Trach dislodged

Published

I was called into a non vented trach patients room by another nurse on the floor....neither of us knew the patient except his pulse ox was 83%. His cuffed trach was lying on his chest. It was covered with mucous and blood and still inflated . I grabbed the first clean trach I could find and placed in back in the stoma. The patient recovered sats after that. So problem is that the one I reinserted was a size bigger than the one he had prior. I had no idea what size he had..the primary nurse was hanging blood down the hall and didnt know whay was going on, happened so fast. His trach size had just been downsized that day. Now the Doctor is very mad. He wanted my name etc... Im pretty sure I did the right thing. Thoughts? How do I handle this so I dont get in trouble. Thanks

Sounds like it was a recipe for disaster, with scattered supplies. Good thinking on your behalf. I would have done the same thing. Phooey on that doctor. And big hug to you.

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Sounds like you did what you had to do with a deteriorating patient and lack of supplies at the bedside. It is not your fault and the doctor should not be angry with you. As others have said, the patient should have had an extra newly downsized trach, bvm, and possibly a size smaller trach at the bedside. The doc is probably just perturbed that the trach came out in the first place-soon after being downsized.

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In an emergency, you do what you have to do quickly with what is on hand. Airway problems can't wait. In an emergency situation you didn't freeze; you acted correctly. The patient seemed to do fine. The doctor will get over it.

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Specializes in ICU.

Wow. I have never cared for a trach patient that I did not make sure there was an obturator and a spare trach (correct size and type) secured above the bed, or at least in plain sight. Also I would have an ambu bag, suction, etc. If you always prepare for an emergency, you won't "have an emergency," because you will be ready for it.

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Specializes in pediatric.

On one hand, you acted appropriately in an emergency situation- you established an airway and prevented the patient from deteriorating further. On the other hand, how could there not be spare trachs (one same, one smaller) at the bedside? That, however, does not seem like it was your problem, since he wasn't your patient. The doc will get over it once all the facts come into light.

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The rule with all the trach's I've worked with is that they need to have their trach type and size posted at the head of the bed with an obturator and spare inner cannulas ready to go, a trach box with full supplies also has to be in the room.

Personally I wouldn't have seen a sat that's holding at 83% as being a need for emergently replacing the trach without knowing the size or anything else about the patient, I would have deferred to the patient's primary RN or RT so long as the sat stayed >80%.

What is it that the doctor preferred you would have done instead?

I agree that any replacement tube at the bedside should be the same size as the one that is in the patient. It appears in this case that the change had just been made and the replacement at the bedside wasn't swapped out. The physician is overreacting and will come to his senses shortly.

However:

A sat of 80% is not the same as a PaO2 of 80%. It's a PaO2 of between 40 and 60, which is nothing to sit on for any period of time.

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Agree that the spare bedside trache should be the same size as the pt is currently using. the MD is probably upset that the emergency equipment and process wasn't followed. every trache pt should have suction ready, catheters ready, obturator, etc. what also bothers me is, how did it pop out in the first place? the ties need to be tight.

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Specializes in Peds(PICU, NICU float), PDN, ICU.

This is a good question for PDN nurses since that is a large part of what we do.

Most people here have answered correctly. I didn't see how long the pt has had the trach. But with a new trach, the hole closes fast. Something in there is better than nothing. I agree with the others that you should have back up trachs with the pt at all times...no excuses. The trachs should be well labeled. A larger size could cause trauma, but I'd rather deal with trauma than no airway.

I'm not sure how the trach came out with the info given and what I scanned through. With a cuffed trach, it should have been harder to pop out than an uncuffed trach. The ties should be loose enough for two fingers to fit between the tie and neck according to the textbook answer. My company policy says one finger between the neck and tie. I would suggest finding out what your hospital policy says and go with that...making sure to document that the ties are secure to CYA. Its possible the pt pulled the trach. Its also possible the trach is too short and the pt needs an extended length trach.

The Dr sounds like an ***. You did the best you could in the situation and you did the right thing from what I've read. But in the future, make sure you tape the correct size trach and a smaller size trach to the hob or place close to the pt where it won't get moved. Make sure a spare set of ties are within reach...the other nurse might not be there next time. Make sure everything is labled. Make sure you document to CYA. Read your policy on trachs. Make sure the RTs are ok with everything. Have a suction Cath ready at all times as well as an ambu bag.

If you want to get more comfortable with trachs, pick up a shift with a PDN agency. You will get very comfortable very quick. There are lots of types of trachs and lots of brands. Each for different purposes.

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Specializes in LTC, med/surg, hospice.

I think you did fine with what you had available. Maybe some posters are missing that you weren't the primary nurse so the onus isn't on you to have the supplies at the bedside.

However, it may be a good idea to suggest a trach inservice for all staff. Some staff just aren't comfortable with them.

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kudos to you. Our P&P for decannulation states to call a code and Ambu bag until RT and MD gets there.

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Thanks for responses. My boss was cool. She said I did fine. The patient actually pulled his trach out and did it again half way the next night. Needless to say, he got a sitter.

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Specializes in Complex pedi to LTC/SA & now a manager.
Thanks for responses. My boss was cool. She said I did fine. The patient actually pulled his trach out and did it again half way the next night. Needless to say, he got a sitter.

Well at least they are being proactive now...sort of. Do they have an emergency kit bedside now too (extra trach current and one size down, suction, obturator, ties, BVM, oxygen tubing etc)

You did well with what you were presented with and clearly your supervisor agrees...

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