Published Dec 10, 2007
I would reinsert the trach if possible..
Is this correct?
elizabells, BSN, RN
On our unit we:
1) attempt to reinsert ourselves, if unsuccessful we
2) call the neo fellow, and if necessary place a gauze over the stoma and bag as normal, if the fellow is unsuccessful we
3) page ENT!
It's always important to keep at least two spare cannulae at the bedside - one of the size the pt has in, one a size smaller in case the stoma becomes edematous and you can't get the same-size one in.
Hope this helps!
Always replace as soon as possible and if possible. There should always be back-up at the bedside, including a size smaller to make it easier to get in place if the original size will not fit at this time.
Key caveat to this:
You must always have proper training before attempting this if you have never done it before.
I was wondering, is trying to reinsert it the better option since the time frame is a lot faster then putting a new one in?
Yes, it is an emergency situation but the goal is to keep the patient alive with no bad effects or complications..
BBFRN, BSN, PhD
Just wanted to add that you need to make sure you insert the obturator into the cannula before you re-insert the trach.
I would also page respiratory right away. Also check your hospital policy. We are supposed to call respiratory (of course I worked on a med/surg/stepdown unit at the time. However, we got many, many fresh trachs there so were comfortable reinserting. I also echo, not to try this if you haven't done it before.
Also, just because the trach is out does not nec. mean the patient has lost there airway. Respiratory should be there in a few moments, esp. when you tell them patient has coughed out trach.
Get it back in a quickly and safely as possible! If you hesitate you could lose your airway and hence your patient. Then re secure it and let the doc know it needs to be re stitched. If you are dealing with trached patients then make sure you get the proper training and ALWAYS have the proper backup and emergency equipment at the bedside.
My modus operandi is pray for the best but always prepare for the worst.
Depends on where you are, but new ones should be right at the head of the bed.
The way that you are asking, have you actually done this before or are you just trying to be prepared for it? You need the obturator to be able to insert the old one so just as easy to use a new one. Takes the same amount of time to prepare it.
Depends on your facility's policy. When I have worked in ICU, we were taught to insert a new, smaller trach tube, with the obulator. And page Respiratory Therapy stat.
When i worked in ICU this accidently happened. We were turning a ventilated patient and the trach just came out. The senior nurse reinserted it, we checked her SaO2 and called for an x-ray straight away. Horrible situation because if we couldn't get it back it properly the patient may have died.
When one of my trach babies learned to extubate himself, he started to do it on a regular basis. He did it twice while his mom had him with her in the grocery store. While it startled bystanders, mom had no problem just putting it back in. By then she was used to it. And we started to discuss with the MD when the baby would be able to be weaned off the trach. It wasn't long after, that they decided that he could get along without the trach anymore.
ebear, BSN, RN
...and after you brown your shorts--at least get your hands on a Kelly Clamp and open the hole til somebody gets there to put it back in! Unless it's an infant. I'll just tell ya right now I don't remember nothin' 'bout babies! As the others have said, make sure you have a backup set at the head of the bed w/obturator! and a smaller size...
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