Laughing, Weeping, Living

Life happens. You laugh about it or cry about it, sometimes both.

Trach Training

on August 29, 2013

Jeremy and I started our parent training today. We each have to learn, and be able to demonstrate knowledge of complete tracheostomy care. We each have to be able to demonstrate that we can trouble shoot problems, identify signs of respiratory distress, change a trach and the ties, perform CPR with and without a bag, suction out secretions, and know what actions to take when different complications arise.

Today we learned about the different parts of a trach:

The obturator is the thin plastic plug that comes inside a fresh trach and keeps the trach stiff for placing in a patient. You take it out immediately once the trach in places because it totally fills up the airway.

The flange is the little pair of wings that sit against the patient’s throat on the outside of the neck. The flange has two little loops where you attach the ties on either side.

The ties are a velcro strip that you cut to size in the back, then attach to the trach flange with thin little velcro strips. The ties need to be changed daily. The whole trach itself needs to be changed monthly for maintenance, or more often if it falls out, gets pulled out, clogs, or otherwise fails.

The trach collar is not to be confused with the ties. It is easy to call the ties a collar, but the trach collar is actually a mask that tents over the opening of the trach and is connected to a source of warm, humidified air. It fastens around the patient’s neck with an elastic. The trach collar is for use when the patient is sleeping or napping. A more portable artificial nose is attached to the end of the trach when the patient is up and about. This contraption has a little filter on it that traps moisture from the patient’s own exhalations, then supplies that moisture to each inhalation. It’s pretty nifty.

Jeremy and I had the opportunity to practice changing trachs and ties on Nicky Boy Doll training doll. Nicky also has a g-tube, an I.V., and a place for practicing blood draws and injections. Poor Nicky. The only thing Nicky didn’t have was lungs that inflate when you give breaths with a bag. Oh well. We did get to practice giving breaths to Nicky with a bag, on the trach and with the face mask. When we suction Agnes’ trach, or get ready to do a bunch of care, if she gets into trouble we would have to use a bag to help her breathe. We can attach the bag to give breaths through the trach. If Agnes loses her trach and we are not able to put a new one in, we can cover her trach site and give breaths through her nose and mouth.

Jeremy and I also practiced suctioning Nicky Boy Doll’s trach. We get a tiny tube that connects to a suction machine. There is a right way to do it: hold the tube with both hands. One hand controls the suction on/off and the other hand controls the fine details of the operation. Grip the tube with your finger marking the “safe suction depth” and keep the suction off as you insert the tube into the trach. As you pull the suction tube out again, turn on the suction and twirl the tube from side to side to pick up as much ick as you can. Suctioning is actually kind of fun, but don’t tell Agnes I said so. I like to do it because it is a concrete way to make Agnes feel better. I can see and hear that I have removed something that was causing discomfort. Plus I kind of like that slurping sound. It’s funny.

Tomorrow Jeremy and I get to learn some more information, and maybe get a chance to practice care on Agnes. I’m a little nervous about changing her trach, but that’s why they do all this training in the hospital. There will be lots of professionals around in case we get in to trouble. I will try not to be anxious. Agnes is doing very well and seems to be much more comfortable with breathing now that she has the trach. They are weaning her down on oxygen and she is completely off the ventilator. She is on only about 25% oxygen; regular room air is 21%. She was moved out of the PICU this afternoon and taken up to the floor that cares for all the trach babies. She is on track to come home in 7 to 10 days.


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