Thursday, October 23, 2014
   
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Common questions about Trach's as well as some Tips

Why do I need humidification?

Humidification helps keeps things moist, since you are no longer getting moisture and filtration from your nose that you need. It also helps keep the mucus thin and you will get less mucus plugs. It will help keep your carina from drying out and help prevent things inside your windpipe from cracking and possibly causing you to start hacking up blood into your tube.

What's the difference between a compressor for humidification and a nebulizer and bottles and cups?

There are bottles that you fill with distilled water for humidification that hook to a compressor. A nebulizer is a medical device that delivers liquid medication in the form of a mist to the airways.
Some people/companies incorrectly refer to the compressor as a nebulizer or the bottle/jars for humdification as a nebulizer so that is where confusion occurs.

Why the confusion?

Some folks confuse humidification mist with the medication mist.
A nebulizer compressor forces air through tubing into a medicine cup filled with liquid medicine. The force of the air breaks the liquid into tiny mist-like particles that can be inhaled deeply into the airways.
A humidification compressor forces air (sometimes oxygen) through a bottle/jar of distilled (sometimes sterile) water which administers a specific FiO2. (Determined by air entrainment port on nebulizer.) Settings on the bottles/jars are adjustable from 35% to 100% and has ports for a feed set and an immersion-type heater.
BE AWARE--some companies refer to the bottle/jar as a nebulizer.

What are all the parts needed for humidification?

Humidification for sleeping you want a compressor that connects to an (nebulizer) bottle that gets hooked up to large blue or white corrugated tubing (get in 100 foot rolls) which is hooked to a drain bag which is hooked to more corrugated tubing which is hooked to a mask that is worn over your trach tube opening.

There are many brands and types out there, this is just what I have used or currently use:

Airlife Cat 002002 Nebulizer with Air Entrainment and Immersion Heater Adapter which I attach to my Bunn Silent Compressor Model 400A. I do not use a heater (because heat can increase the risk of infections).

Airlife Cat 001501 Trach "T" Adapter with Drainage Bag (with 22 mm OD Arms, 15 mm ID Base with 500cc Drainage Bag, Two Oxygen Tube Connectors and Strap hanger)

Hudson 22mm Latex Free Corrugated Tubing. Disposable corrugated tubing comes in a 100' roll with segmentation every 6" to aid you when cutting the desired length. Tubing is easily dispensed from the case it comes in.

Airlife 001225 Adult Tracheostomy Mask

What parts do I need for an asthma treatments?

Pari Duraneb 3000 Portable Compressor with Pari LC Jet Plus Nebulizer for liquid treatments.
AeroTrach Plus or Ace Aerosol Cloud Enhancer for inhaler treatments.

What is the inner cannula for?

Inner cannulas are for catching the mucus crap or other entertaining fluids, you remove the inner cannula clean it and put it back to catch the next round of stuff. This also cuts down on the number of times you have to take out your entire trach tube to clean it. Yes most people take out their tubes to clean them and don't need a doctor or hospital visit BUT some conditions do require a doctor or hospital visit for changing the tubes.

How should I clean my inner cannula?

Everyone develops their own cleaning habit and it's kinda what works for you. Whenever I feel my breathing is restricted I clean my tube, also following my asthma breathing treatment I clean my tube. Some days it can be every couple of hours and other days it can be 4 or 5 hours before I need a cleaning. I use a trach brush and tap hot water. Then once a week I switch my tube for another and the one just used gets soaked in peroxide over night, then it gets soaked in water over night, then it gets air dried over night, then it gets placed into a zip lock bag to wait for it's rotation back into use at the end of the week.

Each person has their comfort levels with how they do their trach care. There are many different tubes and buttons on the market. Now each persons reason to have a trach plays into the question--muscular and neurologic status, activity level, ability to cough, and the quantity and viscosity of secretions for example.

Some folks suction to clean their tubes, others won't suction because they rather not push organisms into their lower airway from the saline/suction combo (read the article "Challenging Current Suction Techniques.")

Some have the lung strength to "blow out the crud" others don't, others have an inner cannula they can take out clean and put back in, some have a trach tube (or a button) with no inner cannula and they simple take out their trach clean it and put it back in while others will use a foam swab to clean it while it's in place. It's kinda up to you to pick what works best.

As for number of times a day people clean, again that depends on their condition and how much secretions they have. I know that most people when ill have tons more secretions than when not ill, so they may clean more times a day. Example-sleep apnea folks that cap their tube during the day are not as likely to be cleaning all the time. Someone with tons of allergies that were always having a runny nose will be cleaning their tube more often, and others fall in between.

Some folks clean a couple times a day, others every couple hours. Everyone is different, everyone's reason for a trach is different.

Looking for cleaning brushes? You will find multiple dealers that sell just the cleaning brushes in the web links section. In the upper right use advanced search, type in brushes you will find a few links. I personally use the ones from Spectrum Surgical.

Suctioning

I suggest you read the article "Challenging Current Suction Techniques" (found in Traches In The News.) The medical and trach community is divided on if you should suction or not. This information is for those that decide they are going to suction and know the risks involved. Personally I stopped suctioning after I was healed. I used the DeVilbiss Suction pump that was rechargeable and portable and came with a built-in 110V / 220V for domestic or international use.

Good suction machines will have vacuum adjustments allowing for 80-550 mm Hg and a free flow of 27 liters/minute and weigh under 7 pounds. A good suction machine will also meet the RTCA/DO160D Aircraft Standard as well as the US Federal Specification KKK-A-1822D Ambulance Standard and the ISO-10079 Medical Suction Standard.

What size trach tube should I have?

That will be a decision you and your doctor need to make. Here are a few things to think about and bring up when deciding the tube type and size.

