Step-down trach at school?

DDRN4me · May 5, 2005

I would have the procedure be to call 911 while someone attempts to insert the step down sized trach, better to have them on their way if need be than not have the trach and have to just wait !!!

Gompers, BSN, RN · May 5, 2005

Okay, I don't work in school nursing but I sure do have a question about this...

Why in the world would a school decide that it's better to risk a child suffering brain damage due to airway problems...than to just have a smaller trach on-hand and try that? I can imagine that if the normal trach doesn't go in, that 911 should be called while the smaller trach is attempted, just in case. But to just NOT try the smaller trach seems ridiculous. I understand there is the danger of tissue damage if the trach is hard to replace, but I think the possibility of asphyxia is more likely and dangerous.

Again, not a school nurse, but one who works in the NICU and we always have extra trachs at each trached baby's crib, and a smaller one in our crash cart.

mtymom · May 5, 2005

:nono:

I am a Public School Nurse in charge of the severe/profound handicapped children's program for my district. I have always requested that my trach kids be sent to school with a same size trach as well as a step-down size trach in the event that the normal size could not be reinserted. In this particular school setting the teachers and teacher's aids are responsible to change the trach in an emergency(training provided by the nurse). It has been suggested to me that perhaps we should not try to insert a "step-down" size trach if problems arise but to omit that step and just call 911. If there is anyone with a similiar situation I would appreciate your input.

I am a nurse for a Head Start program. I think the step-down trach is necessary. Anyone suggesting that you omit that step doesn't know what they are talking about. You are running the risk of that patient dying because they quit breathing while you are waiting for the ambulance. What are they thinking? Good luck and I hope this works out for you.

nitengale75 · Jun 29, 2005

I am a Public School Nurse in charge of the severe/profound handicapped children's program for my district. I have always requested that my trach kids be sent to school with a same size trach as well as a step-down size trach in the event that the normal size could not be reinserted. In this particular school setting the teachers and teacher's aids are responsible to change the trach in an emergency(training provided by the nurse). It has been suggested to me that perhaps we should not try to insert a "step-down" size trach if problems arise but to omit that step and just call 911. If there is anyone with a similiar situation I would appreciate your input.

Just curious as to where in Illinois do you work? I am also a school nurse in Illinois. In our district, teachers and teaching assistants do not touch trachs! First of all, we, school nurses, do not delegate nursing responsiblitites to non-licensed people. And second, our union would protect our teachers and teaching assistants and not allow this to be part of their job description. Our 10 school nurses are all R.N.'s with 6 of us certified. We then employ LPN's to do tube feedings and assist with trach students. But I do agree with the other posts by having a smaller trach available. We had a student who used to like pulling his trach out when he was younger. He is now on a vent with his own private duty nurse at school with him at all times.