Patients ready for trach removal must be off the ventilator, alert, and have manageable secretion burden.
Using a speaking valve with a trach requires an uncuffed or specific cuff trach to prevent complications.
Secretion management for trach patients involves hydration, humidification, and avoiding drying medications.
Deep dives
Trach Basics and Progression
Patients who are off the ventilator, alert, and have manageable secretion burden are good candidates for trach removal or decannulation. The process involves breathing with cuff deflation, downsizing with a speaking valve, and then capping the trach for up to 48 hours. If they pass these steps successfully, it's time to proceed with trach removal.
Speaking Valve and Trach Functionality
A speaking valve allows air in through the trach during inhalation and closes on exhalation, redirecting airflow through the nose and mouth. Patients need an uncuffed trach or a specific cuff trach designed for speaking valves to ensure proper functionality. Avoid using a speaking valve with a cuffed trach to prevent complications.
Secretion Management and Hydration
Patients with trachs are at risk of developing dry and thick secretions due to bypassing the nasopharynx's humidification. Secretion management involves hydration, humidification through trach collars or heat moisture exchangers, and avoiding anticholinergic medications that may dry out secretions. Hypertonic saline nebulizers can help thin out secretions.
Capping Trial and Decannulation Readiness
A capping trial involves placing a cap over the trach to assess if a patient can tolerate breathing without airflow through the trach. Patients ready for decannulation should be off the ventilator, alert, oriented, and have manageable secretion burden, representing a clear indication for trach removal.
Decanulation Process and Criteria
Patients with manageable secretion burden, off the ventilator, and alert are potential candidates for trach removal or decannulation. The sequence for assessing readiness includes breathing trials with cuff deflation, speaking valve downsizing, capping the trach for up to 48 hours, and then considering trach removal if successful.
What is your approach to trach complications? What do all the words in the one liner of a trach patient mean? What are best practices for airway clearance? When is a patient ready for a speaking valve? What is the process for decannulation?
Tags: IM Core, CoreIM, pulmonary, critical care, ICU, nursing care, respiratory therapy, pharmacy
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