A 10mm cannula has 277% more of an area to breath through that a 6mm does.
Pause and think about this a minute, this means it only takes about 1/3 the energy to take air in through a 10mm as opposed to a 6mm cannula. The difference in these numbers is even greater when you get 1 or 2 mm of mucus crap or other entertaining fluids in the tube OR if you add a speaking valve. Some larger size tubes will fit in the current size stoma hole and increase the ID. It has to do with how they are made by the specific company.

Here are a few examples of different tubes and differences of their size 8:
(OD=outer diameter ID=inner diameter)

Shiley Disposable Cannula Cuffless Fenestrated 8DCFN Size 8 OD 12.2mm ID 7.6 Length 79mm

Portex uncuffed Flec D.I.C. Size 8mm OD 10.9mm ID 8.0mm Length 74mm

Portex uncuffed lo-profile Size 8mm OD 11.3mm ID 8.0mm Length 75mm

Tracoe Twist Size 8 OD 11.4 ID 8.0 length 76

Blom-Singer Laryngectomy Tube (What Hubby and I modified for my trach tube--put in a fenestration) Size 8 OD 12.0mm ID 9.5mm
***Since I had been using a Shiley 8 I went to a Blom-Singer 6301 Size 10 OD 13.5 ID 10.5mm Length 55mm It was a easy fit and having a silicone tube made it pretty easy going in and out.

Should you need a larger size tube Traceo Twist has Size 9 ID 9.0 OD 12.5 length 78 and size 10 ID 10.0 and OD 13.8 length 80

Can I take out my tube and leave it out for a while?

This is NOT wise. Your body make up and how your body responds is what determines your stoma closing rate. Some folks trachs close just in the time it takes to remove the tube and put another in, those folks usually have to have their doctor change their tubes and in some cases they have to be put out (out patient procedure). Some folks can go 5 minutes, others folks hours (personally I can go 30 minutes before I run into issues). A few folks can be without a tube BUT you would have to have the flap type surgery which keeps an opening always. BEWARE the stoma hole will shrink up a bunch and the opening might get to small to handle your issues. In the long run you could end up damaging yourself. Best to ask your doctor about this issue BEFORE just leaving your trach out.

My guess is if your tube is bothering you or causing you to cough all the time or is painful, is you have a tube that is not right for you and is misfitted. You most likely need a different brand or a customized one. Help educate your doctor that there is more than one or two trach tubes on the marked.

Tips:

One of the biggest issues is keeping things from flying into/entering your trach tube/opening. This is a direct route to your lungs. So ANYTHING airborne can go into your lungs. BUT at the same time you can't worry about every micro particle.

Here are a few common sense things BUT remember everyone will do what is in their comfort zone so you have to make your OWN choices. All I can do is offer my opinion but in the end it's YOUR CALL--

You probably should use a HME or stoma cover (I have used Cardinal E-Z breathe filter and frame) to help keep the moisture in and the airborne things out.

-Don't be around or have animals (dogs, cats, birds) they all shed and airborne things get into your lungs

-Don't put anything into your trach unless your doctor has gone over all the risks with you...this includes saline.

- If you have asthma stay away from perfume, also be aware some perfumes, body colognes, deodorants, body washes, powders, after shaves and some laundry and hand soap can cause reactions and in some cases drying out your stoma (like smoke does).

-Try not to be in smoke or around smoke, or other conditions that are too dry. Your stoma, windpipe and carina dry out and then things inside can crack and you might start hacking blood.

-Stay away from dusty areas, woodworking can be a problem it will depend on the type of woodworking you do.

-Don't be around when gardeners are mowing the lawn, cutting hedges/bushes/flowers, spraying chemicals or using a blower.

- Stay away from Kleenex type products (puffs, etc) as the fibers end up in your lungs and you really don't want that. Use a handkerchief or a cotton baby diaper!

-Stay away from cotton QTips type products the fibers end up in your lungs and you really don't want that.
Use a foam swab, there are ones made for medical use.

-Use a humidifier (via the 1 inch hose to trach/trach mask) each night while sleeping. I know if I don't use it each night I suffer with either thick mucus sludge or things get dried out that the carina starts to bleed and I hack blood out my trach for days or weeks or if really bad months.

-Aerosol products put out airborne products and you will end up with whatever you are spraying in your trach and lungs. I did some spray painting with a can of spray paint once and when I took my inner cannula out to clean it...it was all black from the spray paint EVEN though I held the can out at arms length and had a cover/HME on my trach and didn't see any fumes/flecks/paint flying near my face.

-When showering keep the water out of your trach tube. You can buy a shower cover or read about showering ideas in Jill's Soapbox.

-When you go to the doctors or Emergency room, if possible send someone in first to explain you have a trach and that you need a private room/area as you can't be around other people due to their germs going straight into your lungs. All hospitals and doctors I have interacted with have NO PROBLEM with this.

-If you need to travel by airplane, the airlines MUST accommodate you and they can NOT refuse you to fly. See full details on flying/traveling with a trach in Jill's Soapbox.

-If you are in climates that is hot and dry (example Arizona) be sure and use your trach mask humidifier at night and a HME during the day.

-If you are in climate that is freezing and snowy be sure and use a HME when out and be prepared to clean or suction when you enter or exit a building. The mucus crap or other entertaining fluids freeze when outside (potential clog) and melt when inside (potential running into lungs and coughing). Also remember if it is freezing outside to keep your trach opening covered so you don't get frostbite in your lungs.

-If you live in a area that has lots of flying insects be sure and wear a HME and try not to be out when the bugs are.

 

 

 

 

 

 

 

 

 

 

 

 

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