vent/trach help!!

[Akeos]

Hey guys, i need your help. I work in home health and I have a pt. who has a trach and is on a vent. here's the situation and i've never had trouble with this before..she usually has great pressures that are easily fixed if they go up. but..

she keeps high pressuring unless shes in one position on her left side...she has to be propped up to the right place or she high pressures whenever i try to reposition her in any way..on her back, head elevated, on a pillow, flat, ect. she high pressures! her lungs are crystal clear, and i can't get anything out when i suction, which is also unusual. i feel horrible for not being able to reposition her..no pt. should be in the same position this long.. it's to the point where i'm not sure i'll be able to change her without the issue.. o and her trach was just changed and i've tried the back up vent and the smae thing happens, so its not the vent either.

it's making me really anxious, i can't think of anything else to do..please help!!! suggestions, advice, reasons this is happening??

[Five&Two Will Do]

Maybe the trach is turning when you turn the patient or perhaps the HME needs to be changed?

[Akeos]

She doesnt have an HME she has a heater attached to her vent. i've tried readjusting the trach a little, which also usually helps, but not this time.

[jammin246RN]

A dumb question I know.... But can you hear lung sounds in both lungs? What about when you reposition her?

[Five&Two Will Do]

Have you tried bagging for a minute to see if there is more difficulty than usual? Also how is chest expansion?

[Five&Two Will Do]

A dumb question I know.... But can you hear lung sounds in both lungs? What about when you reposition her?

That is a great question

[Five&Two Will Do]

Perhaps you can try to increase the inspiratory time a bit if your assessment is negative in all of the other ways we are talking about.

[Akeos]

I can hear lung sounds in both lungs, her chest is rising as normal for her (i was freaked out that it wasnt when i got here, but it is). i repositioned her to her other side which she seems to be doing fine on. it's just when she's on her back, (which is normally how she's positioned) that she is high pressuring. the more i roll her on her side the better here pip gets. could it have to do with the way the new trach might be positioned since she just had it changed?? i'm really at a loss here, but feel better now that she's at least on her other side.

[Akeos]

her lungs sound louder when she's on her side vs. her back, but i wouldn't say they were diminished when she's on her back, just extra loud when she on her side..if that makes any sense

[Five&Two Will Do]

her lungs sound louder when she's on her side vs. her back, but i wouldn't say they were diminished when she's on her back, just extra loud when she on her side..if that makes any sense

Makes good sense perhaps the new trach is too long and when she is lying flat the curve is pushing it into the anterior portion of the trachea? So long as the patient looks good and sats well, I would hang in there and perhaps consult RT asap.

[Akeos]

thank you all for your help! i really appreciate it

[netglow, ASN, RN]

What Five&Two Will Do said.