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.
Friday, June 24, 2011
Saturday, June 4, 2011
Cuff Leaks
R.B. asks, "When a patient is on the ventilator, what causes a leak in the cuff?"
Answer: There are many causes to a cuff leak. First, to clarify, it is rare that a leak within the cuff actually happens. What happens most often is a leak around the cuff. This leak around the cuff is usually caused by a tube that is too small, or by an overinflated cuff.
When a tube is too small for the airway, most clinicians attempt to compensate by overinflating the cuff. This may solve the problem temporarily; however, the problem is that overinflation of the cuff changes a low-pressure cuff into a high-pressure cuff, creating many more problems later on. A small tube should be changed to one of proper size in order to ensure an adequate seal.
Chronic overinflation of the cuff, even in a tube of proper size, can cause the tracheal tissue to stretch in the area of the cuff. This is called tracheomalacia. In this case, the tube should be changed to a longer one to extend past the area of tracheomalacia.
Answer: There are many causes to a cuff leak. First, to clarify, it is rare that a leak within the cuff actually happens. What happens most often is a leak around the cuff. This leak around the cuff is usually caused by a tube that is too small, or by an overinflated cuff.
When a tube is too small for the airway, most clinicians attempt to compensate by overinflating the cuff. This may solve the problem temporarily; however, the problem is that overinflation of the cuff changes a low-pressure cuff into a high-pressure cuff, creating many more problems later on. A small tube should be changed to one of proper size in order to ensure an adequate seal.
Chronic overinflation of the cuff, even in a tube of proper size, can cause the tracheal tissue to stretch in the area of the cuff. This is called tracheomalacia. In this case, the tube should be changed to a longer one to extend past the area of tracheomalacia.
Subscribe to:
Posts (Atom)
