Trach Question

[sbostonRN]

I'm a student nurse and I had a potentially emergency situation this weekend. I was wondering WWYD in the same situation.

My patient had a trach that was well healed, from 2007. This was my first trach patient, so I admit my inexperience. We had just gotten back from a walk in the halls and I was helping him in the bathroom. He coughed, the trach ties came undone and the trach was hanging around his neck. The patient made a motion for me to reinsert the trach, and all my books said the right thing was for the nurse to reinsert the trach as soon as possible. So I reinserted the trach. Now, everything I read seems to say that I should have gotten a *new* trach and inserted a new one. But to leave the patient standing in the bathroom while I ran to grab a new one is a little unrealistic.

After this happened, the patient indicated that he was OK (he couldn't talk, but he gestured). So we walked back to bed, and at that moment my instructor walked in. She listened to his lung sounds and we took an O2 Sat.

Did I do the right thing? What should I have done differently in this situatio?

Thank you!

[wooh, BSN, RN]

That's what I'd have done. Maintain the airway above all else!

[CoffeeRTC, BSN, RN]

Me too. We keep extra trach supplies in the room (LTC)

[kcochrane]

It depends on hospital policy. But honestly, ABCs first. I would much rather deal with a potential infection then someone not breathing. But if a new one is handy, that is your best bet. Some trach patients that have well established trachs can actually wait until respiratory gets paged.

[flightnurse2b, LPN]

yes, in NCLEX hospital, you would have gotten a brand new trach.

but when it comes to the patient losing his airway, you absolutely did the right thing! put the old trach back in, make sure the oxygen sats are good, monitor lung sounds, and worry about changing the cannula later!

[sbostonRN]

Thanks for the reassurance! Yes, he did have trach supplies in the room. But we were in the bathroom and the patient was a high fall risk. I wasn't about to leave him there holding his IV pole while I went to get my sterile gloves and a new trach! :)

I learned an important lesson this weekend - check the trach ties frequently! I'll be checking them hourly along with my IV site!

[tammy07]

good job!!!! always ABC's first

[NotReady4PrimeTime, RN]

It's not like the trach tube fell on the floor. Whatever bugs are on his clothes are likely already found in his respiratory secretions as normal flora. It's also quite possible that since he was trached well over a year ago, he would have no difficulty maintaining his airway in the short term without the tube in situ. You did the right thing.

[sbostonRN]

I just wanted to thank you all for your kind words and encouragement. I got called in by my instructor tonight who placed me on clinical warning. Apparently I made a serious lapse in judgement by not ringing the call bell immediately instead of reinserting the patient's airway. While I see where she's coming from, I feel that it's a rather harsh punishment which will become part of my permanent record.

[caliotter3]

I would have done exactly as you did. You did a good job. As for the clinical warning, it is quite possible that the instructor did this to have this incident as "history" should you make clinical errors in the future and it becomes an issue whether or not you should pass. They call it "the paperwork trail". Don't be overcome by this warning.

[liveyourlife747]

omg, i had a similar situation with one of my toddler clients last wed. i walked out of the room for a sec. and returned to him pulling the vent tubes on the crib and his trach was out. i ripped all the vent stuff off and put that trach back in before alerting the parents to help put the vent back together. haha. it was scary, but there was no way i was leaving him to run across the room, open a new box, get surgi lube, etc to put it a new one in in! i've only been a nurse since july 08, so i was very scared, but i reassured myself later with thinking that i needed to keep his airway patent first.

you did what i would have done. good going!

[Shanny246]

You absolutely did the right thing. My son had a trach and his came out before. He did not have a good airway and started to turn purple right away...I did not even care it the trach possibly touched anything non sterile, I just put it right back in. I gave him a couple hours to relax, get comfortable and happy again, and then I cleaned the site and changed his trach. You had great instincts! Airway safety before anything else.