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Trach ties...

Posted

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

Are the schools teaching something new, or are the nurses not trained right, or are they just doing what they want?

I've seen more and more nurses put trach ties on so the foam part goes through the trach instead of just the Velcro. Its silly and makes no sense at all. I can remove the tie with one hand with just the Velcro through. But when the thick foam is pulled through, it takes two hands. Even saw one today where the nurse turned it inside out and then pulled the foam through. That means she had to undo the Velcro and reverse it before putting it on wrong. Why all the extra work?

Depends on what type of pt your talking about. You absolutely dont pull the foam through the flanges on a peds pt. The Velcro is reinforced at the attached end which prevents tearing. The foam alone may tear easier.

SDALPN

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

Depends on what type of pt your talking about. You absolutely dont pull the foam through the flanges on a peds pt. The Velcro is reinforced at the attached end which prevents tearing. The foam alone may tear easier.

This exactly. I just can't understand why they do it.

brillohead, ADN, RN

Specializes in Cardio-Pulmonary; Med-Surg; Private Duty. Has 5 years experience.

Well, just a couple years ago, nursing school was still teaching twill trach ties!

I've never seen it done with the foam pulled through...what a pain! I'm gonna go with improper training and/or odd parental preference?

systoly

Specializes in LTC, Memory loss, PDN. Has 23 years experience.

does the pt. have the wrong size trach ties?

there should be instructions for the particular type the pt.

is using, on the plastic packaging or the box

personally, i cannot imagine having to use both hands to handle

the ties and still stabilize the tube at the same time

i had zero trach related training in school

SDALPN

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

Right size trach ties. I've seen this a lot on quite a few different patients. Just can't figure out where its coming from. I can't find any logic behind it at all.

systoly

Specializes in LTC, Memory loss, PDN. Has 23 years experience.

Right size trach ties. I've seen this a lot on quite a few different patients. Just can't figure out where its coming from. I can't find any logic behind it at all.

the only thing i can think of is that this is done in an attempt to avoid having the plastic (the back of the velcro strap) touch the skin, but usually the split gauze covers this area anyway

do these pt.'s not use trach sponges around the stoma?

would be interesting to find out the rationale behind this, because i sure can't think of

anything that makes sense either

brillohead, ADN, RN

Specializes in Cardio-Pulmonary; Med-Surg; Private Duty. Has 5 years experience.

I wonder if someone did it thinking it would leave an "air gap" between the trach flange and the skin, to aid in healing of a red/raw stoma region?

I would definitely question it every time I saw it, as in flat out asking the previous caretaker (parent or nurse) what the purpose was of doing it that way.

SDALPN

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

I've seem it so much. But as you all know, if I ask the nurse...they may take it the wrong way or take it as complaining. I figure the ties are still secure in a way so its not causing harm at the moment. But if I have to do an emergency trach change on a wiggly kid, it will take that much longer to get the tie off.

systoly

Specializes in LTC, Memory loss, PDN. Has 23 years experience.

I've seem it so much. But as you all know, if I ask the nurse...they may take it the wrong way or take it as complaining. I figure the ties are still secure in a way so its not causing harm at the moment. But if I have to do an emergency trach change on a wiggly kid, it will take that much longer to get the tie off.

emergency = scissors

SDALPN

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

emergency = scissors

Of course, assuming they aren't misplaced. On this case, I walk in and the kid is plugged or desatting and nothing is in its place. But yes, scissors if they are available.

systoly

Specializes in LTC, Memory loss, PDN. Has 23 years experience.

Of course, assuming they aren't misplaced. On this case, I walk in and the kid is plugged or desatting and nothing is in its place. But yes, scissors if they are available.

yeah that

like a family member saying, "oh i borrowed the scissors, they're around somewhere"

i carry a pair in my bag

smartnurse1982

Has 7 years experience.

it depends.

If its Dale Pedi Ducks or Pedistars,i would not understand why they do it. They do have the adjustable velcro in the back of the neck,in addition to the sides.

Those are the best brand in my opinion.

This other brand i cannot STAND and with those you have to pull the foam through or else the trach will definately fall out.

This bran does not have velcro in the back of the neck like Dale does,only velcro on the sides.

I think they are from Pepper Medical

We cannot adjust it from the back,only the sides

SDALPN

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

it depends.

If its Dale Pedi Ducks or Pedistars,i would not understand why they do it. They do have the adjustable velcro in the back of the neck,in addition to the sides.

Those are the best brand in my opinion.

This other brand i cannot STAND and with those you have to pull the foam through or else the trach will definately fall out.

This bran does not have velcro in the back of the neck like Dale does,only velcro on the sides.

I think they are from Pepper Medical

We cannot adjust it from the back,only the sides

That's different. I'm talking about the ties with Velcro. Dale makes one that you pull through and its an adult tie. But that is thinner on the part to pull through and meant for that. I've never liked that tie, but its not that common at least. The ones I'm talking about have Velcro and aren't meant to be pulled through.

the only thing i can think of is that this is done in an attempt to avoid having the plastic (the back of the velcro strap) touch the skin, but usually the split gauze covers this area anyway

do these pt.'s not use trach sponges around the stoma?

would be interesting to find out the rationale behind this, because i sure can't think of

anything that makes sense either

This is what I was thinking. I saw a mom start to do that because she did not have the sponges. I had to explain the risk of the ties coming lose because there was inadequate contact are of the velcro.

Im literally trying to visualize how the gauze is being put on through the flanges. I sometimes catch the gauze with the Velcro part putting it through the loop but never on propose.

brillohead, ADN, RN

Specializes in Cardio-Pulmonary; Med-Surg; Private Duty. Has 5 years experience.

Im literally trying to visualize how the gauze is being put on through the flanges. I sometimes catch the gauze with the Velcro part putting it through the loop but never on propose.

Not the guaze, the FOAM of the ties is going through the flange.

The ties are a foamy strap material with a skinny velcro strap on the end (separate from the wider piece of velcro that fastens the two ties together around the neck), and only the velcro is supposed to go through the flange's holes and fasten back onto the foam strap.

But if you yank really hard and bend the corners of the foam over, you can pull the part that is supposed to just stay around the neck up and through the flange holes too, after you pull the whole entire skinny velcro strip through. Then, in order to remove the ties from the flange, you have to wiggle and pull to back the foam part back out of the flange holes.... all that finagling is the problem.

Oh I got it! Thank you for clarifying. I wasn't taught that way either. I learned with a shoelace in school. Trained with my company. They never taught us that. Looks like that would by too tight around the neck. I'd like to know the rationale as well.