New vent trach questions

[ccjjcc]

Okay, so the trach adventures are posted under this thread: https://www.alsforums.com/forum/gen...rible-trach-experience-so-far-my-brother.html

My brother is still in ICU because of intermittent fevers and they said possible
adelectosis (sp?) and they took some cultures the other day to see if he has any
other infections...

They changed the trach out this morning and he is miserable now. He said he feels
like his lungs are filling with secretions and they arent' getting them out. They explained
there was fluid sitting on top of the cuff that ran into his lungs and he can't cough it
out. Even though they suction him it doesn't get it. Someone explained to him it just
has to work it's way thru and be absorbed. They also don't use a cough assist on a
trach patient. They seem to have a lot of experience. He is worried his lungs will fill
up and he will die. Sometimes his breaths per minute go up to 38 because of his
anxiety.

I'm wondering if they are missing anything or if there is something else I should
be asking or someone else I should be talking to....my brother said they are blowing
sunshine up my &*$.

?

 

[joelc]

I am sorry to hear this!

They should have been ready to suction the moment they deflated the cuff. This way they would have caught the secretions before they fell down into his lungs. It is only a matter of a short time before they work themselves up where they can be suctioned. Tell him he is not going to drown! It will not take too long for him to get used to the feeling and realize this.

 

[Katie C]

OK, I gotta ask.. is he getting any anxiety medication!?

 

[ccjjcc]

Hi, so he hasn't anti anxiety meds today but has before this. He is also getting some pain meds, like morphine, because of a really sore
shoulder (from the first nursing home - they damaged it). This trach I guess is fenistrated, so he is able to croak out a few words.

 

[ccjjcc]

So, I am having a really hard time right now dealing with him, so I am going over to the caregiver section and vent....

 

[LauraW]

Morphine for shoulder pain? Hmmm, sounds too harsh to me. Joel is right but I wish you could use a cough assist. It really works. Things will get better soon.

 

[ccjjcc]

It looks like it's going to be a long night. He has been gurgling and coughing all day since the trach change. They keep suctioning his mouth.
But he can't get any rest because he says there is fluid in his lungs. They won't use a cough assist here in the hospital - I asked. Unless I
can find a pulmo who will recommend it. I guess the RT's here aren't trained on it? They are going to do a new chest xray in the morning.
Meanwhile, I don't know how he will get the fluid up.

 

[LizT]

would the rt's be willing to manually do a cough assist?
this is when they lay the person back- head elevated slightly, and wait for an inhale. as soon as the inhale is done, but before the exhale,
pressure is applied to the sternum- like giving some one the heimlich manuever- fast and hard. usually two compressions. then you wait for the person to breathe a few breaths and do it again. this will cause them to cough.
are they not suctioning out his trach? you said they keep suctioning out his mouth- what about the trach?
they should be inserting the tube all the way down. there will be resistance when they are at the bottom. then they need to roll the suction catheter between their fingers as they pull it out.
also, gravity plays a big roll and you will learn this. if your bro is laying down for a period of time, and then, say, you are going to put the head of his bed up, suction out his trach before raising the head of the bed. if not, gravity will pull the secretions down into his lungs.
and also, the more you move your PALS around, even if he isnt moving, but you are moving him (im talking whole body here, not just an arm or something) the more he will need to be suctioned.
Also, he may need the settings on his vent changed to a higher pressure.
I know this is alot of info. i hope it will help. i also responded to your post in the caregiver section. Hang in there.

 

[ccjjcc]

Okay, so after all this, it turns out the trach wasn't in right. Yesterday morning someone discovered that it wasn't in all the way and
was causing a leak. They fixed it and no more problems. Sheesh. this was only after several RT's, a doctor, nurses and a pulmonologist
had all shrugged and said you just have to get used to it.

 

[LizT]

That is very upsetting that they are so incompetant- but thank God they figured it out! How is your brother holding up now that they fixed it? and how are you?

 

[TedH5]

Sorry to hear all of the discomfort your brother went through but I am glad to hear that things seem to be looking up.