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Thread: Dealing with a tracheotomy

  1. #1

    Dealing with a tracheotomy

    My friend was injured in an automobile accident a week ago Thursday.She suffered a crack to her C-1 vertebrae and an incomplete spinal cord injury at the C5/C6 level.
    She is awaiting transfer to Craig Hospital in Denver.
    She's having real difficulty in breathing. The doctors here in Montana may decide that she needs a tracheotomy in which case that will put off for transfer to Craig for two weeks.
    My question is simply how to get her through this if she ends up having a tracheotomy. What can we do to make her quality of life better? I know she has real concerns about being unable to communicate.
    When I had my spinal cord injury 18 months ago, breathing was not an issue so I do not know how to advise her. Thanks for your input.

  2. #2
    Is she also on a ventilator or not? If on a ventilator, a trach is the safest way to manage her airway as an ET tube (in the nose or mouth) can cause a lot of damage if left in too long, both to the trachea and to the sinuses.

    If she is getting the trach not because she is on a ventilator, but because she needs to be suctioned or cannot breathe well enough on her own without it, it should be temporary. They will be expert at weaning her from the trach at Craig. Why does she have to wait so long to go to Craig?

    You should ask about a communication system for her (spelling board that is custom made, etc.) and a speech pathologist would be the best professional to help work on a communication system for her. You should also ask if she will be allowed to use a Passey Muir valve (but this will require that she can tolerate having the cuff deflated on the trach for periods of time).

    I would encourage you to download, read, and share with her team the clinical practice guideline on respiratory care in SCI which you can find on a "sticky post" at the top of this forum.

    Welcome to our forums. Please ask questions, and get your friend on-line here too as soon as possible.

    (KLD)

  3. #3
    Senior Member taj2002's Avatar
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    Hi Jenny,

    Welcome to CC. My husband has a trach and has for nearly 7 years now. He has a C3 complete injury and is no longer on a vent but had some complicating circumstances (namely paralysis of one of his vocal cords) which required him to retain the trach for his airway.

    The most difficult aspect of a trach in the beginning is communication. The nurse mentioned the spelling board, but there is also a device called the Dynavox that can be used for communication. My husband also rehabbed at Craig. They have all this stuff and good speech therapists that will work with her.

    The people around her will get pretty good at reading her lips. Also I would suggest asking lots of questions where she can answer yes or no. Start general and then try to narrow it down. Like are you in pain? Is it your head? Your neck? Is it burning pain? Do it like that. Sometimes it is hard to decipher a big long sentence if you are trying to read her lips. Shorter phrases are better. It can get frustrating for both parties doing the lip reading thing.

    If her trach is only temporary then Craig will work very hard to move her to a cuffless trach, then down size the trach and ultimately remove it. She has to go cuffless or have the cuff down in order to speak. My husband uses a Passey Muir valve and did at Craig after he had surgery on his vocal cord. He has no problem speaking with the valve, but it takes a couple of days to get used to. Even though he basically has a permanent trach now, it really is no big deal. We maintain it at home, and I change it myself for him every month.

    I am very hopeful that this will only be temporary for your friend. Like I said my husband has an unusual circumstance. Craig is excellent at vent weaning, trach management and removal, and respiratory issues in general. Let me know if you have any other questions you think I can answer.

    Best of luck to your friend.

    Trish

  4. #4

    Dealing with a tracheotomy

    Thank you for your replies.

    In answer to the SCI nurse, the trach is supposed to be temporary. My friends lungs are terribly congested and her intercostal muscles aren't working properly so she can only take very short, shallow breaths.

    The family was told that Craig wanted the procedure done up here in Montana and then she would get flown down to Craig in two weeks time. I'm not sure why it would take that long.

    I also really appreciated the input as to how to communicate. Yes and no questions sound like a really good place to start. I suck at reading lips, but that's my problem, not hers.

    I know she has some arm movement, but I don't believe she can actually point to letters, but I'm hoping that the speech therapists at the hospital can figure out some way to help her out.

    Thanks again for your help, Jenny

  5. #5
    I'm a C 7/8 and ended up on a vent after my accident too - same thing junk in my lungs and weak breathing muscles. I was intubated for a week then got a tracheotomy which I had for 2 more weeks. To be honest I was so out of it I don't remember communicating much.
    The scar blends right into my scar from my fusion pretty much.
    Emily, C-8 sensory incomplete mom to a 8 year old and a preschooler. TEN! years post.

  6. #6
    Senior Member
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    Quote Originally Posted by Jenny McCune View Post
    Thank you for your replies.

    In answer to the SCI nurse, the trach is supposed to be temporary. My friends lungs are terribly congested and her intercostal muscles aren't working properly so she can only take very short, shallow breaths.

    The family was told that Craig wanted the procedure done up here in Montana and then she would get flown down to Craig in two weeks time. I'm not sure why it would take that long.

    I also really appreciated the input as to how to communicate. Yes and no questions sound like a really good place to start. I suck at reading lips, but that's my problem, not hers.

    I know she has some arm movement, but I don't believe she can actually point to letters, but I'm hoping that the speech therapists at the hospital can figure out some way to help her out.

    Thanks again for your help, Jenny
    Jenny,
    I'm so sorry to read that you suffered a spinal cord injury 18 months ago.
    Welcome to Care Cure. Sorry you had to find us but glad that you did.
    I'm also so sorry about your friends accident. Being trached is not so bad.
    I've been trached ever since I had sleep apnea surgery 2/98. Originally my trache was suppose to be temporary but here it it 3/09 & I still have it.
    I've gotten use to it. I was put on a ventilator for sleep 12/98 & I sleep so much better on the ventilator then I did on the BI-PAP unit w/a mask sitting on my face all night or nasal pillows w/a hose from the BI-PAP going over the the top of my head all night& a head band to hold it on my head. I hear that Craig is suppose to be one of the best rehab hospitals in the country. Where did you rehab may I ask?
    I wish you & your friend the best.
    Take care !

    BOB

  7. #7
    Hi Trish,
    My son was intubated for several weeks before they put in a trach. He had the trach about 2 months and was able to have it removed. He also has a paralyzed vocal cord from being intubated. He could not eat or drink without choking and aspirating into his lungs. What they did at shock trauma is a minor surgery where they injected a botox like substance into that vocal cord to puff it up. They said it might have to be done again in 6 months but he has had no more problems and able to eat and drink normally. His voice is a little raspy but that is no big deal. They told me they give it a full year after injury and if it does not repair itself that there is a surgery they could do to fix it. Just something you might want to find out about.
    DavesMom, Diane

  8. #8
    Botox would NOT be used for a paralyzed vocal cord. That would just make things worse. Collegen or plastic is what is injected into a paralyzed cord to make it thicker and close the airway better (and hopefully increase voice volume) if the vocal cord does not come back by itself.

    Vocal cord paralysis in SCI can be either from traumatic intubation or from damage to the recurrent laryngeal nerve with anterior spine stabilization surgery.

    (KLD)

  9. #9
    The big thing for me was having people there to do cough assist to get the junk out. That causes the most difficulty in breathing. bronchial dialators and other nebulizers to break up the junk is good to. It's a process, but your friend will get used to it. It's good to have a support system. I thought it would never end, constantly coughing up secretions! I still do, because I have a trach but I can deal with it on my own. Hopefully, this will be only temporary for your friend. Just have patience and let your friend know there are many others who know what they are going through!

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