Tracheostomy Care

[ToddMSRRT]

Hello Folks-

For those of you that work with tracheostomy patients (specifically those with disposable inner cannulas) what is the practice standard of changing the inner cannula? When I looked for the evidence based practice information, basically what I found is that there is little to support anything but institutional preference or manufacturers recommendations. The problem is that in my setting (LTC) the inner cannulas because of lack of buying power are very expensive ($11.00 each) We went to a process of Q week and PRN about 6 months ago and have had 0 issues in 24 patients. The patency of the cannula is checked several times a day by the Respiratory Therapist and the nurses, rinsed as needed and changed when the caregiver thinks it is needed and weekly. I am interested in any thoughts or experiences.... Thank you

[GreyGull]

It varies around here also. In one hospital it is q12 and another q8 based solely on the shifts the RNs or RTs are working with the order or protocol stating "q shift". We occasionally break policy when there is an "ordering problem" from Central or the manufacturer without any problems.

For one subacute associated with the hospital, they use Portex trachs (same as the hospital) and don't use inner cannulas except for a patient who might have thick secretions. Another subacute changes the IC q24 hours on pm shift. Home health here is q week and prn with not too many problems even with some questionable living conditions.

Of course there are also trachs that don't have an IC such as Bivona and Shiley SCT which do okay for the long term.

You could go to Shiley non disposable but that would be a pain for the long term if you have several patients and I see less benefit from removing the IC every shift to clean.

I have found secretions tend to adhere to Shiley (except are the single cannula trachs - SCT) more than Portex. Portex ICs can also be a little cheaper than Shiley.

If your rinsing procedure is acceptable from an infection control view point, I don't see an issue with your practice now.

Have you posted your question on the AARC forum? The RC Journal also has a few articles about the use of inner cannulas.

[JRN72]

Spent the last year working on a vent dependent unit of 22 pts. Most long term....very long term, others in for weaning. Inner cannulas, when they had them, were changed daily, each had an order for prn as well.

[steelydanfan]

In ICU we had protocols for trach care and cannula change q12 hours. On the floor, RT is responsible, but I always do trach care and and change on my shift if it looks gunky and let RT know.