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Thread: BFF getting trach/vent.help need to learn all i can-another question added 7.10.11

  1. #11
    Hi Liz, back late from some time away. I hope to help when come back tomorrow. m afraid I've got no wiser words of experience that Scaper.
    My hub uses vent at night and during days for rest.
    The trach has bena gosend in some ways and a curse in others. In our case the good ourweighs the bad.
    Wishing you both some peace in the adjustment.

  2. #12
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    I have a cuffed trach and I don't use a vent during the day. At first the two hardest things were needing suctioning and speaking ... as you seemed to surmise. When I first got the trach I got an infection. It seemed that I needed to be suctioned every few minutes. After the infection cleared up and I got used to it I now suction maybe twice or three times a day. Speaking can be a problem. I use a Passey-Muir speaking valve which helps greatly in speaking relatively normally. If you don't have it on you have to cover the hole with your finger to speak very well and you have to take a breath. This often results in broken up sentences as you run out of air.

    Maintenance is pretty easy. I have a disposable inner canula but I still clean it out sometimes during the day. This is where the suctioning and a trach brush comes in handy.

    Also, I get a fair mount of secretions around the stoma so I still have to use the gauze pads to absorb it. It's kind of annoying but it does work.

    I change out my trachs by myself. Some people say that it hurts but I don't have very much feeling in the area so most of the time I don't even know its there.

    If you have any particular questions, please ask.
    Last edited by StarLord; 07-10-2011 at 12:59 PM.

  3. #13
    Quote Originally Posted by mcco5543 View Post
    Ok guys I got further information. Just one piece. My friend would NOT be on a vent during the day, she would have a trach but then she would be vented at night. I just saw her in the hospital today. It's still all being discussed. Her main question and fear is this.

    When she's had ventilators in the past after surgery she just remembers the horrible choking,suffocating feeling and needing/wanting to be suctioned every two minutes. The only relief she experienced was when she was sedated. I'm guessing that the pressures they used for the vent after surgery is maybe more forceful when what they use on someone who uses a vent regularly? Yes? No? I have seen many a person with a vent out and about and they didn't seem to be uncomfortable or choking. They seemed actually perfectly "fine". (excuse any faux pa I make in asking my questsions. My intent is never to be rude or ignorant, only to learn becuase I am ignorant in the "lack of knowledge sense, but don't want to be ignorant in the "rude" sense of the word"...

    Thanks for your help. If anyone can answer my question and I could take the answers back to her that would really help.
    Large amounts of secretions are a lot more likely at the beginning and should thin out as her body becomes accustomed to having a foreign object in a very sensitive place. Personally, I find that trachs made from stainless steel produce less irritation, but I don't think they're commonly used in the US. The only time I feel like I'm choking (other than when I am in fact choking) is during turns and transfers, when my trach collar sometimes gets pulled crooked and the trach tube digs into the side of my trachea. Good positioning (both in bed and chair) and making sure vent tubings are straight and not too heavy are really important. Caregivers need to be as gentle as possible when handling her trach. And of course you want to do everything possible to prevent infections, which can produce absurd amounts of secretions. Constant handwashing, regular trach changes, good ostomy care, and mainly - keeping sick people away from her. An unfortunate Catch-22 of suctioning is that (while frequently unavoidable) it's another source of irritation and potential for infection, leading to, you guessed it, more suctioning.

    It will take some trial and error to find vent settings she's more comfortable with. Some people like bigger volumes and less frequent breaths, or the opposite. Different brands of vents have different options. Most long-time vent users have a model they swear by. And a model or two they hate. The "shape" of each breath can also be adjusted. Some people like a sharp inhalation while others like a smoother, more drawn-out wave pattern. A respiratory therapist will hopefully help her figure it out.

    I spent my first few months on a vent terrified and begging for help. No sugarcoating, it's not an easy thing to adjust to. But it does get easier. The body gets used to it and eventually, so does the mind.

  4. #14
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    Wow this is great info! I'm confused though.

