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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