Respiratory Therapy - Tracheostomy Tubes Review
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- Опубликовано: 6 фев 2020
- This vide we break down the variations of tracheostomy tubes. What you need to know about the variations and things not to ever forget!!!
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Feel free to email me any questions or concerns @ respiratorycoach@gmail.com.
BEST WISHES!!!
I wished you were my teacher when I was in Respiratorycare program!
I am so glad to have found your videos, quite by accident. I am a physical therapist, and I am providing 24/7 care for my husband. He is quadriplegic for 43 years, if you Google his name, Ken Ryno, you would see how active he was prior to his stress heart attack 4 years ago. That's when he acquired his trach. He used a ventilator in ICU for 9 months. Once home, he was weaned off the vent but could not wean off the trach or oxygen. He is 6'4" tall and after several changes is using a 6 uncuffed unfenisrated trach. He has problems with aspiration. We always have suctioning devices close by. It is just wonderful to have your videos to watch. I want to learn as much as I can to provide the best care. But respiratory therapist don't make house calls, or provide outpatient therapy. We live in a remote area, so I am providing care due to sheltering in place.
Thank you for all you do
cupping is best solution
I think I know more about trach tubes now then what I learned in school
I'm not sure if that's a good or bad thing. Lol. I do appreciate the kind comment, ProfessorNeal, and thanks for watching!!!!
As a mom sitting in the hospital with a kiddo who has a fresh trach, this video is extremely helpful to keep with me during our training to go home. Thank you!
Hope you get to go home soon!
I started working in a Resp PCU floor as a nurse, which seemed overwhelming considering my experience with trachs have been limited. Your videos have helped me visualize and thoroughly understand these concepts. I'm ten times more confident in my care and thank you for your hard work in creating these videos. Also, I have acquired such a respect for the RTs out there and their overwhelming knowledge, always a pleasure to work with them
I am not a respiratory therapist, but I am a caretaker for my brother, who just recently had a stroke, and they gave him a trach and peg tube before releasing him from the hospital. I am looking for as much information as I can find this video has been awesome so many life-saving tips I do have some medical background, but not respiratory therapist and I am very shaky when I am having to even think about changing his inner canulum. He didn’t have insurance for sometime 1st day on the job where he had the stroke.so it’s been a long wait before we can get home healthcare.we are responsible for his trach care. He is still being suctioned Secretions are down some but not to the point of being able to use a speaking valve neither do I know how to decrease the balloon, so I’ll leave that alone after watching your videos.Thank you so much for caring the way you do.❤
I work in an LTAC and I have learned more about trachs during my time there than I ever thought I would know. Honestly, we really don’t use fenestrated trachs. If you need less volume in the airway to allow the person to use the PMV, then just downsize the trach. Also, there is a sticker that comes with the PMV kit that you put on the pilot balloon as well as a sign to place at the head of the bed. It will be a huge signal for them to deflate the cuff before placing the PMV. We also use PMVs in line with the vent circuit, which is awesome! PMVs are also a huge tool in getting people to be able to swallow.
Are you seeing anyone using a foam cuffed trach? I literally have never seen one in my career other than in class at school.
Also, there are trachs that have a water cuff (Bivona TTS is the best example). I’ve only really seen those in pediatrics.
As for XLTs, it has become very apparent to me that many clinicians do not understand the reasons for using an XLT, especially why you would use a proximal versus a distal. We get a lot of patients from outside facilities who had a regular Shiley placed who really needed an XLT, and actually required emergent changes or procedures to fix the error.
Trachs are cool to learn about and I can tell you that I definitely know more than other people about them because of my LTAC experience, which I think is great!
Also… keep a spare inner cannula at the bedside for plugging, a 10 cc syringe, and lube!
Like always 💯 thank you , thank you thank you !
Thank you. Great video!
Excellent explanation with visuals!
This is a very nice Video. You explained very well the concept of tracheostomy. I'm gonna stay tuned to your upcoming videos.
