When the Trach tube comes out, how do you ventilate the patient?

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I can't find this in my book anywhere, when the trach comes out accidentaly, and you want to ventilate the patient with the ambu bag, do you ventilate their mouth or their stoma? I always thought you would ventilate the stoma but another student told me they would ventilate the nose and mouth. Please help!

Also, is there any reason why grown adults bite the ET tube? why do they do that?

If you can simply make an incision into the trachea (tracheotomy) and put the tube in, why bother doing the tracheostomy? What would happen if you left a person with a tracheotomy in place for long term?

Also, how is the care different for the two patients?

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I have seen real RN's who sadly know very little about this subject, let alone a nursing student who is trying to absorb this information

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Specializes in PACU, OR.

No (HORRORS! Pulling the trachea out..!!!) the tracheotomy is the surgical procedure of making an opening into the trachea for the purpose of establishing an airway in a person whose upper airway is obstructed. You got that right, but the resultant opening is kept patent by insertion of a tube, of which there are different types. This opening is called a stoma, hence the name tracheostomy. The trachea is not pulled out! Unless, of course, you have a grudge against that particular patient...:D

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Specializes in Education, FP, LNC, Forensics, ED, OB.

Threads on like subjects merged and thread moved to Nursing Student Assistance forum where the OP can receive assistance for this homework question.

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The main thing is to know is what type of opening the patient has and where it goes or doesn't go. Then you can more easily refer to the proper P&P in your manual.

No (HORRORS! Pulling the trachea out..!!!) the tracheotomy is the surgical procedure of making an opening into the trachea for the purpose of establishing an airway in a person whose upper airway is obstructed. You got that right, but the resultant opening is kept patent by insertion of a tube, of which there are different types. This opening is called a stoma, hence the name tracheostomy. The trachea is not pulled out! Unless, of course, you have a grudge against that particular patient...:D

This depends on the type of surgeries done in your hospital. Some doctors like to differentiate between -otomy as the incision meant to close when something is not there holding it open and -ostomy with the ostomy being more permanent and will not close once the trach is removed.

I have also posted a photo here of a stoma being formed when the trachea is brought to the surface. It is a HORRORS! photo and I apologize if some are squeamish. (Google Images is a great tool - yeah that posters and graphics display thing again)

To form an -ostomy (according to the purist of ENTs surgeons), after a laryngectomy the trachea is brought to the surface and the stoma is formed. A more permanent ostomy or stoma can also be created without the laryngectomy if the patient needs tracheal access but still has their larynx some upper airway access. Of course many use the terms interchangeably and may not actually realize what their patient has.

Example of a stoma s/p laryngectomy (you are looking directly into the trachea)

http://www.dwp.gov.uk/img/laryngeal-cancer.jpg

In the above photo you will see a little tag stick out which is a prosthetic speaking valve (Blom-Singer) that fits into the fistula between the trachea and esophagus.

Below is a neck resection with laryngectomy where the trachea is being prepared to form a stoma at the surface.

http://www.rborl.org.br/conteudo/acervo/Images/10-figura2-68-5.jpg

Text that goes with that photo:

http://www.google.com/imgres?imgurl=http://www.rborl.org.br/conteudo/acervo/Images/10-figura2-68-5.jpg&imgrefurl=http://www.rborl.org.br/conteudo/acervo/print_acervo_english.asp%3Fid%3D466&usg=__yr2iqNbvu9YPcQYDkkeXfQhv30A=&h=254&w=350&sz=9&hl=en&start=94&sig2=YCac3blewN2vmnp2Vg72og&zoom=1&itbs=1&tbnid=qMxvj1GMM2KkrM:&tbnh=87&tbnw=120&prev=/images%3Fq%3Dtracheotomy%2Bincision%26start%3D80%26hl%3Den%26sa%3DN%26gbv%3D2%26ndsp%3D20%26tbs%3Disch:1&ei=YmO2TLrEIoG2sAODopTeBA

Diagram of a tracheostomy s/p laryngectomy.

http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Larynx/Treatinglaryngealcancer/Laryngectomy.gif

This is a tracheotomy incision that needs a little TLC and Bacitracin.

http://amamasblog.com/wp-content/uploads/2008/11/t-infected-incision-2.jpg

Tracheotomy incision with a trach

http://www.rch.org.au/emplibrary/ward8west/trache_3.jpg

Note that there is still an intact trachea above the trach.

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Specializes in Gerontological, cardiac, med-surg, peds.

A big thanks to GreyGull for your amazing insight and knowledge. Thank you for so freely sharing out of your vast reservoir of expertise. I have learned much from your posts on this thread.

Moderator's friendly reminder: This thread has been moved to the Nursing Student Assistance Forum. This is a safe place (in other words, a haven) for students to come asking for help without being dissed by the membership. All unhelpful and off topic comments on this thread (that threaten to derail the thread) have been and will be removed. All references to these unhelpful comments have also been removed. Thank you and carry on...

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Specializes in PACU, OR.

:bowingpur

Thanks, Grey Gull, your diagrams and even the HORRORS! piece are joining my notes!

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ive had my trach for 12 years now and its only came out one time.

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i think gg alluded to this earlier, but the thing that always flummoxed me when i was a student was why some people with trachs would need to be bagged to the tube and why some could be bagged with a face mask.

this is because nobody bothered to explain to me the difference between:

1) a quick opening in the front of the neck to access the airway because of the need for long-term (but maybe not permanent) ventilation support with humidification, to avoid having an endotracheal tube in mouth or nose-- increased incidence of infection, and very uncomfortable. they might not be able to come off a vent postop, have a temporary condition (like botulism or guillain-barre), or a serious lung infection that makes the work of breathing just too hard for them. these people can be mask-bagged in an emergency if nothing has messed up their upper airway (pharynx). they may have their trachs out when their medical issues resolve (they recover their ability to ventilate themselves effectively), or they may be permanently trached if their respiratory effort will never be adequate (als, for example).

2) a quick opening in the front of the neck to access the airway because the upper airway is temporarily closed, as from a massive allergic reaction, trauma, or a foreign body stuck in there. these people will have temporary trachs with humidification until their emergencies pass; they can be bag/mask ventilated only if their upper airways are cleared of whatever closed them in the first place.

3) a permanent opening in the front of the neck to access the airway because the upper airway will always be gone. you see this in laryngectomy, for example-- there is no more airway between nose/mouth/pharynx and the trachea, it's been surgically excised. these people can never be bag/mask ventilated because there's no connection between the mouth and lungs. a lot of them don't even have tubes in there, once their stomas are mature. they need special attention to humidifying the air they breathe, because they have no way to do it themselves without a way for air to pass through nose/sinuses. also can't smell anything, or very little, and this also affects their sense of taste. all sorts of safety and quality of life issues there.

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