Smelly Trach

[katekath]

I have a few questions I hope a RN or anyone with trach experience can answer me.

I was cleaning my mum up yesterday night at the hospital when I realised the stoma area where the trach tubes are smelled foul. I notified the nurses, but they told me it is normal. Is it?

They also used Mepilex dressing to absorb the phlegm that are oozing out. I was told by a RN from another hospital that this dressing is useless since the phlegm continues to ooze out all over the dressing portion that is non-absorbent and stains her clothes. Should they be using cotton gauze instead?

In addition, they refused to change the dressing, though it is soiled and insisted the dressing can only be changed one a week. Won't that cause more infection? She already had pneumonia, which is subsiding currently.

 

[judylyne]

I.ve taken care of children with trachs and on vents for years and they had their dressings changed twice a day or more often if needed. We used split gauze dressings. Sometime they smell bad but don't have an infection.

 

[freddiesnetty]

They are wrong, I went through this with Freddie this sounds like asudomonia, not sure about the spelling, this is a nasty infection. It can only be treated with certain antbiotics. You need to act on this real fast, and don't take NO for an answer.............
Hugs to you
netty

 

[freddiesnetty]

Sorry I just noticed that you mentioned pneumonia, that will increase secretions, but the smell is an issue....Come on JoelC where are you? He and quadbliss are very helpful, and as far as changing the dressing, if it is oozy, it needs to be changed........Sometimes I will change the dressing every few hours and he is once again getting over pneumonia. This is not good to have a foul smell....Raise some hell and get her the treatment that is needed....I raise hell with them on a constant basis. You are in the hospital, not in jail!
netty

 

[brendapals]

netty is right!

I had a patient for about 3 yrs, with a trach, and she rarely had any drainage. When she did, she had some type of infection brewing somewhere, so yes, please, ask your mum's nursing staff to check with her doctor, or ask for the lab results of her latest CBC and see if her white blood cell count was elevated, often indicative of an infection.
It pays to be proactive!
I hope for the best for you and your mum,
please keep us posted,
brenda

 

[joelc]

Great suggestions!
I agree with what everyone is saying! Start screaming as the smell is not normal and likely indicates an infection of some kind! The dressing needs to be changed daily, or more often if there are a lot of secretions coming out the stoma. We clean around my stoma using long Q-tips and saline solution then put a new dressing on. It does not stink. I cannot imagine leaving the old dressing on for a week - that is dead wrong! Please start complaining and find a doctor that will help and check her out. I fear she already has an infection that needs to be dealt with ASAP!

Does your mom have a fever? That is usually an indicator for an infection. Since she is just getting over pnemonia the smell might be because of that, but the dressing should still be changed at least daily and the site cleaned as well!

 

[katekath]

Thank you all for your replies.

I went to the hospital wanting to pick a quarrel with any nurse, who tell me "it is normal" again, but found my mum breathless after suction and perspiring a lot. The last time she suffered from respiratory failure, she had the same symptoms and I called the nurse immediately.

She plugged in the machine to measure her oxygen level and walked away, even though the O2 level read 57% and dropped to 34%! I thought she was going to call the doctor, but my sister found her chit chatting with another nurse! Okay, that is the last straw. I was breaking down when I saw her turned purple!

Turned out that they never cleaned her inner cannula, resulting in the dried phlegm blocking the opening at the other end during suction.

I am going nuts with this poor nursing care. 3 doctors and 5 nurses were in there with her and none can do anything until another doctor from ICU came down to help.

I did pestered them enough to clean the stoma, but decided I am going to buy the necessary supplies and clean her up myself. I asked for her report and it was stated she has UTI and is on antibiotics for that. She doesn't have a fever when I saw her yesterday and she told me no one told her she has a fever during the day.

Don't think it is good to transfer her now, but will surely argue my way out to get her transferred to another (better) hospital.

 

[freddiesnetty]

OH MY GOD!

I can't believe this happened..............I am in shock!
I have had your mom on my mind all day yesterday..............I can't believe this is happening to you............AS SOON as your mom is well enough to travel, I would absolutely transfer, YOU should not be having to bring stuff from home to change her dressing. Isn't that what you are paying for in the hospital? Jesus Christ, I have heard and it all.............I am so SORRY that you have to go through this...........

I change Freddie's inner canula, every other day, like clockwork. It seems to me that they are incompetent and don't give a s$%t.............I can not imagine how you are feeling..........My heart aches for you...
My suggestion is to keep raising hell, they will eventually listen...I know, I have had to fight for everything Freddie gets. It is a travesty to even hear of this........I will be praying for YOU and your Mom.
HHMMM, I don't know about where you are but, I would go to the hospital administration and see if that helps also....I hate to say it, but sometimes people just think oh well they are going to die anyways...........Just keep pushing, eventually some of them will fall!

