Treatment by respiratory therapist/inner cannula difficulty

[sistrmoon, BSN, RN]

I'll preface this by saying I'm no trach expert, but I've dealt with a fair number in 8 years of Onc due to head/neck cancers.

This weekend, I was doing trach care on a patient with a disposable cannula. I removed it without issue. When I attempted to put in a new one, I was unable to, and the patient was coughing and red faced. I called in another experienced RN, and she was also unable to. A Respiratory Therapist came and was eventually able to, but with great difficulty and about 10 minutes of maneuvering. He said he had to "face it up" to get it in. I didn't witness this as we were in report so I'm not sure exactly what that meant. We had tried different angles without success.

The next morning, a different RT came to do a treatment(we do nebs on all patients except trached.) When they come, they will suction and do care if needed. I mentioned to her the difficulty of the prior day. I said the patient had a tumor that had pressed on the esophagus so maybe that was a factor and she said it wasn't possible like I was stupid.

So we go in and of course she pops it in no problem. She loudly says to the patient in a rude tone, "Well, they had a problem yesterday but it went in JUST FINE for me!" This felt like either she didn't believe what I'd told her or she was implying nurse incompetence. This was unnecessary and disrespectful, not to mention, it wasn't just us but also an RT with difficulty the day before.

I know that RTs complain about bad treatment from nurses but I always treat them with respect and defer to their expertise.

So 2 questions: any idea why we might have had difficulty the day before? And, did I do something to deserve this treatment?

Nurse and Respiratory Therapist opinions welcomed. This has been bothering me.

[nrsang97, BSN, RN]

Without being there I cannot say that you did something wrong trying to reinsert the new inner cannula. I can say the RT was rude unnecessarily. She could have said "Here come with me and we will change his inner cannula together" so she could have possible seen the problem you had.

[dudette10, MSN, RN]

Can I just say how unprofessional it is when another nurse or department makes pointed comments about the care given by the primary nurse?

Where I work, PT/OT are the biggest offenders. I finally had a "come to Jesus" discussion with the worst of the worst who found SOMETHING wrong every time she worked with a patient. It had become a habit with her and had to stop. What really got her was when I relayed patient comments to me after she left about her rudeness to me. Nine times out of ten, the patient wasn't sure what she was so upset about. She stopped behaving that way, with my patients, at least.

[RNNPICU, BSN, RN]

Maybe a plug had filled the trach as you were inserting the inner cannula, especially since the pt was coughing. You might have just been meeting resistance as well. So many variables.

I am sorry the RT made that comment, nothing you have posted would have warranted a comment such as that one

[limit68]

Hey! I had very similar experience ! My patient was thyroid cancer case. His prime diagnosis was Laryngeal obstruction. He went through trachoma at the first time and was waiting for further operation. That day MD changed his trachea tube from plastic to metal . Only 2 mins the patient said he can hardly breath. Doc immediately changed back the trachea tube, but didn't work. We tried 1bigger size, it didn't work too. My patient can't made it,he passed away, only a few mins. We analysed the case, the tumor was very low. Trust me, it's totally not yr fault. And that doc in your hospital just lucky and too cocky. Even I feel angry for what she said to u! Btw, I'm a nurse who from China, I'm doing oversea training here ,very happy to meet you guys.

[JustcallmeNurse]

I see a lot of these trach patients for the same, head/neck/laryngeal cancer and I have also occasionally had problems inserting a non-disposable or disposable IC back in. I would say that maybe there was a plug in there, maybe they coughed after the IC came out and there was some mucous occluding the outer cannula, or maybe it was positioning. I've had some patients with larger/thicker necks that if they were looking down, or sometimes even straight ahead that the IC would not pass through. When that happens if the patient just extends their neck to look up, that usually "de-compresses" the area enough to pass the IC though.

Hope that helps!

(And that RT was un-necessarily rude.)