No inner cannula in trache

[Inventor]

My trache was installed six weeks ago and changed four weeks ago. It is a soft seal cuff model that comes with an inner cannula. However, the inner cannula was not installed in the hospital nor was I given any instructions regarding it. Wondering if lack of an inner cannula might have some drawbacks? Google told it is especially useful when suctioning but that does not apply in my case since the cough assist device brings the mucus all the way out. And the phlegm is so thick it sometimes clogs up the outer cannula so I assume the inner one would have serious clogging issues.

 

[Narrowminded]

Inventor - Some traches are meant to go without an inner cannula. My husband has always had a Shiley and his requires the inner cannula or you cannot connect the vent. If you are not useing a vent yet, then not sure that it would matter. Yes, the inner cannula can get full of junk, so you change it at least once daily. Depending on the type you have, it is either washed to be reused or it is discarded.

As far as I can tell from you picture it looks like you are on a vent, so given that, I think you may have a trache that does not require an inner cannula and does not use one. If you can figure out the exact name of your trache it would help us determine the answer.

Hugs,

Sue

 

[Inventor]

The replacement pack should contain an identical set and it had a pair of inner cannulas. However my current trache has none installed. The vent fits the 15 mm connector anyway. I am on life support vent 24/7.

 

[Narrowminded]

Inventor - I looked that up and it states on Smith Medical that it can be used with our without the inner cannula. If you would decide to use the inner cannula, they just slide in very easily and basically you can't do it wrong. The connector for the vent is on the trach itself, which is different than the Shiley that my husband uses. Brian has been on the vent for 7 years now, so unless you find that the trache is getting clogged, I would not worry about the inner cannula. If your secretions start to be an issue, then you might want to use them. In your case, based upon the literature, they are not necessary.

Hugs,

sue

 

[Inventor]

Thanks. My main concern is whether lack of inner cannula might impair the hygiene. But I guess the frequent use of cough assist should keep the surface of the outer cannula relatively clean.

 

[Narrowminded]

I don't think it will make a difference. Keeping it clear with the cough assist is the main thing. They are made with a material that is not supposed to hold onto secretions. What is outside of your neck can be cleaned with q-tips and some water. Hopefully Dianne H will stop by. She's had a trache a lot longer than Brian and may have some additional advice for you.

Hugs,

Sue

 

[KateEmerson]

I would focus on the thick phlegm to get it thinned out. Do you have a humidifier on the vent full time? Are you drinking plenty of fluid everyday? We measured all fluid intake with a goal of 2 liters a day. The cough assist, humidifier on the vent, and fluid intake were our keys. Never have had a trach with inner cannula in 4 years and only had a serious problem once when trach got completely blocked. Need to have an emergency plan for that as I did not and I almost lost my PALS. Your care team would need to know how to change the trach or another emergency option would be to lower the cuff and use an ambu bag with a full face mask until emergency services could get you to a hospital for the trach change. The thinner you can keep the secretions will greatly reduce this possibility or plugs or pneumonia.

 

[Inventor]

I have had a chronic lung infection for two years while depending on bipap and mask. I drink four liters a day and take 1800 mg of NAC. The humidifier is on all the time. Still after six weeks of cough assisting through the trache instead of mask, the amount of phlegm that comes out of my lungs is unbelievable. Cough assisting every hour and the mucus separator gets half full each time.

 

[Diane H]

The inner cannula is there for emergency situations where the trach is plugged up. Replacing the inner cannula is a fast and easy way to remove a large mucus plug. If the plug is below the trach tube, changing the inner cannula won't help. Mucus buildup is different from mucus plugs. A mucus plug is a thick, almost solid ball of mucus. They are generally small enough to be removed with suctioning. They may not fit through the suction tube but will be stuck in a blob at the tip of the suction tube when you withdraw it. As Sue said, Bivona trach (Smith Medical) is made from a silicone plastic that prevents the build-up of mucus inside it. That eliminates the need for an inner cannula that can be removed for daily cleaning. It can make the removal of a plug easier but isn't made for that purpose, but rather to keep the trach from gradually clogging up. Mucus plugs are prevented by being well hydrated, turning side to side when in bed, and by coughing. That makes a CoughAssist machine helpful even after you have a trach.

Shiley trachs have been the standard trach tube for decades. The inner cannula makes sense as the first trach until it is determined that the patient isn't prone to plugs that can't be suctioned out, which is rare.

I have had a Bivona for most of the 13 years since I was trached and haven't any problem with the trach plugging up. When my secretions get thick, we use the small saline squirts to help suctioning. They work best if you squirt one in and then go back on the vent for a minute or two, but if you can't wait, they still help. I only need them once in a while, and that is more likely a situation where suctioning doesn't clear the rattle further down in my lungs.

 

[Inventor]

A stupid question, but why would one need suctioning if there is a cough assist machine available? My feeling is that in addition to being comfortable, it is more effective than suctioning in getting mucus out. And as for mucus plugs, it either sucks them through or, failing that, pushes them back out of the cannula.

 

[KateEmerson]

Inventor, did you have this amount of secretions before the trach and vent? And were they as thick as they are now? Both the amount and thickness ( especially with the hydration and humidity you're doing) sounds very unusual .

 

[Inventor]

I have had lungs full of thick phlegm since 18.12.2015 when the infection started. Cough assist through the mask was not very effective as I can not hold my mouth open and the junk had to be coughed out through the nose. Now that the cough assist has a direct route, the two years' worth of junk is on the move. Or that is my theory anyway.

 

[Narrowminded]

Inventor we only use the cough assist if the suctioning doesn't clear the problem. It is called a cough assist for a reason to help assist with a cough to bring mucous up. The other issue is the more you irritate the lungs either with use of the cough assist or through suctioning the more mucous it will produce. It's as simple as your body trying to repair an irritation.

Yes there are times where you may get a cold etc that will require more suctioning, but as a rule, if you can limit use, you will see the mucous slow down a bit. Now, there is also an issue where you just produce more than you can handle. Not thick gloppy stuff, just general like in your mouth. In that case there are some meds that can help slow it. Brian is on Robinul for that reason. Others find help with Atropine or Scopolomine. Some have gone for Botox shots.

I would suggest you ask your physician for a follow up culture of your mucous to make sure that any infections have been cleared. It may be that there is still something lingering that was not treated by whatever antibiotics they had you on. However, something to check that can help suggest an infection is the color and smell of the mucous you are getting out. If it is clear or even white, you should be fine, if however is it yellow, green or has a foul or fruity smell then you have an issue.

Hugs,

Sue

 

[Narrowminded]

One more thing, when you use the cough assist to get the mucous out, how many rounds do you do to accomplish that? With suctioning, if done properly, it can be in and out 1 time and your done. Less irritation than several rounds of the cough assist. While Brian doesn't like the suction, he will avoid the cough assist far more than the suctioning. He does not really care for the cough assist unit.

Hugs,

sue

 

[Inventor]

I do one set of 20 with the cough assist. Usually that gets everything out. Repeated if necessary (which happens rarely). With suctioning we only get a fraction of what the cough assist brings to the separator cup. The stuff is thick but clear.