Pulling out the trach

loriangel14, RN · Nov 16, 2013

I had apatient do that once.We called RT stat and they put it back in.

poppycat, ADN, BSN · Nov 20, 2013

You should have an extra trach & a step-down trach at the bedside for just this situation. It needs to be replaced immediately.

meanmaryjean, DNP, RN · Nov 20, 2013

You put the spare back in- right away. And you should not have to wait for RT- this is a nursing action to maintain a patent airway.

My homecare kid decannulates himself ALL the TIME. (He's a toddler)

loriangel14, RN · Nov 20, 2013

You put the spare back in- right away. And you should not have to wait for RT- this is a nursing action to maintain a patent airway.
My homecare kid decannulates himself ALL the TIME. (He's a toddler)

Even the RT had trouble getting it back in.There was blood and tissue everywhere.Plus the patient was panicking.

TraumaSurfer · Nov 20, 2013

You put the spare back in- right away. And you should not have to wait for RT- this is a nursing action to maintain a patent airway.
My homecare kid decannulates himself ALL the TIME. (He's a toddler)

It is a nursing procedure ONLY IF YOU HAVE BEEN PROPERLY TRAINED and have done a few insertions with supervision. Once you false track a trach, you may have given the patient a death sentence. This could also mean your license will be put in jeopardy with a sentinel event especially if you have not been properly trained.

Follow your P&P. Learn how to manage an airway with a BVM if necessary until a qualified person can replace the trach.

meanmaryjean, DNP, RN · Nov 20, 2013

It is a nursing procedure ONLY IF YOU HAVE BEEN PROPERLY TRAINED and have done a few insertions with supervision. Once you false track a trach, you may have given the patient a death sentence. This could also mean your license will be put in jeopardy with a sentinel event especially if you have not been properly trained.
Follow your P&P. Learn how to manage an airway with a BVM if necessary until a qualified person can replace the trach.

Of course! Mea culpa

moonshadeau, ADN, BSN, MSN, RN, APN, NP, CNS · Nov 26, 2013

What the above posters said is correct about re inserting the trach if able ASAP. One patient in the ICU decannulated himself and ended up intubated with ETT in his stoma because there was so much swelling. Always a scary situation for the nurse and the patient, whatever the setting.

TraumaSurfer · Nov 26, 2013

What the above posters said is correct about re inserting the trach if able ASAP. One patient in the ICU decannulated himself and ended up intubated with ETT in his stoma because there was so much swelling. Always a scary situation for the nurse and the patient, whatever the setting.

Swelling is not normal. The stoma might close quickly depending on the method the opening was made but it is not due to swelling. If there is swelling it could be a sign of infection or trauma. Intubation with an ETT might be the best and the patient may need a trip to the OR for a closer examination of that stoma.

Also, if the trach is 7 or less days old, reinsertion by the unskilled could lead to damage. This is why special instruments are placed at the beside of these patients. It is also why a physician usually does the first trach change.

anon456, BSN, RN · Jan 14, 2014

We keep a spare trach and one 1/2 a size smaller at bedside in plain view. If the patient pulls it out we immediately replace it with the same sized trach. Some patients are able to breathe through their stoma or mouth and will not desat and will be easy to replace. Others are more challenging.

Sometimes there *is* swelling because it is cuffed and there is trauma with it being pulled out. And sometimes we have patients who have especially difficult airways to replace due to anatomy or recent post-op. With those patients if the trach comes out we call a code blue while trying to replace it to not waste time.

If unable to get the trach back in very quickly, and if the patient is starting to desat, call a code blue. Cover the stoma and bag by mouth. Some patients cannot be bagged by mouth due to anatomical differences. We have a sign at bedside that gives this information so anyone can run in and intervene appropriately for the patient even if they are not that patent's nurse. It's better to call a code blue right away if the trach cannot be replaced than to waste time trying longer and then it becomes serious by the time someone decides to call a code and takes time for people to get there.

ANY nurse who works on a floor with trach patients needs to know how to replace a dislodged trach. All nurses in our hospital go through basic trach training and trach CPR. It is a basic skill learned in nursing school, too.

systoly · Mar 18, 2014

as usually, there's not a one size fits all

my trach pt's are PDN and waiting for someone or transporting

are not viable options, but of course all nurses are trained and

experienced with trachs

a lot of our pt's have trachs for pulmonary toilet, so while we don't

want the stoma to close, there's no immediate danger to the pt.

we just can't wait a half hour or more