When to consider enlarging trach hole?

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milton939

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Feb 24, 2016
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Loved one DX
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12/2015
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BD
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Dhaka
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Dhaka
Last Saturday, we went to a ENT surgeon for a checkup, as we suspected mom's 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. Her tracheostomy was done on last February.

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 becomes ok 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 ?


[ note: posting same question again, by starting a new thread, as nobody might have noticed ]
 
Milton,
If she has improved since the size of the stoma arose, you may want to observe her to get more of a sense as to whether the op would be worth it. This will also give you time to consult with the surgeon about better sedation/pain control if you and she decide that increased breathlessness justifies the operation. If the stoma narrows more at any point, it could be an emergency procedure so you should be prepared in that regard.

It is difficult to say whether an hour without PAP means improvement or not. You may wish to have her pulmonologist re-evaluate her most recent data, especially in light of her increased breathlessness and stoma changes.

Best,
Laurie
 
Laurie, do you think this breathlessness is linked with narrowed stoma?

As I've said earlier, during this breathlessness of 5-7 minutes, her O2 saturation is 94%+. She complains about pressure in the chest only, which she thinks the cause of breathlessness.
 
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