Thank you so much for making this video! I'm a nursing student, not a respiratory therapist student, but this video was super helpful! As nurses taking care of the patients with tracheostomy tubes, this is essential information! Good job, I love your passion!
You sir are a gentlemen and a scholar! thanks for the help!
Thank you for sharing those kind words, Jordon. Glad to help and thanks for watching!
Thank you Joe,
this is a wonderful lecture as usuals.
God Bless you!
Thank you! I appreciate you watching and kindly commenting!
You are my hero !
Superb as always! Thanks!
Thank you, Henrique. And thanks, as always, for watching!
I cannot thank you enough for this video!!
You just did. Thanks for watching and kindly commenting!!
As always, great review! Absolutely love watching your videos, your teaching skills are so helpful. I appreciate you more than you know!
Thank you! I appreciate your support more than YOU know!
ahhh, i love your video its helps me alot .. i wish you were my professor when i am in my college days … GOD BLESS you and your channel … this channel is underrated …
But you help us a lot ..Thank you SIR “ i love you “ and best wishes to you as well …❤️❤️❤️
Thank you for every information I learned from you, you’re a great guy. God bless you
Thank you for the kind comment. I appreciate you watching and commenting!!! Bless you!
Excellent content as always. Love how you mentioned having an end tidal detector any time you have to replace a trach tube. Those colormetric end tidal detectors have saved me and my patients countless times and is something I put in every patient's room that has an artificial airway as well as take on every vent travel. Lube and a 10 mL syringe are two other things that seem minor but have saved me countless times as well. Keep up the awesome work and content!
Hey Matthew, thank you for that contribution. Great advice! Thanks for watching and leaving the kind comment.
I was so close to giving up due to frustration with trachs. But then I came across this video and you explained it so clear enough for me to understand!
Thank you so much!
Hi, Helen. That makes me happy that you're sticking it out and not giving up. Nothing is too much to learn or overcome. Glad you found the channel. Thanks for commenting and watching!
Thank you very much !
Thank you for this video! I just learned about trach tubes in lecture and actually saw an XLT trach during my clinicals. This was a great, quick review!
That's awesome! Was it a proximal or distal XLT?
Excellent teaching 👍🏽
That's a talent to be able to explain the way you do. When you have a chance, would you please make a video about pronining, the physiology behind this. Thank you
Got you on the list, Olga. Thank you for watching and for leaving the kind comment.
amazing video! whenever you get a chance, could you make a video about the physiological effects of Mechanical Ventilation and why those adverse effects happens? thanks for posting these videos, you’re the best
Thanks, Ricky! Absolutely, I'll work on this soon. Thank you for watching and commenting!
Keep up the good work, really informative 👍
Will do! Appreciate the view and comment!
Thank you!!! Always so informative.
Great video,thank you for the work you do
Hey Isaac! Thanks for the comment and for watching. Have you done anything clinically with the P0.1, you asked about a while back? I've really been monitoring it and have some really good case scenarios that I hope to share soon. Interesting stuff!
@@RespiratoryCoach i actually did use the P0.1 on one of my early morning weaning protocol and it was very interesting but it is a parameter that is rarely used so it took a while to explain to my relief during report. I also used SIMV+ but i must say unless you know what to look for,most therapists just assumed it was the traditional SIMV
Definitely something it takes time to understand and learn how to assess and utilize. So important that RTs like yourself take the initiative to learn it for themselves and then teach others for the betterment of our patients. Strong work!
Great review.
Cool! Exactly what it's suppose to be. Thanks for watching!
THANK YOU!!!
You're welcome!
Great video !
Thanks!
Have you seen the new shiley's? The inner cannula's to them seem smaller and the sizes on the flange are a little confusing. Can you go over that please? Thank you so much!
Could you speak about emergency situations such as trach tube dislodgement?
Can you going into detail on what is the obturador for and how it looks.
Great video with a ton of info! I have actually seen a false tracked trach and the patient ballooned up BAD! Thanks for sharing the tips!
Thanks, Eddie. I've seen the same thing once before. Once was enough for me!
