Not the greatest night...

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Specializes in tele, stepdown/PCU, med/surg.

Hey all,

Last night I had a very busy night. Not too many patients but one super duper busy one. He was a hemiplegic with a trach, and was admitted for C-Diff (pseudo. colitis), UTI with a horrible stage IV on his coccyx. I came to work tele and this stuff is SO not tele lol...

Ok so he came from ICU with a rectal tube. I hate those things cuz I've only used them a couple times and everyone seems to say something different about them. This one is called "Flexiseal"? and some nurses said that it didn't need to be deflated like the previous ones did even though it does have a balloon. It said "45cc" on the port. It leaked at one point I think cuz he squished the tubing so that was an 1 1/2 clean up, plus I had to redo his dressing on the wound. The tube is no longer leaking but I've always been concerned with rectal tubes. The thing is his stool is completely liquid and if he didn't have the tube, he would always be dirty, skin would rot, and his stage IV would never heal until he gets septic and die. These poor people.

Also, this guy was on humidified air to his trach with inline suction. He would have a normal voice and then occasionally have a quite gurgly voice. I would suction him and get some and sometimes he would sound better. The thing is he had a good cough. His sats never came down...I'm just wondering how to tell if you're suction him enough. Trachs always seem to sound a little moist. If he can cough, he really doesn't necessarily need suction right? I'm new to trachs, that's why I'm asking.

Anyway, thanks for reading!!

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Specializes in cardiac med-surg.

very busy

and you survived !!!!!

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Specializes in Pediatrics Only.

Busy indeed!

I cant answer you on rectal tubes, but I can give you tons of answers about trachs.

Some people with trachs are able to clear their airway by coughing and then using a tissue to the trach to clear the secretions (almost like blowing your nose). I dont imagine its a great thing to do, but its been done.

If this person was alert and oriented enough he would be able to tell you if he needs suctioning or not. If not, you did the right thing by suctioning him when he sounded as if he needed it. Sometimes when a trached patient coughs, they can get the secretions up the trach, but are not able to expell them. Therefore, only shallow suctioning is needed. Its also always good to suction a trach patient every few hours.

To learn more about trachs check out

www.tracheostomy.com

It gives you all the information that you need to know about trachs.

-Meghan

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Specializes in tele, stepdown/PCU, med/surg.

Thanks guys and thanks Meghan,

I had the same patient the next night and they capped his trach. He was able to cough up secretions all the way to his mouth and occasionally I used a Yankauer in his mouth and got some up. He has agood cough so that is good. I feel better thanks!

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Specializes in ICU;CCU;Telemetry;L&D;Hospice;ER/Trauma;.

Flexiseals....

we use them at our facility....

They do have a very soft balloon that is supposed to not need deflation while inside the patient...but .....

If you have patients who have vascular compromise??? I would deflate the balloon for a few mins....just to allow repositioning and a chance to ward off the possibility of internal necrosis against the bowel wall...

You can get the company info. on line.....just google Flexiseal...

Also...you sound like you handled it all really well...good job!!

It's hard to take care of all those tubes and such with an isolation patient and have other patients as well...

The others here spoke well of trach care....the goal is to keep an airway open...most alert patients will suction themselves after a while...if they are able....you did just fine....good for you!!

hope your days ahead are not as busy....but just as rewarding.

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Specializes in ICU, Research, Corrections.
Hey all,

Last night I had a very busy night. Not too many patients but one super duper busy one. He was a hemiplegic with a trach, and was admitted for C-Diff (pseudo. colitis), UTI with a horrible stage IV on his coccyx. I came to work tele and this stuff is SO not tele lol...

Ok so he came from ICU with a rectal tube. I hate those things cuz I've only used them a couple times and everyone seems to say something different about them. This one is called "Flexiseal"? and some nurses said that it didn't need to be deflated like the previous ones did even though it does have a balloon. It said "45cc" on the port. It leaked at one point I think cuz he squished the tubing so that was an 1 1/2 clean up, plus I had to redo his dressing on the wound. The tube is no longer leaking but I've always been concerned with rectal tubes. The thing is his stool is completely liquid and if he didn't have the tube, he would always be dirty, skin would rot, and his stage IV would never heal until he gets septic and die.

I LOVE Flexiseals :yeah: You don't have to deflate Flexiseals. A few things you need to be aware of:

1. You need to keep a clear path from the tubing to the bag. In an obese patient, this will require some creative pillow stuffing. Do not allow a leg to lie ontop of the line, pooh will back up and leak and make a HORRIBLE mess!

2. If your patient is coughing very forcefully...they will pop that flexiseal right out with the balloon inflated. Deflate the balloon and reinsert it. Do not get a new kit out....your manager won't like it, they are very expensive!

3. The stool has to be liquid for a flexiseal to work. Pasty is not good enough, pure liquid!

4. Rectal tubes of any sort are contraindicated if the pt has a spinal injury, I believe it is T4 or T5.

Enjoy!:lol2:

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Specializes in pedi, pedi psych,dd, school ,home health.
I LOVE Flexiseals :yeah: You don't have to deflate Flexiseals. A few things you need to be aware of:

1. You need to keep a clear path from the tubing to the bag. In an obese patient, this will require some creative pillow stuffing. Do not allow a leg to lie ontop of the line, pooh will back up and leak and make a HORRIBLE mess!

2. If your patient is coughing very forcefully...they will pop that flexiseal right out with the balloon inflated. Deflate the balloon and reinsert it. Do not get a new kit out....your manager won't like it, they are very expensive!

3. The stool has to be liquid for a flexiseal to work. Pasty is not good enough, pure liquid!

4. Rectal tubes of any sort are contraindicated if the pt has a spinal injury, I believe it is T4 or T5.

Enjoy!:lol2:

# 4 would be due to autonomic dysreflexia, which could happen with almost any spinal injury...just something else to keep your eyes out for!..if you need more info go to the spinal cord injury association website (I think its www.spinalcord.com) they have a wealth of info!

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Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.

I didn't know that about Flexiseals and spinal injuries- good to know.

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Flexiseals are ok in my book.

Sometimes if they are leaking, if you deflate the balloon, take it out, and put it back in again, it helps.

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Specializes in ICU;CCU;Telemetry;L&D;Hospice;ER/Trauma;.

Here's an excellent evidenced based article written by a Wound Ostomy RN consultant....that talks about flexiseals...

Although some say that you don't have to occasionally deflate the balloon, there is contraindications listed here for doing so....

Follow your own intstitution's written policy....

They, on average cost about $614.00 a piece....(very spendy)...

hope this helps...

http://www.o-wm.com/article/6544

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Specializes in tele, stepdown/PCU, med/surg.

thanks guys for the great comments. And to CRNI for the article link which was very helpful. One thing to note is rectal management systems (flexiseal) are not approved for use beyond 29 days.

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Specializes in geriatrics,med/surg,vents.

Even with a good cough a pt can get a mucus plug especially when the trach is capped.I've seen this happen,so suction the trach too.

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