Trach dislodgement

Alex Egan, LPN, EMT-B · Nov 28, 2014

If the person is hyperextending their neck and the ties are on the loose side sure. It can look like it. I work home care and do all my own stunts when it comes to traches, so I can't offer any advice on when and when not to involve RT.

AmyRN303, BSN, RN · Nov 28, 2014

I'd think better to be safe than sorry, honestly.

MatthewBSNRN · Nov 28, 2014

I'd think better to be safe than sorry, honestly.

Exactly my feeling. We have an RT on duty around the clock. I've spoken to my manager at length because this particular RT is very unprofessional and condescending. God forbid anyone asks him to do his job. It's very frustrating but I will not compromise on safety just so I don't have to deal with him. I'm a newer nurse...if I see anything even slightly weird I'm going to get someone with more experience to assess the situation. It's just frustrating to me when people are less than professional and lazy and don't put patients and ensuring patient safety first. Sorry that turned into a venting session LOL.

JustBeachyNurse, LPN · Nov 28, 2014

Yes hyperextended neck + loose ties may appear like a ready to dislodge trach. One strong cough and it can expel.

I also work home care so there is no RT to call except when DME is called for vent/equipment failure.

If I were in the hospital the RT would be called. Better than walking in and finding the trach next to the patient or across the room.

Lazy staff members exist in every discipline. If the RT felt it was an overreaction they could have used it as a teaching moment to explain the findings not complain and moan. Such as it looks like this because ____. Next time do _____ first. if you see ____ call rapid response. This is how you check placement /trach ties/etc.

sallyrnrrt, ADN, RN · Nov 29, 2014

as both a RN & RRT, I am ashamed of that resp. professional. i am sorry you experienced this. I wish I had been working when you had the crisis, I would have gladly assisted.

ontheway2crna · Nov 29, 2014

It's the pt's airway.... if you ever have a question about it dont hesitate to ask again even if that guy is a jerk.

GrannyRRT · Nov 30, 2014

You have an RT who is probably covering all departments including the ER and ICU.

Since RTs can not be at every patient's bedside with an artificial airway all the time, the RN or LPN should have enough basic trach training so they can care for these patients safely. Caring for a trach patient is also part of your job. If you came across with the attitude this trach patient is solely his responsibility, I can easily see his response towards you.

One of the first things which should be taught is trach positioning to center and secure. This can ensure correct position to prevent dislodged trachs and damage to the wall of the trachea.

This RT might just be expressing frustration with a system which has set you up for failure. It would probably be in your interest to work with the RT to help the nursing department provide more education rather than fueling the fires of hatred between disciplines.

sallyrnrrt, ADN, RN · Nov 30, 2014

that is why I wish I had been working with OP, it would have been a wonderful teaching sharing knowledge, and tricks of the trade, we are a team, and when any crisis is delt with calmly, "i have found this to be useful" we work together.....yes that RT probably had 4vents in icu, several stat nebs and Abgs! AND COVERING ER, but some calm taking time to share knowledge would have reduced the RT work load in future, besides, it calms the nerves :)

sallyrnrrt, ADN, RN · Nov 30, 2014

grannyRRT, nailed it nursing and respiratory need to work together

it might be easier for me to accomplish or see this since I am both.

but Granny has some great advice also

GrannyRRT · Nov 30, 2014

Sometimes you might also forget what it is like to cover 200 patients and have everything paged to you as STAT.

I wish I had time to thoroughly teach everyone.

The RT in this situation did respond to the bedside. He did not blow off the call. He may have been short with the OP but we don't know what his workload was like. He might have been in the ER trying to keep a child from being intubated or prepping for a meconiun baby in L&D. He might have come back later to teach when things calmed down. But if the OP stated or projected that he thought this RT was lazy and didn't care, I probably would not have come back to that either.

It is difficult to always be perky when stressed for time and trying to prioritize many patients and tasks. There are many, many discussions on this forum about this topic by nurses. Had this RT spent a few minutes with the OP, someone else (doctor or nurse) would probably be yelling at him for not responding fast enough to them. Some shifts you can't win.

sallyrnrrt, ADN, RN · Dec 1, 2014

still when i respond, i am already ther, the teaching i can do prevents, an un necessary call sometimes when i am busy, but I am both a very experienced critical care nurse, an experienced RRT, I do generally know what the nurses are un sure of..... But GrannyRRT is right, being responsible for 200pts, 4-6 vents in icu, possibly a post cabg, needing extubating, and stat abgs every where, it frustrating, but if we share our knowlege with a health

care professional, it may enable that professional to handle the situation in the future........