@@RespiratoryCoach Agreed!
Than you
Excellent
Thank you! Cheers!
I have a trach. 2nd one
In less than 5 years.
Thanks so much for the clear explanations in this video! Just a quick question-when a person does not have a speaking valve but has an inflated cuff, how does that air exit the lungs? Thanks much!!
Does the air go back up thru the trach tube and out the stoma area? I guess my main question is-does having the cuff inflated still allow 2-way air flow? Hope this makes sense
Yes, air will exit the lungs through the tracheostomy tube when the cuff is inflated WITHOUT a speaking valve.
Hello Sir! Thank you for the great info. I'm in a bit of a complex situation. Can I ask for a few minutes of your time and expert advice?
Long story short, after many failed surgeries and other conventional treatments, I decided to get a trach for my sleep apnea recently. Due to my abnormal structures, I have to actively and consciously flex my throat muscles to breathe. While this is tolerable when awake, my upper airway remains totally collapsed at default during sleep which causes severe and unusual sleep apnea.
When I got the trach, I was hoping this would be the cure I was looking for until I find a different solution (possible jaw surgery in the future). They've given me Shiley 6 (6mm i.d.) and while my sleep apnea did improve a little bit, my sleep was not as great as I expecting it to be. (I forgot to mention, I had sleep apnea my whole life and thought it was normal to be tired until I slept well for two days about 10 years ago and realized how normal people actually slept.)
I just could not understand how people can breathe thru what essentially is a small straw? I knew the bigger my stoma was, the better i would breathe during my sleep. And I've been searching online for a bigger trach tube but I think the biggest one there was Shiley 10 which had inner diameter about ~9mm with inner cannula.
Then I noticed there was a procedure called laryngectomy which had trach as part of its process. The tubes offered during that procedure were much bigger and simpler. The biggest lary tube i saw had inner diameter of 13.5 mm, did not require inner cannulas and had softer material. I'm wondering if these tubes can be used for trach patients as well? Is there a medical reason against it? I'm sure the bigger hole would help me a great tons.
I also noticed that with my upper airway closed and the trach hole being so small, I could use a ventillator maybe a bipap? to have that external help to help me breathe during my sleep so I don't have to keep actively breathe. Is this feasible?
I unfortunately coughed out my tube a couple days ago and wasn't able to put it back in. I'm seeing my doctor in a few days and going to ask for a re-surgery for a bigger hole and other advices. Can you share your thoughts as well? Thank you.
Thank you Joe, this was very helpful. Can you also please talk about when subcutaneous emphysema is present post trach tube change? What to do besides removing the trach tube and bag the face? Thank you so much!
Hey there Respiratory Coach, first of all excellent video per usual, very thorough. Second,can you please make part 2 to this video speaking about the other things that you did not have time to mention about tranche tube in this video? Thank you
Hey, Jay. I sure can. I'll put it on the list to get out soon. Thanks again for watching and commenting.
Excellent presentation as always! I'd like to add one helpful hint. Especially possible if you have 2 or more trached patient's sharing a space; placing a too small(improper size) inner cannula in a trache will result in a significant loss of volume and pressure which can be near impossible to figure out where the leak is. I spent hours tackling this one day years ago and now think of it quickly when such an issue occurs. Lots of isolation patients in private rooms have reduced the likelihood of this but it can certainly occur even when not sharing rooms.
Great insight and a wonderful addition to the conversation. Thank you Kenneth!!!
I made sure my cuff was not inflated whenever they put on my speaking valve.
Good idea, Stephanie!
How long does one need pain management care after having a tracheostomy?
if they need bipap or cpap and they are trached I've seen the cuff inflated and deflated. Can you explain both please? thanks
Hi coach! What's the worst thing that could happen if you have a fenestrated tube with non fenestrated cannula, cuff down, with passy muir and om high flow. I was following an RT and was told it doesn't matter if you put a fenstrated or non fenestrated inner cannula in that scenario. Thank you
neuromuscular disease. frothing from mouth. gagging on secretions. eyes water and sting. how often should cough assist be used and what are the parameters?
