Monday, October 22, 2012

A trach post

A friend asked if I would do a post about trachs.
I never really thought about it, but its a great idea!
A tracheostomy is a surgical opening into the neck, below the vocal cords, where a tube can be placed for breathing. There are many reasons a trach is placed. Damage to the upper airway from some kind of trauma or tumor. It the patient has tracheal malaysia or narrowing of the airways. Some are trached for their lungs, like if a patient needs a ventilator. Or for paralyzed people that need a ventilator to breathe.

Jax was trached originally for his lungs. But once they trached him, they did see that his airways were extremely narrow, all the way down to the bronchi in his lungs.
I had been taking care of trach patients on a weekly basis before Jax was trached. I feel very blessed to have that knowledge because a trach can be a scary thing if you've never seen or dealt with it before.
I know adults and children can be very different. Since I've never taken care of adults, I'm not going to go too far into their care. I know that most adults don't wear any kind of cover over their trachs. Some don't even have a tube, just a hole in their neck. Which I find interesting since if we take our kids trachs out, the holes close on their own. So obviously something different is done with these patients to keep those holes open.

Children are a whole different story. I can't find my pics of when Jax was first trached, but my blog post with pictures is here. When you put a trach in a person, you are bypassing the body's natural filter, the nose. The nose filters, and humidifies the air you breathe. If the child is not on a ventilator, they have whats called a nose, or HME that covers the trach. This replaces what the nose is supposed to do. Its not the same thing, but its pretty close! A trach with just the opening and no HME looks like this.

I've seen a couple children with nothing over their trachs. I don't recommend that. Besides the fact that stuff can go in that hole, the air they breathe is not being humidified or filtered.
Another thing a trach does is make the body produce a lot more mucous. When you put a foreign object in the airway, the body automatically makes mucous to fight it. That is why you always have to have a suction when you have a trach. It also makes kids much more work because you can't leave them alone in case they need suctioning. Some older kids can just cough up their junk. Jax does not have a strong enough cough to get the junk out. You always be careful if a trach kid is coughing because some can shoot junk out of their trachs like a canon!! I've been coughed on many times when working in the hospital. Sounds gross, and it is!

HME's come in many different varieties. Of course there is the ventilator that some children use.

There is also a mask that blows humidified air. But your still connected to a fairly short tube. Most kids sleep with this if they are not on a ventilator. An HME is for portability. Some kids can get really dry and yucky if they don't use this mask as much as possible. Its the best thing to keep the trach humidified.

Then you have your HME's. There are so many different kinds. The one in this picture can be worn alone. Its the white piece. The green is an oxygen attachment. This is getting to be obsolete though. Its big and bulky. I hated it for Jax.

The nose below had the oxygen attachment right on the HME. Its much smaller than the green piece above. You can also pull that tubing off if your child doesn't need oxygen. (Sorry its kind of blurry!)

There is also something called the passy muir valve. This goes over the end of the trach, and allows kids to vocalize. Some kids can be heard without this valve, but it works great for kids that otherwise can't. Jax doesn't tolerate this valve. It makes the child work a bit harder, so some sensitive kids, like Jax, can't use it.

If you have a trach, there are a few more supplies you need to have with you. The suction, of course, is always by Jax side! I also have an emergency kit in a big baggie. It has an extra trach (you always want an extra trach!) an extra HME, and any other trach supplies we use. Some people also carry an ambubag. We have one in the car. Some people don't need this, but its basically CPR with the trach. You put the bag on the trach, squeeze it by hand to give breaths to the child.

I think the biggest thing to remember with trachs, is that people live a totally normal life with trachs. Every child is different. There are kids that are much more work. If their trach comes out, or they need suctioning, they can stop breathing or drop their oxygen levels very fast. There are other kids that pull their trachs out all the time, and breathe just fine without it for a while. If your child gets a trach, you will learn what their normal is very quickly.
There are many times I say I hate the trach. But its like any other thing, sometimes it is hard. If Jaxson is really junky, there are times I don't sleep all night, suctioning him out. Sometimes its hard in public to suction kids out. It can make an outing harder if you have to constantly suction. So no, its not always easy, but life is not supposed to be easy!
One really great thing about the trach is if you have a child that has a tenancy to have respiratory failure and need the ventilator, the trach makes it much easier. No more traumatic intubations! A lot of times you don't need the nasty sedation meds with a trach and ventilator, like you would if your child was intubated. We LOVE that part most of all! Surgeries are easier, and illnesses are easier.

Ok, question time, please feel free to ask if you have any questions or I left something out!


Jess said...

Hi! I'm visiting from The Bates Motel!

What great information! I don't have any experience with trachs so this was very interesting to learn about!

Lane said...

Very Informational Post! It brought me right back to our trach days!

Alaina and Kyle said...

Thanks for sharing. I loved it!

Colleen said...

This is really good information for parents starting out with a trach!

Anonymous said...

Thank you! Informative for sure... what about swimming though? Like submersion in water

totlybatty said...

What is the Second HME with the oxygen connection??? We have the green attachment and I hate it! We've tried a few with the O2 port on the HME but they are worse than the green thing. This one you have looks like it would work so much better! We've been living in a lower elevation and my daughter doesn't need oxygen here but we are moving back up for a few months so we will have to go back to the tether. :p