Trach change!

[Mavsmomma01]

I take care of a trach/vent patient. I have a question regarding how to insert the trach if it slips out completely (ie during trach care) but does not fall on the floor, mattress of crib, etc. Is an obutrator needed to insert the trach?

As long as the trach is still being held when it slips out and has not been contaminated the same trach is to be reinserted, per the parents.

[Alex Egan, LPN, EMT-B]

Firstly, please clarify the setting you're working in, I assume you're doing PDN. Emergency trach changes require the same steps as routine changes. If the trach your client uses has has an opturator, such as a Shiley, then yes absolutely it would need to be in place for you to safely reinsert the trach. If the trach does not come with an operator such as a Bavona, then no. However if using a Bavona, be sure to have the stylet appropriately sized and handy, in case reinsertion is difficult. Of course a dab of lube is also always necessary. If you're working for an agency contact your clinical manager and clarify the specific policies of your company regarding emergency trach changes.

[RNNPICU, BSN, RN]

I take care of a trach/vent patient. I have a question regarding how to insert the trach if it slips out completely (ie during trach care) but does not fall on the floor, mattress of crib, etc. Is an obutrator needed to insert the trach?

As long as the trach is still being held when it slips out and has not been contaminated the same trach is to be reinserted, per the parents.

You would need to use the obturator to insert the trach, it helps keep the trach firm when entering the stoma, ermove the obturator immediately upon insertion. You can use the same trach in a scenario you described, but I would follow your companies policies as well

[RNNPICU, BSN, RN]

With regards to the Bivona trachs, they also have an obturator, it just looks different than the Shiley trachs. Both the Shiley and Bivona trachs are soft and need the support of the obturator to safely insert the trach

[JustBeachyNurse, LPN]

I take care of a trach/vent patient. I have a question regarding how to insert the trach if it slips out completely (ie during trach care) but does not fall on the floor, mattress of crib, etc. Is an obutrator needed to insert the trach?

As long as the trach is still being held when it slips out and has not been contaminated the same trach is to be reinserted, per the parents.

If you are working PDN and don't know the answer you need to call your clinical nurse supervisor or clinical nurse educator to review protocol. The parents are right in this scenario but next time they might not be and its your license on the line. Obturator/stylet for reinsertion is best practice. Any unscheduled or emergent trach change should trigger an incident report, notification of parents, clinical manager, and physician/provider.

[Alex Egan, LPN, EMT-B]

With regards to the Bivona trachs, they also have an obturator, it just looks different than the Shiley trachs. Both the Shiley and Bivona trachs are soft and need the support of the obturator to safely insert the trach

MY flextends generally come with a wire stylet. Regardless whatever came with, you do need to use

[brillohead, ADN, RN]

The obturator has nothing to do with sterility/contamination, and quite frankly I'm rather concern that you're working with a trach patient without understanding the purpose of the obturator and the proper procedure for trach insertion.

Please consult your clinical supervisor for additional training.