Resp Coach, when would you BVM the mouth and cover the stoma, when would you cover the mouth and bag the stoma ?
Thank you.💯
No, thank you, Kwaku! I appreciate you watching and commenting. Say, did my key points help you pass your CSE exam?
Thank you so much! May We have a video on oxygeno therapy please?
Absolutely, actually one of my very first videos. I'll redo at some point, due to the lighting, but the content is what it is. Check it out...
ruclips.net/video/0UrmVBSsdPA/видео.html
Respiratory Coach Thank you 🙏 sooooo much. Be blessed
@@barbarasrt7855 Barbara, you are very welcome! Enjoy and best wishes!!!
How do you quickly ventilate a patient when the trach tube comes out?
What is rule of thumb to select the suction catheter patient with tracheostomy
Hey coach
If a patient has a feeding tube, should the cuff be deflated when they are being fed?
Hi, thank you for the video. I had a trach put in 42 days ago, it started with an uncuffed size 6, 12 days later the infection was so bad I had to go for another surgery to remove that one and they put in a size 8 uncuffed, that one lasted 9 days and I was back in the emergency room for more infection and hard to breath, now I have a 7 uncuffed and I'm back on penicillin cause I have another infection and my collar bones are unbearable to to touch, not eating or sleeping I have another ENT appointment tomorrow, is this how my life goes on now? Looking for any advise please help thank you!
When a cuffed trach person eats, should the cuff be inflated or deflated?
When you’re open suctioning, why is it cuffed down?
My husband has a trachiostomy. He has had excessive coughing from the beginning. He has a cuffed finistrated trach that has an "overgrowth issue in the finistrated slot". We have had little or no after carr support for this issue. The only solution given is use an unfinistrated inner canula (still continues to scab and bleed)
Note: He has the trach due to carcinoma tumor in the throat.
He has had 4 surgeries. This has been used in place of intubation.
He can brreathe past his trach.
Do you have a source of (tech support) or trouble shooting theses things.
I would refer you back to the care of physician for this issue. I know that's not much help, but there is really nothing that can be done from a respiratory therapist standpoint. I have seen this before. Not a fun situation. If he's able to breathe around the TT then perhaps a non-fenestrated tube would be appropriate to prevent the growth into the fenestration. But again, seek out medical attention to determine the best plan of action. Best wishes!!!
It is safe to change tracheostomy from shiley to metal for permanent?
Why aren't Montgomery Trachs used more often? And why are the Shelly trachs so long? We don't want to use it because of this reason, it's so much harder to keep clean because of the length.
Is it recommended to give a neb with the speaking valve in place or should you remove it and replace after the treatment?
The speaking valve should be removed during drug aerosol therapy. This will reduce deposition of the aerosolized meds on the speaking valve, and increase airway deposition of the meds.
What happens if the tracheotomy comes out and you can’t get it back in. How should I ambu bag the patient?
Hello can you assist me with this tracheostomy thing for my father
If you place a speaking valve on the trach and deflate the cuff what are the chances that the cuff may come out?
Hi! You must first understand that the cuff is not intended to keep the tracheostomy tube from coming dislodged. A properly secured tracheostomy tube should not be at a greater risk of coming out when the cuff is deflated.
Coach what happens when you use a cuffless trach on a pediatric patient on a mechanical ventilator?
How will you explain that this will cause leaks?
What will be the vte reading?
The vent wont be able to measure the vte's? .am i correct or wrong?
Anytime you provide positive pressure through a cuffless airway there will be some level of a leak. This will cause your Vte to measure lower than delivered Vt. The large the leak the smaller the Vte. You are correct.
What are the causes of blood always being in my tube ive had it for a month now and now I'm starting to get choked on small blood clots getting in my tube
Hi Henry! Honestly without being able to assess I couldn't say for certain, but one common cause is tracheal trauma associated with aggressive suctioning. A bronchoscopy may be valuable in identifying the root cause of the bleeding. Best wishes!!
