Trach management

[Anesthesia19]

What's your go to in handling a trached patient going to the OR? If its matured and uncuffed, do you replace with a cuffed trach and ventilate through that? Remove completely and intubate from above and replace uncuffed trach at conclusion of surgery? What if it's a fairly fresh trach? Thanks in advance!

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[coffeebythelake]

What's your go to in handling a trached patient going to the OR? If its matured and uncuffed, do you replace with a cuffed trach and ventilate through that? Remove completely and intubate from above and replace uncuffed trach at conclusion of surgery? What if it's a fairly fresh trach? Thanks in advance!

Mature, swap with cuffed trach or armored tube. Very low risk of false lumen. Normally I think of at least 7 days to mature, and in certain situations (e.g., radiation, etc) might be several weeks.

Fresh trach, they should already have a cuffed trach. You shouldn't have to do anything. Bivonia trachs filled with water should be able to tolerate enough pressure for most cases. But... If not sufficient, talk to ENT and have them around, swap with armored tube through a guide like a bougie. Have your difficult airway equipment around, be ready to intubate from above if needed. Check with a fiberoptic scope.

 

[vector2]

Also, if you have to change an uncuffed trach to a cuffed trach in a tight stoma or difficult anatomy, the best, least traumatic tube changer of an appropriate length is probably already sitting in your cart

Just pull/cut the suction adapter off and go to town. Much better than using a rigid bougie or a cook exchange catheter that's 10 feet long.

 

[fakin' the funk]

Also, if you have to change an uncuffed trach to a cuffed trach in a tight stoma or difficult anatomy, the best, least traumatic tube changer of an appropriate length is probably already sitting in your cart

Just pull/cut the suction adapter off and go to town. Much better than using a rigid bougie or a cook exchange catheter that's 10 feet long.

Nice idea

 

[nimbus]

The other thing that comes up are trached patients who require lung isolation. In my experience it’s always better to pull the trach and place a DLT from above rather than trying to isolate with blockers through the trach.

A trick I like to use when replacing the trach is to insert my gloved pinky through the trach stoma and feel the tract. I feel it gives me useful information about the depth and trajectory of where I need to aim the trach.

 

[deleted875186]

A trick I like to use when replacing the trach is to insert my gloved pinky through the trach stoma and feel the tract. I feel it gives me useful information about the depth and trajectory of where I need to aim the trach.

Gross

 

[deleted697535]

Also, if you have to change an uncuffed trach to a cuffed trach in a tight stoma or difficult anatomy, the best, least traumatic tube changer of an appropriate length is probably already sitting in your cart

Just pull/cut the suction adapter off and go to town. Much better than using a rigid bougie or a cook exchange catheter that's 10 feet long.

Back in the UK theres a guideline that says you shouldnt ever remove a trache without using some form of exchange catheter. Maybe its overkill but if i still do it

 

[nimbus]

Gross

You must be politically conservative😉

 

[deleted171991]

Back in the UK theres a guideline that says you shouldnt ever remove a trache without using some form of exchange catheter. Maybe its overkill but if i still do it

The UK also came up with this: Tracheostomy

Smart people. The app is also great.

 

[bigtuna]

The weinmann exchange kit is great for newer trachs.