Trach Patient

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Specializes in Assisted Living, Med-Surg/CVA specialty.

I had got a pt with a trach the other day, came from a nursing home, Dx CHF/Hypoxia. Sounded like he had pneumonia to me, too. On isolation for Hx of MRSA of sputum. Trachs scare the crap out of me. . . I'm always terrified to touch them b/c I'm scared I'll do something wrong and the trach will come out. He was suctioned a few times with no problem during my shift.

Can anyone run down trachs with me real quick? With trach care, is all thats involved is changing the dressing around the trach and cleansing the area? How often should that be done? How would you find out what size trach the pt has, since If I remember correctly, all trach pts should have a spare trach at the bedside? I'm not even sure where to get a spare trach (new RN just off orientation at my first Med Surg job)! I havent done anything with trachs since nursing school, can you tell? :(

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Specializes in Peds (previous psyc/SA briefly).

http://tracheostomy.com/index.html

That's a great trach page!

Procedures and policy are different place to place, but trach care is typically BID, I think. (Sterile cleaning around the trach, checking the ties, cleaning the neck...) Suction is usually needed pretty frequently for us (kids = respiratory) so you get used to it fast. Avoid suction if possible - suction what you see and see if that solves any rattle. Deep suction when needed (for us, that's usually a lot.) Suction the mouth and nose only after the trach (then you are done with that catheter, of course.) Sterility here is good. ;) If your pt is "well" as far as respiratory care goes and the trach is established, maybe trach care can be done qd. Change ties as needed (wet, dirty, ANY time there are loose threads or anything.) Get two people for a tie change.

I'd hope that the chart has the exact type of trach! Our MPD (or supplies) has our trachs. Also, the trach itself typically states the manufacturer and size... if you can get that close. :)

Be ready to pop a new tube into that hole...

Quick and dirty - that's all I can think of!

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To help you out, go on-line to the different companies and they will send you free information for your patient, but it is stated so simply, it is a learning tool for you as well. The trach should have its size on the flang. Bedside should be the same size and one size smaller. Dressing changes are to be done when the dressing becomes wet which is frequent so if you don't need one it is better not to use dressings. Trach ties are to be changed daily at least. If the patient has had the trach for a while, the stoma is healed and replacing the trach if it should come out is easy.

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Specializes in Long Term and Acute Care.

Trachs are basicly gross and even worse is that nasty slurping noise they make when I suction. This made me think... On my NCLEX I had a new format question, one of those check all that apply aout trach care. One was 'a pt with a permanent trach may not go swimming'...I have no idea? can they swim? It didn't say if the trach was capped or anything.

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I work on a respiratory floor in long term care. We have 10-12 trachs at any given time. We are required to do trach care QD and prn. That includes taking out and cleaning the inner cannula, changing the straps, changing the trach dressing and suctioning if needed. But in many places the RTs do that. Respiratory should be able to help you figure out what size the trach is and where to get a spare.

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I had a trache pt last night. Established 2 years and no cannula. I have allways worked with the tubed type. Anyhow this patients sats were 81 to 83 on RA. I attempted a suction and his secretions were bright red he had been digging at it with his fingers. Eeewww. Anyhow. He did not appear in distress but I put oxygen on him at 3 l per minute due to his low sats and He was a newer admit with little history for me to go by. Maybe these sats were normal for him?? Anyhow. I put nasal prong on him. Should I have placed a mask over his trache?? Witg a cannulated trache I could have hooked up to it. Confused what to do here. Thoughts?

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Specializes in med/surg, telemetry, IV therapy, mgmt.

see https://allnurses.com/forums/1832873-post14.html for tracheostomy care websites.

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Specializes in ER, ICU,.

He did not appear in distress but I put oxygen on him at 3 l per minute due to his low sats and He was a newer admit with little history for me to go by. Maybe these sats were normal for him?? Anyhow. I put nasal prong on him. Should I have placed a mask over his trache?? Witg a cannulated trache I could have hooked up to it. Confused what to do here. Thoughts?

Why no inner cannula? Was his cuff inflated or deflated? Why not call your friendly Respiratory Therapist to come asses the pt and place on ATC?:loveya:

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As a Nurse Educator may I suggest that you get with your manager or mentor and be truthful with them. Tell them that you are uncomfortable and that you need additional training. You should have been checked off as competent before even being given such a patient.

It is going to be up to you to protect your license. You should not be accepting any patients that you are not competent to take care of, and there is nothing wrong with saying so. Your manager will respect you for it and seek out help for you until you are comfortable. Remember to do no harm. You want your patients safe and well.:no:

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No rt available at this institution

it was an established trache that had no cannula

Like I said this pt was not in distress and if he was I would have sent him out.

I will speak to the nurse educator tomorrow

I have worked with trached pts a lot just NOT ones without a cannula!

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