Originally published on June 24, 2011 Dr. S.A. asks, "I just received a rehab patient with a trach button who has developed pneumonia. Can I just replace the button with a regular trach?" Answer: A trach button is often placed to maintain the stoma while the patient is gaining strength through rehabilitation. The benefit of a button
R.B. asks, "When a patient is on the ventilator, what causes a leak in the cuff?" Answer: There are many causes to a cuff leak. First, to clarify, it is rare that a leak within the cuff actually happens. What happens most often is a leak around the cuff. This leak around the cuff is usually caused
Originally published on May 29, 2011 T.H. asks, "What is the purpose of a fenestrated tracheostomy tube?" Answer: The word fenestration comes from the French word, "la fenetre", meaning 'window'. So a fenestrated tube is one with a window, or a hole, on the dorsal shaft of the tube. The purpose of this hole is
W.C. asks, "I've noticed a small amount of bleeding from my trach recently. Should I be worried?" Answer: The two most frequent causes of tracheal bleeding are due to frequent suctioning and lack of humidity. Regarding frequent suctioning, one should not decrease the frequency of suctioning just because of the appearance of some blood. Rather, this
Dr. C.R. asks, "What kind of home supplies do my tracheostomy patients need?" Answer: Patients need many supplies to manage their tracheostomy. They need plenty of suction catheters, suction machine, tubing, inner cannulas (if disposable), tracheostomy cleaning kits, trach holders, and an extra trach of the same size, and one size smaller. It is essential
Originally published on November 25, 2011 R.H. asks, "We have a tracheostomy patient who is being airlifted to a different facility in another state. Should we have any concerns with air transport?" Answer: The biggest concerns with transport of any kind is dislodgement. So the usual precautions for ensuring tube security should be in place. These include ensuring
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 size smaller, suction catheters (and a
Dr. E.H asks, "What are the most common emergencies with tracheostomies?" Answer: The two most common emergencies with tracheostomies are mucus plugs and inadvertent decannulation/displacement. Mucus plugs occur because of inadequate hydration and inactivity, resulting in thickening and stasis of secretions. Initial presenting symptoms of mucus plugs are respiratory distress and/or desaturation. Treatment involves removing/cleaning
This was a 10-year study done at a tertiary care teaching hospital in Tanzania and included 214 patients. Male to female ratio was 3:1, with a mean age of 38 years. In their study, the most common indication for tracheostomy was upper airway obstruction secondary to trauma or neoplastic causes. Eighty-six percent of tracheostomies were temporary,
Originally posted on January 16, 2012 Decannulation failure is defined as the need to replace the airway after the tube has been decannulated. This Australian study examined 981 ICU patients who received tracheostomies. Seventy-seven percent of them were placed percutaneously and 23% were placed surgically. The mean duration of placement was 16 days. A total of 823 decisions