Irritation & coughing increased after Trach change. What to do?

[milton939]

My mom's Tracheostomy tube was replaced last month, with 'Covidien ( presently Medtronic) Shiley 6FEN Tracheostomy tube cuffed with inner cannula'. Recently we've noticed that, she is coughing more every time her ventilator tube moves, which shakes her Tracheostomy tube, as it's causing irritation in her throat.

Along with this, every time we deflate the cuff by releasing the air in the cuff, to allow her to speak for a while, she starts coughing.

Does anyone have any similar experience?
Any advice on resolving this issue?

 

[Diane H]

Those are both normal experiences with a trach. The question is why it is worse with a new tube. Over the years I have had a couple of trachs of my usual brand, type, and size that seemed to be a little more of a problem. When I had the next trach change done things went back to normal. She may be more comfortable with a Bivona brand trach as they are softer and more flexible than others. Sizing is different from the Shileys so be sure the right size is ordered.

 

[milton939]

Last Saturday, we went to a ENT surgeon for a checkup, as we suspected the Trach tube has become displaced (instead of being straight, it was leaned on the left side of her throat. May be due to the vent being positioned on the left side of her bed). Along with that, Sputum like secretion can be seen in the Skin area around the trach . Mom also complained about tightness and slight pain in the trach area inside the throat.

After examining the trach inside the OT, the ENT surgeon informed us that, the insertion/hole made for the trach tube has become narrow. ( As I remember, the initial trach was sized 7.5, but present one is 6.00) He suggested operating again and enlarging the trach hole.

Last time mom was very shocked and cried a lot, complaining that she was almost being slaughtered during the tracheostomy operation, as only local anesthesia was used. It was very painful for her. So, we decided not to go for enlarging the trach hole, right away.

[ Slightly off-topic: While on the OT, they paused our portable vent & attached their oxygen tube with mom's trach. They forgot to use their ventilator or may have not understood that, we were using a ventilator. Mom complained later to us that, she had to struggle for breathing. But her saturation was kinda OK, when we received her outside of OT. So, seems she can go without vent for an hour or so, with only oxygen support through her trach. Is it a sign of improvement? ]

Moreover, after returning home, we found that, mom's problem with irritation in the trach tube has decreased. Now she can sit (with support of pillows on her back) and can lean of her left/right, almost like before. The coughing due to irritation has decreased a bit. Her O2 saturation is mostly 94%+. Only problem right now (which may be ignorable) is she seems to become feeling a lil breathlessness / gasping for air, even if her O2 saturation is 94%+ and that stops in a few minutes

So, I'm confused right now, should we immediately go for the operation or ..... ? What risks are there if we do not go for it ?