Need help with trach care at home

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caroliney

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Hi Everyone,

I am coming to the source of knowledge for help in caring for my husbands trach. He finally decided to do the trach with his Pulmonetic LTV 950 Ventilator. However, we need some do's and don't from those that have experienced the tracheostomy. I feel privledged to know about this forum and rely on those of you with actual information. Doctors know what should be done, but have not the actual experience, which I am seeking.

When uncuffing husband today, he actually started choking like, so is this really necessary to do? As I understand a balloon is placed near the end of the outer cannula. He really was scared when this happened. I am just so uncomfortable seeing him like this.

Hope you can shed some light on your experiences and help us. Husband is still in the hospital for a few more days. Need to know more about all this before he comes home, that is for sure.

Thanks, Guys.

Caroliney
 

quadbliss

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Hi Caroliney,

Some people (like myself) have a mucus build up just above the cuff. If you remove the air from the cuff, secretions will flow, via gravity, directly into the lungs. Jen and I do this intentionally every night after I lay down in bed. Jen does mouth and trach suction until we get it all cleaned out.

When a person first gets trached, there are many new sensations and you are relying on medical equipment to keep you alive. This is very scary for a while. As you learn to trust the vent, and become familiar with the new signals from your body, you become more and more relaxed. Eventually, he will be completely comfortable with the machine that breaths for him. :-D

Getting back to your question, why is the hospital asking you to take down the cuff? I don't remember ever taking it down when we were in the hospital.

Mike
 

Brentt

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Hello Caroliney, I am thinking that you are talking about removing the air from the cuff. This is a common practice as it allows the build up of mucose to either be suctioned out with the catheter or coughed out by the patient providing they have the strength to do so. If you are removing the air from the cuff while the ventilator is on, you should be ready to suction as soon as you deflate the cuff. Also do not insert the suction catheter in beyond the length of the cannula as this can cause aspiration of the mucose into the lungs. As Mike stated there is a balloon that traps the buildup of mucose above it. When you deflate this balloon the mucose can be very thick and gooey. Tell your husband to try to cough as hard as he can to expell the buildup into his mouth or to swallow it. Be ready with the suction catheter to help if he can't cough it out and he begins to choke on the buildup. If he is able to cough the phlegm up into his throat but he can't get it to his mouth, you can use the yankauer to go deep into his throat to get to this mucose. He will most likely gag on the yankauer because of how deep it must be inserted if you should go this route. It takes time to get used to these sensative areas but it will eventually become a normal routine.
Are you going through any training at the hospital or are you going to a rehabilitation hospital once he is stable? I strongly suggest that you get the training required to care for a home vent. I thought it was required before you could bring him home.
Talk with your case coordinator about this. If there isn't a required training then you should pump the respiratory techs about all the procedures.
Brentt
 

caroliney

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trach care

Thanks Brentt and Mike!

I had some training on care for the trach today by the respiratory therapist. However, your info seems most important to us since you are the experienced ones. My husband is experiencing hot flashes , but may be due to the morphine for pain they are giving him.

He feels uncomfortable when he is gasping & gagging, which is understandable.

Mike, the doctor decuffed my husband a little(let the air out of the cuff) which seemed difficult yesterday for him to breathe. RT put some air back into the cuff today and raised his ventilator pressure up some, which seemed to work for him. The doctor was trying to see if he could tolerate decuffing him a little, not sure why, since he does not speak clearly anymore, does not eat anything except through the peg tube and had great difficulty swallowing, prior to the trach, And the secretions did flow when he did this, but the breathing became difficult for him. He may, also, be nervous with all this new breathing methods, etc.

Mike, are you in a reclining position when you remove the air from the cuff or are you speaking of the trach & mouth suctioning only laying down in bed? We have alot to learn about all of this, but guess we will get through it. Any suggestions are always welcome.

You are very kind to share this with us and you will never know how much we appreciate the info.

I appreciate you taking the time to reply. Many thanks to you both for the reply.
I feel that this site is so helpful for the new PALS.

Have the utmost respect for our doctors and medical staff, but there is nothing better than on hand experience as you know what it feels like and exactly what works for you.

Mike you have been so helpful in the past with the pulmonetic 950 ventilator for us, and knowledgeable. Thanks for all your help.

God
Bless,
Caroiney
 

quadbliss

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Hi Caroliney,

We normally take down the cuff when I am reclined in bed.

You said something else that concerned me. You mentioned that the Respiratory Therapist increased the pressure. Is the vent set for pressure control or volume control? They initially set me to pressure control, but every time I ate, I felt short of breath. The pressure setting on the vent couldn't overcome the added pressure of a full stomach. Once we changed to volume control, the problem went away immediately. In this mode the vent delivers a consistent volume, regardless of the pressure it must overcome.

Mike
 
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