Tracheostomy & inhaled meds

[Donna9]

Hi, I'm new to Med/Surg. When caring for a patient with a tracheostomy (long-term) who is able to speak without covering the opening, do I give inhaled medications like Spiriva or Advair through his mouth or through the trach? It seems like it would go through the trach, but the medication says it is for oral use only. What is recommended? Thanks.

[NuteRN]

As with a lot of things, that depends on the patient. Someone who's trach is plugged most of the time might take inhalers orally, and the same with someone who is obese and has was trached more for prophylaxis. I've had some, though, that take it through their trach at home. The best thing to do is ask them what they normally do, or ask a RT.

[Beesandsoxfan]

As an RT, I do not recommend Diskus-style meds to be administered to patients that have a trach tube. Let me explain both possible routes:

1. Thru the trach tube is not possible because there's no adaptor made for it to be administered properly because this type of med requires pt. inhalation effort.

2. Thru mouth is possible, but with a an artificial trach tube occluding at least 2/3 the patient's trachea, how much of the medication will actually reach the lungs to be effective ?

Patients with trachs should have their bronchodilators, corticosteroids, and antibiotics thru aerolsol nebulation. However, they can also be administered thru trach with an MDI (metered dose inhaler) set-up and pushed in with an ambu bag w/ 10 pumps after each puff.