impression that only a doc could reinsert the trach. I will be sure to check my hospital policy as well.

RescueNinja · Apr 17, 2010

Thanks for all the replies. I guess I was under the impression that only a doc could reinsert the trach. I will be sure to check my hospital policy as well.

Good luck! Some hospitals train their nurses to reinsert in an emergency situation and others just expect you to know it.

XingtheBBB, BSN, RN · Apr 20, 2010

We don't have a policy for keeping the next size down at the bedside but I always toss one in the room when it's my pt. Also, if you can't even get that in... stoma closing too quickly or too much... put in a suction cath. You can mechanically ventilate through that to a point. (resp will help you get it connected up with a 5 ETT) At least you're holding it open until the MD can dilate.

tri-rn · Apr 23, 2010

So which should you put in ... the new trach or the obturator? And how do you mechanically ventilate if you opt for the obturator?

XingtheBBB, BSN, RN · Apr 23, 2010

You might need the obturator to place the new trach. Some would place just the obturator in a true "can't re-cannulate" emergency just to hold the place. If the smallest trach on the floor doesn't work, I'd opt for the suction catheter over the obturator. That's just me in my experience. Ask around work to see what they prefer. Remember, most likely, your pt can be vented with a face mask, too, if you loose your stoma. Know the history to know when they can't.

TangoLima · Apr 24, 2010

All trach patients should have emergency trach supplies at bedside. That being said, I had a patient the other night who had been there for 2 days and nobody bothered to place the emergency supplies at the bedside or or routine trach care supplies. When I asked the patient if she had been getting routine trach care, she told me "not so far". I couldn't believe that had happened in our ICU!

We dont stock trach care supplies on the floor, and we can't obtain these supplies in the middle of the night. So, I did what I could with what I had. The patient was "supposed" to go home the next day, so I ordered one trach care kit for the next day. I'm glad nothing happened on my shift!

RN Joe 86 · Jun 3, 2010

Great question! Hopefully there is an obturator in the room. If not, most trach stoma sites are well developed anough that with a little surgilube you can place it back in. If all else fails and the RT or whoever isn't there to help, occlude the trach site and either place them on a nrb mask (If they're not apneic) or bvm them until help arrives.