Trach's in Home Care

[hoolahan]

OK, here is my question. I opened a case last weekend, a young man with a trach, a plastic Shiley type, placed for sleep apnea. So he says, I got a very poor history, and on the weekend, it is hard to speak with anyone who knows anything about his case.

The HMO sent twill "tapes" to tie his trach with. Now I have a critical care background, and I remember the days when that was the only choice anyone had, but why would that cheap HMO send something so difficult for even many nurses to do properly? I put in a request for the foam/velcro type of ties.

I have not had many trach's in home care, and none in my own caseload, so I am wondering, are we suypposed to tecah the pt to change the ties themselves? I have one pt who I am in e-mail contact with, she was a nursing school instructor, and she has had a trach for quite some time. She agreed with me that this would be nuts to teach a pt. I also felt that no one should be alone when an airway is changed, heck, I am sure someone else is nearby when I change trach ties in the ICU for heavens sake. Is anyone out there teaching pt's to do this for themselevs? If not, how often do you change the ties? My other pt/rn says q 2 weeks or prn.

Any insight?

And where the heck is everyone?? No posts in this forum for a while, wake up HH nurses!!!

[hoolahan, ASN, RN]

That's the thing about working weekends, I never find out!

I did look for his chart, but never found it. I wondered which nurse they gave him to, but couldn't figure it out.

I'd like to know too!!

[kids]

Hi! Been reading you guys for a while...just got around to registering... I am Clinical Coordinator for a Nation wide"yada yada yada"...any way, I have been doing trach/vents/adults/peds/facility/homecare for about 7 years... Medicaid will pay for velcro type ties, usually its just a matter of telling your supplier what you want. I have a strong preferance for the Posey brand trach tube holder...is one piece, with velcro on either end, comes in 3 sizes (S,M,L) each size accomidating a large size range, it is also softer, wider and more durable than the Dale. Also, we change trach ties at least daily-soiled or not, with trach care. They need to be changed anytime they become damp with any liquid-bathing, persperation, secretions. Longterm trach clients are very prone to yeast infections under their trach ties. There is also a 'device' called a trach chain. It is a surgical steel chain-like a larger version of a dog tag chain, and it clasps the same way...they do not have to be changed and dont trap any moisture.

[NRSKarenRN, BSN, RN]

Welcome kids r fun! Thanks for the great advice and welcome. Hope to see more of your posts. What concerns do you have re homecare these days? Please post anything you feel is important for us to know about in this forumn.

Correction re "FREQUENCY OF TRACH TUBE HOLDER CHANGE".

(Re-read info posted, don't know where the brain cells were before.)

1.FRESH/NEW trach patient: Change trach tube holder daily or more frequently if damp/soiled. Pay special attention to skin beneath trach flange plate and back of neck.

2. Patient with trach several weeks to ~ 6 months: Change trach tube holder daily. May gradually increase time wearing holder between changes to 3-5 days; change immediately if damp or soiled.

3. Established NON-VENTED patient: Change trach tube holder 3-5 days recomended; Minimum of weekly to prevent skin irritation from constant neck rubbing. Change immediately if damp or soiled.

(Patients often have minimal secretions; if frequent sputum producer would continue daily change.)

4. Established VENTED Patient: Would continue daily change if having daily nursing care. Otherwise, change q 2-3 days when vent tubing changed.

Long term patients have a way of deciding whats best for themselves. As long as no skin irritation and good hygiene practiced, leaving on up to a week is acceptable. Check patients neck & beneath trach holder EVERY visit to home/Drs office for signs infection or breakdown.

[hoolahan, ASN, RN]

Welcome kids-r-fun, I hope you post often!