Preparing for a perc trach

[nursingdude78]

Hello,

I am a new ICU nurse still in orientation. I was wondering what the nursing considerations are to keep in mind for someone getting a perc trach and what kind of supplies you gather etc.

[JJRBuckeyeRN]

We do a lot of perc trachs on our unit. Here is what I do to be prepared:

*Check coags with AM labs the morning of the procedure.

*Turn off appropriate gtts (ex: heparin, argatroban, etc)

*Make sure to have AMBG bag and suction set up

*Have an intubation kit on standby

*Sterile attire

*New trach and trach supplies (trach tie, etc)

*Sutures

I also usually try to have the IV pole at the foot of the bed so that it is away from the MD's doing the procedure and I can easily get to it. I also make sure to have a pressor mixed and ready to go if I am worried that my patient might become hypotensive ( it is a good idea to already have the pressor line primed and connected in case you need to start using it). I also usually have an extra liter of saline in case I need to start bolusing the patient.

Make sure to document when the first incision is made and when the airway is confirmed. The MDs usually like this information.

I hope this helps. Let me know if you have any other questions.

[CraigB-RN, MSN, RN]

And depending on your unit, the flexible scope.

[moonshadeau, ADN, BSN, MSN, RN, APN, NP, CNS]

Lots of Vec, Versed and Fentanyl, and an extra set of eyes to watch my other patient while I am in the perc trach for 45 minutes.

[upstateRN]

I am in agreement with the above. Appropriate sedatives and pain relief if not already running an infusion. Also, having the extra fluids and a bag of pressors at the ready are excellent suggestions too. It's Murphy's law, and many times they are needed. I have seen patients drop their pressures fast depending on their reaction to the agents that are given.

An additional note, we are in a teaching hospital, our policy mandates a critical care fellow be at the bedside. Depending on your facility, you have to make sure those things are in place as well. Of course, always ensure there is a consent in place before anything is done. Sometimes people get trigger happy and some of the fundamentals have not been addressed.