Hang in there and know that I am thinking about you.........and I do not believe that an UTI would cause a smelly trach. Keep asking about the asuedimonia sp? And I can tell you by not keeping the stoma nice and CLEAN will lead to this also....
When Freddie got it I couldn't believe it. I keep this place so sterile and I NEVER touch anything to do with the trach without gloves................NEVER!
Seems to me that there is alot of lazy nurses there............
On that note I would continue to raise hell on an hourly basis............:x:x:x

Don't give up!

HUGS!
netty

 

[katekath]

Hi Netty,

The nurses refused to give me anything I requested to clean her stoma, fearing that I will endanger her life, though I think leaving them to do it is worse. I am not sure if it is because my mum is in a highly subsidised ward. I wish I can afford to upgrade her, but I can't.

I tried to get my father involved (though he does not want to and only reluctantly agreed after I nearly lost my mum) and asked him to notified the doctors about cleaning the inner cannula. Guess what the doc said? "Cleaning the inner cannula will introduce bacteria into her lungs." I almost cried when I received the message from my father about this. I raised the issue of asuedimonia, but none of the doctors or nurses on shift seemed to know anything about it.

I am on half day leave today (finally my employer is letting me go for a while) and will talk to the nurses again today. Hopefully, I can get something through into their dense heads. :x

Thank you so much for your thoughts and prayers. I will update when I can again.

 

[joelc]

I am so sorry you are having to go through this!

I also cannot believe the incompetence of the medical people who surround your mother.
GET HER OUT OF THERE!

Sorry, I know this is not helpful to you, but they are totally incompetent.
Your best course of action is to find another hospital.

My heart and prayers go out to you and your mom!

 

[freddiesnetty]

I could not even reply to this last night, as I was just in tears, THEY do not know what they are doing, I know that you are in a situation, but as soon as your mum can be moved, it needs to happen, I feel like those nurses, docs etc. etc., do not know ANYTHING about a trach, to hear that changing the inner canula introduces bacteria to the lungs is rubbish. They come sterilized in a package and they should use gloves to change it out. I am amazed at the ignorance of this hospital staff.. I am dumbfounded for words, and everyone will tell you I am never at a loss of words, I am AMAZED! I feel for you and want you to know that you are doing the best you can...........BUT when you can MOVE her, they are putting her life in danger.

I did get to thinking about something off of the subject of ALS but not really, I am so grateful to live where I live, YES we do have some serious problems here, We have twiddle dee and twiddle dum running for office to be the president of our country, economic problems and yadda yadda, I could go on for ever. Here in the USA we do at least have the right to speak up and YELL out if needed and fight for our sick ones. I can not imagine having to deal with the issues you are, I know even the Canadians have wonderful health plans that pays for alot of things. I have noticed that they may have to wait for doc appts, a little longer but still we are getting some adequate care, I can not imagine what you are going through. So on that note, even though my country has so many problems, I AM PROUD TO BE AN AMERICAN!

I do not want you to feel that I am putting down your country, on the contrary, I am just realizing how much I LOVE mine............

I will be praying that this resolves and ALL of your issues with the hospital get resolved!
Your Friend,
netty

Sorry for my ignorance, but is there an MDA there or ALSA?

 

[CindyM]

This is a terrible situation. I hope you get it resolved soon!

 

[brendapals]

katekath,
Oh my goodness, I can't even begin to imagine what you are going thru with your mom. Please know that many of us are praying for you and your mom, and I am right along with a lot of other folks on here, I hope and pray you can get your mom out of that hospital!
talk soon,
brenda

 

[katekath]

Update

Hi all,

Many thanks for your thoughts and prayer. Prayer works! Thank God!

The day after that emergency, the sister of the ward instructed the nurses to wash her inner cannula everyday then. My mum's stoma is cleaned everyday now and dressing is changed everyday too. I still watches them like a hawk when I am there to ensure they are doing everything right. They allow me to help with diaper changing now (actually I always step in, but they are more receptive to me being there now), so I can make sure they clean her properly and in the right way.

She has more phlegm yesterday when I saw her and needed more suctioning. The phlegm was whitish and not green or yellowish. I hope it is not a second infection.

I spoke to another doctor of the ward and he told me the trach is to be changed monthly. Is that true? Even if they are not changing the size or type of the trach? I just want to make sure I have the right info and not be lied to again.

Netty: I spoke to the social worker, but there isn't much help nor associations, who can help people with ALS in Singapore. People (esp. at the top) are largely ignorant about ALS. It also frustrates me to the core that because my mum is not born with disability, she is not considered for a lot of subsidies, which are little to start with. She has no insurance as her policy ended early this year. It was my fault for not ensuring the renewal. In addition, because I am opting for homecare, I am not entitled to any subsidy for hiring help or rental of bipap etc. I am praying hard for help to come from elsewhere and keeping my hopes up.

 

[joelc]

I am so glad things are improving! Praise God!

Yes, the tube should be changed every month to 6 weeks. It is a simple and quick procedure. When mine is changed it takes about 5 seconds for the whole process and I don't feel a thing.

Also the white phlegm is a good sign.