Vent/Trach nurses: If a trach becomes dislodged, what do you do?

meandragonbrett · Dec 11, 2007

Should always have spare ones at the head of the bed. We've also stuck an ETT in there at times when unable to get a new trach to go in.

cvryder · Dec 11, 2007

Should always have spare ones at the head of the bed. We've also stuck an ETT in there at times when unable to get a new trach to go in.

We had to do that once with a morbidly obese patient whose brand-new trach came out before it had been in 24 hrs! He ended up keeping that ETT in until they could get a specially-ordered extra-long trach for him.

Normally there should be an extra taped at the head of the bed.

leaflet · Jan 12, 2008

Ok silly question in re: to this discussion. Say the trach comes out, you grab the obturator, are you reinsrting the one that just came out or a new sterile one? Then if that size doesn't work you grab the smaller size and attempt to reinsert that sterile one.

judytheoldrn · Apr 11, 2008

When I was Nurse Ed on a ventilator stepdown, I got signed off on changing trachs, then signed off other staff nurses on each shift - hoping that there would always be someone there who had done it at least once. It can be tricky based on the individual's anatomy - in 8 years of routine q 30 day changes, there was only one I couldn't get in - someone with kyphoscoliosis and a weird anatomical trachea.

Here's a tip for emergency - insert a suction catheter into the stoma while you are waiting for the right person to come to reinsert. This will keep the stoma visible and the new tube can actually be threaded right over the cath and then the cath remove - you'll have to remove the adapter at the end of the suction cath to get the trach tube over it, but it works every time. If you do end up with a smaller tube, let the surgeon know immediately so s/he can reinsert a larger one (my patient ended up with a 4 in the end and still has it many years later)!

hup143 · May 31, 2008

If all else fais, cut a section of suction catheter to place it into the stoma in order to keep the stoma open and maintain an airway. Be sure to cut long enough so that it cannot be aspirated. Hold on to the catheter and call the er services.