First Trach Change

Originally published on November 30, 2011 There is very little research regarding when it is safe to do the first tracheostomy tube change. Commonly, the first tube change is done between post-op day 7-14. A study was just published in Critical Care Medicine and showed that it is safe to do the first tracheostomy change

Complications During Tube Replacement

Originally published on June 23, 2010 C.L. asks, "What are the chances of esophageal or tracheal rupture, or subcutaneous emphysema with reinsertion of a dislodged tracheostomy tube?" Answer: I have never encountered esophageal nor tracheal rupture during reinsertion of a dislodged tube. Nor am I aware of any reports in the literature. Theoretically, it could

Positioning for Trach Reinsertion

Originally published on July 30, 2010 C.L. asks, "If inadvertent decannulation occurs, what is the best patient positioning for reinsertion?" Answer: Supine positioning with neck hyperextension is ideal for reinsertion. However, this may not be appropriate for all patients. The key is visualization of the stoma and adequate lighting. I have reinserted trachs in all

Frequency of Tube Changes

Originally published on November 23, 2010 J.C. asks, "How often should a tracheostomy tube be changed? Answer: Tracheostomy tubes should be routinely changed on a regular basis to prevent infection and other complications; and in the case of children, to keep up with their growth and development. Most manufacturers recommend changing their tubes every 30-60

Bloody Secretions

Originally published on October 5, 2010 B.L. asks, "What should I do if the secretions become bloody? Am I suctioning too much?" Answer: Secretions can become bloody because of tracheal irritation. And yes, this can be caused by frequent tracheal suctioning or strong coughing. However, the presence of bloody secretions should not cause you to

Emergency Equipment

Originally published on October 12, 2010 Nurse C.D. asks, "What type of emergency equipment should I have at the bedside?" Answer: One must always be prepared for an emergency, and the key is to have essential items always available. These items include: extra tracheostomy tubes of the same size and type, as well as one

Your Most Valuable Tool

Originally published on October 31, 2010 B.W. asks, "What does it mean if I start to have trouble passing the suction catheter?" Answer: Meeting resistance upon passage of a suction catheter usually means one of two things: either the inner lining of the tracheostomy tube is becoming coated with secretions, or the tracheostomy tube has

Water or Saline?

Originally published on May 6, 2010 A respiratory therapy student asks, "What am I supposed to use to inflate the cuff of a Bivona TTS trach? I've heard they should be inflated with water, but I've also heard saline. Which is it...and why?" Answer: The Bivona TTS and the Arcadia CTS tubes are both made

What is Downsizing?

Originally published on May 30, 2010 P.T. asks, "What is the purpose of downsizing?" Answer: The purpose of downsizing is to allow the patient to do more breathing around the tube, rather than through the tube. When the initial problem that initiated placement of the trach is resolved, downsizing may begin. For example, when the

Discharge Instructions for the Patient with a Tracheostomy

Originally published on December 1, 2010 G.J. asks, "When patients with a tracheostomy are discharged home, what do they need to know to take care of themselves?" Answer: Patients and families who are being discharged with a new tracheostomy need a great deal of teaching in order to become comfortable with their care. Ideally, this