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Thursday, October 20, 2011

Tracheal Bleeding

W.C. asks, "I've noticed a small amount of bleeding from my trach recently. Should I be worried?"

Answer: The two most frequent causes of tracheal bleeding are due to frequent suctioning and lack of humidity.  Regarding frequent suctioning, one should not decrease the frequency of suctioning just because of the appearance of some blood.  Rather, this should be a cue to switch to softer suction catheters.  I usually recommend red rubber catheters, which are not suction catheters, but are actually they are urinary catheters, technically called "coude" catheters.  These are especially helpful because the tip is closed, rather than open, so there is less trauma to the tissue with the use of these catheters.  Because the tip is closed, they may not be quite as effective as the standard suction catheters, but complete healing of tracheal tissue has been observed in as little as 24 hours after the switch, so this is an option.  Please note: Red rubber catheters cannot be used in the patient with a latex allergy.

The other frequent cause of tracheal bleeding is lack of proper humidity.  This is especially true in the fall and winter in colder climates....or other places that have low humidity (like hospitals!).  This dried blood can collect within the tracheostomy tube and begin to occlude the airway.  In fact, one patient had no trouble at home, but came to the hospital and required almost daily trach changes because of the accumulation of dried blood within his tracheostomy.  The problem resolved as soon as humidity was added to his ventilator circuit.

Now that fall and winter is approaching, you may need some extra help with humidity.  This can include room humidifiers, soaking a gauze in water or saline and placing lightly over your trach, using an HME (heat moisture exhanger), spritzing some atomized saline (Ocean nasal spray) into the trach and mucous membranes, increasing water intake, and more frequent changes.

If there is a large amount of bleeding, contact your health care provider for further evaluation.

Sunday, October 2, 2011

Capping a Trach

J.D. asks, "I heard that there are many benefits for capping a trach.  Can you explain?"

Answer: Yes, capping a tracheostomy tube can provide many benefits; the primary benefit is usually allowing a patient to speak.  First, not all tracheostomy tubes should be capped.  A standard cuffed tracheostomy tube should never be capped, even if the cuff is deflated.  When the cuff is deflated, it still provides a great deal of bulk and resistance in the airway.  Even if a patient appears to breathe comfortably at one moment, things can change suddenly.  In addition, patients may not be able to fully expectorate their secretions, as they may get caught on the folds of the deflated cuff.

Other benefits of capping a tracheostomy tube include restoring subglottic pressure which can in turn restore taste, smell, improve cough and defacation.  Another benefit of capping is that the quantity of secretions tends to diminish.

For more discussion on capping, refer to Chapter 5 on phonation and Chapter 11 on downsizing.