You have a patient who is trached but not on a vent. The patient pulls out the trach and but the trach is placed back in by the NP. Can you use a nasal cannula ETCO2 to confirm CO2? What would you suggest to confirm CO2?
Hello again, Nigel. In my opinion, the best confirmation would be to utilize an etco2 attached to the tracheostomy tube. I can see using a nc etco2 if I have no other options. Just be sure to inflate the cuff, and the etco2 should be zero. Hope this helps, and thanks again for watching!
@@RespiratoryCoach What do you mean when you say zero?
when you reinsert a trach for whatever reason, should you have capnography or colormetric to make sure you didn't false trach?
haha I wrote by comment too soon.
It definitely wouldn't hurt anything and sounds like a good idea to me! I love any scenario where we can implement capnography for purpose of better patient outcomes. Thanks for sharing!
2.8 yr old + trach...ventilated astral 150
P. SIMV
Non cuff cannula.
Sat 100%
Exhalation also through mouth ..is this OK?
Trach >1yr
Sounds like it is for your situation, but if you have doubts, consult your physician for more information. Thanks for watching and commenting.
Why do trachs seem to leak so much more than ET tubes and how do you fix this?
Most likely because traches can be more positional and the patients are typically awake and more active.
So, as long the inner is not Fen we can use Mechanical ventilation even if the tube was fen?
That's correct!!!
Thank you so much I really appreciate 🙏🌹
Hi, while I am preparing for my TMC, I came across an insufflation-ex-suffocation therapy question, and I realized that I have not heard about it, could you please explain what it is?
Hello, Elizabeth! Mechanical insufflation and exsufflation is the act of mechanically providing a large positive pressure breath followed by negative pressure to quickly withdraw that large tidal volume. This therapy is used to aid a patient in the removal of airway secreations. Typically utlized on neuromuscular patients, and/or patients having difficulty in removing secretions due to an inadequate cough. Hope this helps to clarify things for you. Thank you for watching and asking your question.
Respiratory Coach thank you!!
So, are you saying for a speaking valve to work, you need fenestrated tube?
No, not at all, but a fenestrated trach can aid in tolerating a speaking valve. I am saying that the trach tube cuff must be inflated anytime a speaking valve is in use.
@@RespiratoryCoach
Thanks! Understood, but I still can't talk with a speaking valve and a non-fenestrated tube. That is why I asked. My doctors/speaking therapists have been no help to me dealing with my silence.
Hi. Is it normal to or does it happen
1,) keep on coughing with tracheostomy?
2.)Few to no secretions when suctioning but still coughing
3.) the phlegms went out from the stoma instead of the tube
Thank you in advance.
Absolutely. Nothing you stated I would consider odd for a trach patient. We see this commonly. Especially #1 and #2.
Thank you very much for your reply. Do you have any suggestions on how to avoid/lessen in case of excessive coughing with no phlegm or secretions? Thank you.
What is the purpose/function of the obturator?
Basically like a sylet for endotracheal tube.
Obturator tip is round tapered so not to damage the soft tissue when inserting the trach tube
Ty !
When did they start putting so many commercials on your videos?
LOL. Not sure. That's a RUclips thing.
@@RespiratoryCoach well, it will not stop me from learning from you. You helped me with both my tests and I’m looking forward to learning new content from you in the future. Thanks as always Joe! 😁😁😁
I want to be in your class
You're in it Jose!!!
You talk too much ahead of the actual video. Please go right to the topic.
I appreciate you taking the time to watch the video and then leave a comment. Thanks for the feedback!
Your knowledge and expertise are just awesome. The quality of your videos is also the best. Many people make vides but the quality of sound is very poor. In brief everything about you is very good except that you talk too much at the beginning of the video maybe relevant, however people don't have too much time. Thank you for not getting offended. There is some kind of maybe a pulmonologist (Egyptian accent), he uses a bad language almost like a profanity in his videos. His knowledge is good but the wording he uses is very inappropriate and very poor.
You doing exactly what you COMPLAIN about, TALK TO MUCH!