Peds, Trachs and plugs....

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Specializes in School LVN, Peds HH.

I'm a Ca LVN. In LVN school, we learned how to suction, clean and dress a trach. We were vaguely told about mucous plugs, but the instructors told us that RT's were always around and they take care of all the trach things.

Fast forward to tonight... my pediatric patient had a plug. I did the appropriate things... i.e. suctioned, saline mist in nebulizer, ect... my patient didn't even desat, and after a while coughed up a fun plug. When I was oriented to the job, the DON told me I could pull the trach and put a new one in. I don't even think thats in my scope of practice!

If something happened, and I had to pull the trach, would I be held liable? Also, does anyone else know other ways to clear a plug?

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Specializes in Peds/outpatient FP,derm,allergy/private duty.

Hi Raekay! It is a lot of responsibility we have in home care with these patients and no respiratory therapists nearby. Are you taking care of this patient at his home?

Anyway, I've discovered it's pretty much up to us to educate ourselfves on vent and trach care, as I got very little training when I first went into the field. I was told early on that if a trach is plugged and nothing is working to clear the airway, you need to pull the trach out to open the patient's airway because any considerations you may have at that point aren't going to matter as A is Airway, and without it your patient will not surivive.

Luckily, I've never had to do that. It would probably be a good idea to go over your policies and procedures with your supervisor for guidance on that. Here's a thread that contains links to NRSKaren's excellent resources on trach/vent care.

What is the best book available on ventilators? - Nursing for Nurses

There are also some more topics at the top of the page in the Pulmonary Nursing section of allnurses. Best wishes to you!

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where i work, on weekends there are no RNs..we have 2 trachs and one is always getting a plug....we take the trach out sometimes of we cant suction it out...pops back in easy....he has done this so much i could do it with my eyes closed...hehe

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Specializes in School LVN, Peds HH.

That makes me feel better :) I know when I oriented I asked the DON if we could pull trachs and put them in and she said yes. She even showed me how on a dummy. But, the last hh gig I had taught me how to do things and lvn's weren't allowed to do them. It calms my heart to see that other lvn's have pulled trachs in their time :)

Thanks so much for your responses!!!

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Changing the trach is an acceptable intervention for a malfunctioning (plugged) trach. Normally one does not change the trach by oneself, but with the assistance of a second person, for safety sake.

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Specializes in School LVN, Peds HH.
Changing the trach is an acceptable intervention for a malfunctioning (plugged) trach. Normally one does not change the trach by oneself, but with the assistance of a second person, for safety sake.

Good to know! :) Thanks Caliotter! :up:

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This happened about a month ago. Suctioning moved the plug. Family member and I changed the trach. Large mucus plug was adhering to the end of the trach. It was just a matter of time before it plugged the lumen of the trach again. That is why you should change the trach as a routine response to difficult mucus plugs.

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