Dr. S.A. asks, "I just received a rehab patient with a trach button who has developed pneumonia. Can I just replace the button with a regular trach?"
Answer: A trach button is often placed to maintain the stoma while the patient is gaining strength through rehabilitation. The benefit of a button is that it provides no resistance within the airway, yet it maintains the stoma in case an artificial airway is needed. If there is concern about secretions and the need for frequent suctioning, it is best to replace the button with a regular tracheostomy tube. Otherwise, one would need to open the button every time the patient needs suctioning, and the introduction of a suction catheter would be directed toward the posterior tracheal wall.
One must realize that the trach button consists of three parts: the tracheal cannula, the closure plug, and a series of spacers to adjust to the exact length of the stoma. In order to remove the button, first remove the closure plug with the spacers. This will release the tension against the distal petals of the cannula. The cannula can then be removed easily and replaced with a tracheostomy tube.
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