tracheostomy tubes
I guess I'm a dinosaur. I go back to the days of metal bedpans and bathbasins. When the patient left the unit we would scrub these things up, bag them, tape them with the special tape and send them back to central supply to be autoclaved. I also remember metal trach tubes. They were pretty awful. They'd get old and bent and the inner cannula wouldn't slide in and out of the outer cannula and the lock would wear out. What a difference when they started making plastic trachs out of PVC. They were great. It seemed like we were living in the space age at last . Sonnyboy came home with a PVC trach in place. We'd change it every week and just throw the old one away. We had to do "trach care" every day which involved removing the inner cannula , cleaning it with peroxide and a little brush, rinsing it in saline , drying it and replacing it into Sonnyboy's outer canula. All this had to be done with a sterile technique to prevent contaminating his airway and lungs with any new "bugs" and it had to be done quickly because Sonnyboy is on a vent and it's tubing only connects to the inner cannula.
The trach tube we were using was pretty rigid. One day last fall while the ENT docs were doing a change they put the whole thing right through the back of Sonnyboy's trachea into his esophagus. This was a bad thing to do. It took a few minutes for everyone to figure out why Sonnyboy was not able to breathe and we were close to that final curtain when somebody figured out what was wrong and removed and then reinserted the damn thing into the right part of Sonnyboy's anatomy. Sonnyboy spent the rest of the evening in the OR and the next month in the PICU.
It was pretty obvious that he needed a new kind of trach tube and after some investigating they came up with a custom made silicon Bivona . The silicon is soft and flexible, The airway is held open with a series of metal rings kind of like an imbeded spring. Also, the balloon that inflates to form a cuff to keep airway pressure in is filled with saline so its very soft and flexible. The tube is custom made and cost $350.00 to the old tubes $80.00 but it is made to the specific length that Sonnyboy needs. The biggest problem that the docs had was that it did not have an inner cannula and they worried a great deal that we would have problems with plugs of mucous.
It turns out that mucous just does not stick to silicon the way it sticks to PVC. We have followed in ENT clinic since discharge home last fall and the tube stayed clear with regular suctioning. Since it is long and since Sonnyboy is fragile inside we do use bronchial aspirating catheters, but even so the tube is great. Sonnyboy is comfy.No more hair raising weekly trach changes at home and no more daily inner cannula cleaning. The Bivona was changed last month when Sonnyboy was in the OR for his G Tube problem and the ENT docs are very happy with it.
Maybe now we are really in the space age.
Though the tube was initially quite expensive we are saving in the long run.
The price of weekly trach changes. The cost of daily trach care kits and saline and peroxide. The cost of regular suction set against the bronchial aspirators and sterile gloves. And the human cost in terms of stress and physical discomfort would make me choose on the side of the Bivona.
Most docs are going to use what they are comfortable with and what they are used to. But you know, there are hardly any more metal trach around these days...
The trach tube we were using was pretty rigid. One day last fall while the ENT docs were doing a change they put the whole thing right through the back of Sonnyboy's trachea into his esophagus. This was a bad thing to do. It took a few minutes for everyone to figure out why Sonnyboy was not able to breathe and we were close to that final curtain when somebody figured out what was wrong and removed and then reinserted the damn thing into the right part of Sonnyboy's anatomy. Sonnyboy spent the rest of the evening in the OR and the next month in the PICU.
It was pretty obvious that he needed a new kind of trach tube and after some investigating they came up with a custom made silicon Bivona . The silicon is soft and flexible, The airway is held open with a series of metal rings kind of like an imbeded spring. Also, the balloon that inflates to form a cuff to keep airway pressure in is filled with saline so its very soft and flexible. The tube is custom made and cost $350.00 to the old tubes $80.00 but it is made to the specific length that Sonnyboy needs. The biggest problem that the docs had was that it did not have an inner cannula and they worried a great deal that we would have problems with plugs of mucous.
It turns out that mucous just does not stick to silicon the way it sticks to PVC. We have followed in ENT clinic since discharge home last fall and the tube stayed clear with regular suctioning. Since it is long and since Sonnyboy is fragile inside we do use bronchial aspirating catheters, but even so the tube is great. Sonnyboy is comfy.No more hair raising weekly trach changes at home and no more daily inner cannula cleaning. The Bivona was changed last month when Sonnyboy was in the OR for his G Tube problem and the ENT docs are very happy with it.
Maybe now we are really in the space age.
Though the tube was initially quite expensive we are saving in the long run.
The price of weekly trach changes. The cost of daily trach care kits and saline and peroxide. The cost of regular suction set against the bronchial aspirators and sterile gloves. And the human cost in terms of stress and physical discomfort would make me choose on the side of the Bivona.
Most docs are going to use what they are comfortable with and what they are used to. But you know, there are hardly any more metal trach around these days...
posted by CCCCppppCCppp at 5:14 AM
2 Comments:
Ain't plastic great? And silicone! Aside from what it has done for the fashion industry they make all sorts of stuff out of it including hot pads that actually protect your hands and your medical equipment.
New equipment isn't always the answer. Had an older nurse go old-school on me with the gaint blood drawing needle and it hurt less than the nurse using the little mosquito lookin' blood drawing dealie. It came down to the fact the older nurse knew what she was doing, found the vein right away and got down to business.
Next: The trainee tries to draw Phos's blood and manages to escape with her life.
Ha, told you I posted! Now off the refrigerator and pitch out all the nasty tofu-burger...
Post a Comment
<< Home