Trach experts! ACLS experts! Please clear this up for me...

[SunnyPupRN]

If I had to manually ventilate the pt with the Ambu-bag, it would connect to the trach, but how do you close the nose and mouth to prevent the air from escaping? Our protocol is to first vent via trach, if that fails, to try the Ambu over the mouth and nose, then try to use the CPR barrier over the mouth and nose....which I don't get ...because if the pt could breathe via oral/nasal route, why would he have a trach in the first place?

Also, the artificial lung connected to the Ambu bag never inflates when I test the bag. Is it supposed to? I tried sealing the valve to see if it would inflate, but that just makes it hard to squeeze the Ambu bag.

[BittyBabyGrower, MSN, RN]

You don't have to close off the mouth and nose to bag thru a trach, just put the bag on, adjust the flow to make the bag inflate and bag. Now, if you have to remove the trach for whatever reason you have to occlude the trach hole with something like Vaseline gauze or your hand and have some else bag thru the mouth nose.

People/kids have trachs for a lot of reasons but it tomprovide them with a protected airway, not necessarily because they can't breathe thru their mouth or nose.

[vanilla bean]

If the trach is cuffed & the cuff is inflated, that effectively seals off air from exiting via the nose and mouth. If the trach is uncuffed or the cuff is deflated, you will lose some volume of air through the mouth and nose as the air bagged in will follow the path of least resistance. Assess for chest rise and fall with bagging and/or auscultate to assess effectiveness of bagging. There are a number of ways to effectively bag a trached patient depending on the particulars.