trach changes- how often??

[mshnurse]

Hello, there are a few nurses and speech therapists at the hospital that I work that are extremely interested in finding out how frequently other hospitals change the trachs on patients. Per the Shiley insert, they should be changed every 29 days....however, our hospital policy states "prn". We are a large teaching hospital that has had patients that required going back to the operating room to have trach changes because of granulation tissue growing thru the fenestration holes. Part of the problem at our hospital is because we are a large teaching/trauma hospital. The patients get the trachs placed in Truama ICU, however, by the time the patients get to the stepdown units and med/tele units the trach may have been in too long and no one seems to know who and when should change them.

I'd love to have feedback, information, etc from other nurses and speech therapists.

[mysticalwaters1]

Hello, there are a few nurses and speech therapists at the hospital that I work that are extremely interested in finding out how frequently other hospitals change the trachs on patients. Per the Shiley insert, they should be changed every 29 days....however, our hospital policy states "prn". We are a large teaching hospital that has had patients that required going back to the operating room to have trach changes because of granulation tissue growing thru the fenestration holes. Part of the problem at our hospital is because we are a large teaching/trauma hospital. The patients get the trachs placed in Truama ICU, however, by the time the patients get to the stepdown units and med/tele units the trach may have been in too long and no one seems to know who and when should change them.

I'd love to have feedback, information, etc from other nurses and speech therapists.

Do you mean the entire trache changed or just the inner cannula. Sounds like the entire thing. I don't know if it's policy but at my hospital usually the ENT doctor would completely change the trach every 30 days. And we use dissposable shiley inner cannulas that we take out throwaway, apply new on once a shift so 2-3x a day. Oh and the doctor would come up to the med surg floor the pt was on to do so not ICU, or if the pt was there would do it there too.

[mshnurse]

Thanks for responding. Yes, I did mean the entire trach. Changing the

inner cannulas is part of our daily trach care. The problem is the entire

trach change and downsizing trachs from 8's to 6's, etc. Speech often

requests a smaller size trach when working with PMV's.

[mysticalwaters1]

Thanks for responding. Yes, I did mean the entire trach. Changing the

inner cannulas is part of our daily trach care. The problem is the entire

trach change and downsizing trachs from 8's to 6's, etc. Speech often

requests a smaller size trach when working with PMV's.

I'm in an acute care hospital and the pt I was thinking about was a nursing home pt with a longterm trache no vent and needed to be change. I don't know if back at the nursing home the doctor would meet there, or the office. i would think he would direct the NH pt to our hospital same day surgery to get it done but I'm not sure, but I remember they were telling me usually 30 days.

[NRSKarenRN, BSN, RN]

inital trach change done by surgeon/ent doc 5-7 days postop; however if issues had been noted might be delayed till 14 days post op. 15- 30 days post tracheostomy considered mature stoma. thereafter, rn's permitted to change entire trach usually q 2-4 weeks to prevent granulation tissue attaching outer cannula. most long term patients outer trach changed q month. excessive tissue growing at stoma site suggests granualtion tissue inside trach suggesting q 2 week change. excessive tissue can be controlled with application of silver nitrate sticks. consult ent if needed.

american thoracic society - tracheostomy tube care

stanford university:

tracheostomy weaning and decannulation protocol

revised trach care handbook

emedicine - tracheostomy : article by charles e morgan, dmd, md

changing a tracheostomy tube

a new model of tracheostomy care: closing the researchpractice gap

[mshnurse]

Karen-

Thanks for the information that you posted on the forum. I will pass the information on to the other members of the committee that I'm on. Nursing/respiratory council. This council consists of nursing, resp therapists and speech therapists.

Lisa

[mmsparkle]

Hi Lisa,

On my unit (Medical High Dependency) we use Shileys, which require changing every 3 months. The inner cannulae are cleaned 2 or 3x per shift. Portex tubes stay in for 1 week only.

However in the last place I worked different criteria were used.

Hope this helps. Am off to read up on the sites posted earlier!

mmsparkle

[KellieNurse06]

In the home it's every 3 months, my daughter has one; and we were lucky to get the insurance to allow one every month with dr's order for infection prevention. She used to have a cuffless shiley and we changed it weekly, which is unheard of, but again we had the doctor write for weekly changes. When she was changed to cuffed due to vent use at night, they fought us but eventually compromised to a new one monthly. I change it in the home myself too.........

[Shanny246]

Once a month