trach questions

[pittsburghgal]

My PALS has had a trach since last July. He had a very long hospitalization and the outer portion of the trach was changed in the hospital prior to discharge in Sept. Can someone tell me when this needs to be changed? I change the inner cannula every day and do routine daily trach care as I was taught at the hospital. We saw the surgeon who did the procedure (and PEG) for a follow up visit in Nov. and she said once a year. We saw the pulmonologist 2 weeks ago and I asked him the same question. He didn't answer and said "you need to follow up with an ENT physician". I am concerned about this because there is a mild odor coming from the trach that both my husband and I are aware of. There are no secretions and he feels well. The area around the trach looks fine. My husband told the pulmonologist at his visit 2 weeks ago but he didn't even look at it and just repeated the advice that we should follow up with ENT.
Sharon

 

[Diane H]

You are not getting a straight answer from your doctor because there is no standard time frame for changes. I started out with changes every six months or so, but soon recognized that it just didn't matter. As long as the trach isn't causing problems, changes are not really needed. The exception would be if trach changes cause more than a little bleeding that stops quickly. This would indicate the presence of granulation tissue. That requires more frequent trach changes so that the granulation tissue doesn't build up enough to make the trach change difficult. This is a more frequent problem with old fashioned fenestated or so called "talking trachs". I try to do a yearly change just to keep on some kind of schedule. The only thing that can wear out is the cuff if you have a cuffed trach.
My trach changes are done by a respiratory therapist in the Outpatient Center of the hospital. They do need a doctors order but the doctor doesn't do it himself. There are no doubt other options for getting the trach changed.
Why are you using a trach with an inner cannula? That isn't really necessary. The newer trachs are made with material that mucus doesn't stick to as badly as older style trachs. Not having to clean/change the inner cannula is a big time and money saver! Trach care becomes a daily soap and water cleaning around the stoma and replacing the gauze. The Bivona trach made by Smith or Portex is "softer" or more flexible than many and therefore more comfortable.
The odor from the trach is worth checking out though if there were an infection it would be getting worse and have drainage. It is more likely to be coming from the lungs rather than the trach area especially if suctioning brings up a yellowish, tan, even greenish mucus. This should be checked out by your pulmonologist and I worry about his knowledge of caring for trach patients if he wants you to see an ENT about an odor that is just as likely, if not more so, coming from his lungs!
Click on my name and then on my blog to get more information on home care of trachs and vents.

 

[pittsburghgal]

Diane,
Thanks so much for all the great information. The trach is a Shiley trach with disposable inner cannula. I don't see how the tubing from the Trilogy would attach on this particular trach if there was no inner cannula. The cuff is not inflated. Could we request a change to one of the softer trachs you mention when we are scheduled for a trach change?
We also worry about the pulmonologist because any time we ask any questions about the trach he says to follow up with ENT. We do not have an ENT doctor at this point and it is difficult for us to get to any doctor's office because I have to arrange transportation and my husband is very sensitive to the cold.
Sharon

 

[Diane H]

A trach without an inner cannula is made to fit to any ventilator tubing. You can request a different type of trach tube to be used at your next change, but that has to be ordered by your pulmonologist. Betcha he says "Ask your ENT"! Any chance of getting a different pulmonologist?

Just curious... Since your husband's trach is not inflated, can he talk -- or is the ALS preventing him from speaking legibly?

 

[pittsburghgal]

I'm sure that's exactly the response we would get from the pulmonologist! We switched to him after our first pulmonologist seemed to have no experience treating ALS patients and told us to return in one year! The pulmonologist we see now was suggested by our ALS neurologist that we see at the ALS clinic.

My husband speaks pretty clearly with the trach (even without the speech valve on). His voice has changed and he speaks slowly though.
I read your blog and found it to be very informative. Thanks.