Question about Trachs

[mpbc25]

Have any of you ever heard of washing a trach and re-using it? I always thought trachs were a single use. To be more specific I'm talking about the Peds Shiley trachs... I'm wondering what everyones input on this is... I had NEVER heard of washing and reusing a trach... what about you guys?

[sweetielin]

i also have a question. are lpns allowed to suction a trach? maybe it depends on your facility?

[trachnurse]

I have a client with a metal trach that we clean once a shift or more depending on the amount of blood and mucus build up. We too use 1/2 strength hydrogen peroxide (h2o2) and sterile water. I like to let it soak if there is a lot of gunk, just for a minute or two though. I have a question though... I dont understand the obturator use. I know it blocks the airway, so if someone could explain it to me I would be grateful! Thanks

[trachnurse]

oh I am an LPN and I suction all the time as do a couple other LPN's that wrork there

[BBFRN, BSN, PhD]

I have a question though... I dont understand the obturator use. I know it blocks the airway, so if someone could explain it to me I would be grateful! Thanks

The obturator is there in case of the need for an emergency trach change or reinsertion (like if the pt pulls the trach out). It decreases trauma to the trachea upon insertion and helps to guide the trach in.

[trachnurse]

thanks for your quick reply, do you put the obtuator in before or at the same time as the outer cannula?

[NRSKarenRN, BSN, RN]

have patient deep breath & cough, clear mucous/suction if indicated.

wash hands.

have sterile field or open trach packet carefully and use paper wrap inside as sterile field.

hyperextend neck (towel roll or pillowcase works great)

don gloves: sterile=hospital, clean=home.

attach trach ties to one side of collar.

nurse puts the obturator inside outer tracheotomy tube so rounded end protrudes past edge of trach

remove old trach

inserts into trach opening on inhalation or hold breathe if patient able-might need thumb on top of obterator if pt coughing (hold onto that trach as they exhale!)

attaches trach tie other side

insert inner cannula

if balloon, inflate per recommendation.

apply split 4x4 if needed

document procedure and patient tolerance.

if painful for patient(esp with neck tumor), get order for dab xylocaine gel to be used on end of obturator, will help numb area post procedure--also premedicate with pain med.

child:

changing a tracheostomy tube

adult:

tracheostomy, adult

[trachnurse]

thanks so much! Now that I know the answer, I think, gosh! I should've been able to figure that one out!

[kids]

Have any of you ever heard of washing a trach and re-using it? I always thought trachs were a single use. To be more specific I'm talking about the Peds Shiley trachs... I'm wondering what everyones input on this is... I had NEVER heard of washing and reusing a trach... what about you guys?

In homecare it is not at all unusual to disinfect and reuse trachs in children. Especially in kids who have MRSA colonization and need frequent trach changes. A good part of it is a cost saving measure, often insurance companies will only pay for 1 or 2 trachs a month.

If you haven't already done so I suggest checking out the vent info thread in the Peds forum, it has a couple of good trach references. https://allnurses.com/forums/f41/pediatric-vent-info-88548.html