How do I protect airway when trach gets pulled out?

[ahicks]

I am a new grad working in the ICU. Recently there was a patient in my ICU that pulled out their own trach. What is the best way for me as the nurse to protect the airway until the doc can get their to put trach back in. Please elaborate, I have very little experience with trachs.

[ittybabyRN, RN]

I work in a NICU and we always have a trach "ready to go bag" at the bedside, it is also brought with us if we are taking a field trip with the pt. In the bag is a trach of same size and one size down, suction catheters, sterile gloves, anything we would need should a trach come out or if we needed to emergently change it, and it is the nurses responsibility to care for the trachs, including the once a week trach changes where we take the old one out and put a new one in

[CNL2B]

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).

I'm not sure about the "ditto" part - at my hospital, it is not the nurses responsibility to reinsert. Yes, we need to ensure all the appropriate equipment is in the room (extra trachs, obturators, etc.) and know who to call, but that's it. I do work at a teaching hospital and our docs are in a call room on the same floor of the hospital though -- at most, a few minutes away. Typically what we will do is just manage the airway until they get there. Usually you can get by with bagging a patient for a little while (may need to cover the stoma) if they need it. What I have usually found is that the ones that are pulling out their trachs are usually feisty enough to breathe on their own for a few minutes -- LOL! (although that certainly isn't always the case!)

[ShaunES]

In our hospitals ICU it is policy that nurses do not reinsert airways (how often do you actually get to use it, and do you want to stuff it up and make further reinsertion more difficult?), nor do we keep trachys at the bedside (a lot of waste given all items at the bedspace are the patients, and when they leave it all gets chucked/taken with them).

The intubation trolley has all the equipment needed, and the difficult airway cart has even more in the event it all goes pear shaped.

These are ~15 seconds from every bed, and we have two medical staff covering every 8 beds, for a total of 8 medical staff, and a minimum of two senior registrars.

I'm not sure all these instructions of "put it back in" is wise, given that every situation is different (surgical trachy vs perc, why are they trachied, etc)