Tracheaostomy venting

[Anggelica]

I had a pt that had a planned tracheotomy put in 4 days ago. In my nursing opinion he required a lot of suctioning and after I suctioned it. pt still was still feeling SOB, so i would change the inner cannula and the pt would have some relief. He has cuff trach, inflated.

My issue was:

1. i have been suctioning him pretty much every 1 or 2 hours with more often changing the cannula too because of SOB and when I changed it the inner canula was pretty much have a lot of secretions that adhered to it. My work got mad at me because I was suctioning and changing the cannula too often. Are they right? they said he needs to learn to cough it out, with I agree but in my nursing opinion, his lungs is still not that strong to cough it out. He is only to the point where where he can cough it out, up until the inner cannula. I have been trying to suction it out as much as I can but to it was very thick.

2. When the next shift came they refused to suction it for him because according to them he needs to learn to cough it out. Which is fine by me because I respect their nursing decision. I felt like they should respect my nursing decision to change it especially if his stats are going down and he looks as pale as a ghost.

3. Mind you when I has him yesterday, he did not have any breathing treatments. right at the change of shift, i was able to beg for breathing treatments. In my opinion, this will increase sections therefore needing for more suction, but before I suction it I try to make him cough first and it doesn't work I suction.

4. I sorry about the rant I just frustrated and I really do not know what is right and wrong now because according to my research and the textbooks if I interpreted them correctly the patient, assuming the pt is alert and orientated, can tell you if he needed suctioning.

5. they told him to use Incentive Spirometer but his cuff is inflated. I did give him one and made him use it but it would not work. To my understanding when the cuff is inflated most are will go in and out of the trach tube and if you block it the pt will not receive air because it pretty much goes in and out of trach tube.

6. I have asthma, so when A pt tells me he is short if breath, I do not ignore it even if this O2 is good. I sympathize with them because it is very anxiety provoking if you cant breath and no one believes you.

[MunoRN, RN]

Are you humidifying the patient's intake air?

[LadyFree28, BSN, LPN, RN]

What was his lung sounds?

Like Muno said, was the pt on a humidified trach collar?

Also, what is your policy and procedure and plan of care? You are in a position where textbook is not emphasized, but the policies and plan of care for the pt.

I'm also curious as to what setting you are in; if they are "complaining" about changing inner cannulas, you must bear in mind how your setting handles changing inner cannulas, especially if they are based on supply for the pt and they are of limited supply.

[NightNurseRN13]

Isn't it pretty normal to have increased secretions with a new trach? Can you remove the inner cannula and clean it then replace? And are you allowed to deflate the cuff just while he uses the incentive spirometer?