    So the trach makes you feel like your choking and needs to be suctioned even not hooked up to a vent? (i'm so sorry i'm so stuck on stupid when it comes to this topic). I was hoping that eventually the trach (minus the vent) would just feel like a part of your body.
    Liza R. McCollum

  5. #15
    Hi Liz, My husband found the Bivona brand of trach tube better than the Shiley he started out with. When he was in rehab they used the stainless type Scaper talked about, but not available here.
    His has a cuff that we inflate for being on the vent only. Otherwise it is down for eating, speaking etc.
    An aide and I change it ourselves monthly and except for a minor procedcure for some scar tissue has been free of complications.
    The secretions seem to be different for everyone, Some days we only suction a few times and other times a lot. We also use a cough assist.
    Finding the most flexible suction tube was the most helpful. the first ones we were send were harder clear tubing. Now we have red rubber very flexible ones.
    He is a very laid back guy and does not have a lot of anxiety about the vent, but if it were me I would.
    Reading other people's experiences here is a great help. I'm no expert.
    Last edited by LindaT; 07-11-2011 at 04:30 PM.

  6. #16
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    "An aide and I change it ourselves monthly and except for a minor procedcure for some scar tissue has been free of complications.
    The secretions seem to be different for everyone, Some days we only suction a few times and other times a lot. We also use a cough assist.
    Finding the most flexible suction tube was the most helpful. the first ones we were send were harder clear tubing. Now we have red rubber very flexible"

    You said an aide and yourself change it monthly? change which? the trach or the vent?

    also you suction what a few times daily and sometimes a lot? the trach or the vent?
    Liza R. McCollum

  7. #17
    Quote Originally Posted by mcco5543 View Post
    Wow this is great info! I'm confused though.

    So the trach makes you feel like your choking and needs to be suctioned even not hooked up to a vent? (i'm so sorry i'm so stuck on stupid when it comes to this topic). I was hoping that eventually the trach (minus the vent) would just feel like a part of your body.
    If you have secretions, they obstruct the trachea whether you're actually hooked to the vent or have the trach capped off (usually with a plug of some kind). Likewise, the trach tube and trach collar can become crooked and irritating on or off the vent. The trach tube itself becomes encrusted with dry secretions over time. Don't forget it also sits in an area likely to trigger the gag reflex. It does become more comfortable, but never natural. My entire care routine is designed around avoiding my trach as much as possible. My caregivers know that any rough or accidental contact is painful, jarring, and the quickest way possible to piss me off.

  8. #18
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    Ok, well all i remember is the last time she was on a vent after surgery she just coughed and gagged and choked and was purple...it was awful. I don't want that to be the rest of her life. That's her main fear at the current moment (and secretly mine too)
    Liza R. McCollum

  9. #19
    Is there a Respiratory Therapist where your friend is that can help with your questions?
    They became our best friends during ICU, rehab and later deciding to keep the trach.
    I can't say enough about them.
    You are a good friend to be so concerned and I understand your fear.

  10. #20
    Liza,

    Using a ventilator and having a trach sounds scary, and it can be -- especially in the beginning -- but most people I know eventually get pretty comfortable with their vent and trach.

    That's how it was with me. In the beginning, I didn't trust that the vent would not fail, and if it did -- what would happen? What about pop-offs? Would the alarm sound -- every time? I now trust that my vents are extremely reliable, and the alarms are extremely reliable too. I'd elaborate about this, but since your friend can breathe on her own, that gives y'all (sorry, I'm from the South) a wonderful safety net, regardless of what issues may arise.

    You said to teach as if you were a two-year-old, so here are some basics:

    The trach: the term is short for tracheostomy tube, which is a curved item that is placed in one's neck & trachea. Typically, it has an inner canula which is a hollow tube that fits the inside of the actual trach. Having an inner canula is a brilliant design, because if secretions get stuck and are interfering with the airflow, it's much easier, quicker, and safer to change or clean the inner canula than it is to change the trach.

    There are different brands and styles of trachs. One key aspect is whether the trach has a "cuff" or not. The cuff is an inflatable balloon that wraps around the curved portion of the trach like a big ring on one's finger. When it's inflated, it seals off the person's airway and no air goes past their vocal chords, so no speech is possible. The inflated cuff (a.k.a. "cuff up") insures that essentially the full volume of air reaches the user's lungs, which is particularly good when the person isn't very medically stable. The deflated cuff (a.k.a. "cuff down") allows for speech, but some of the volume given by the vent will be used for speech and/or exhaled out the user's mouth and/or nose, so not as much air reaches the user's lungs. Consequently, with the cuff deflated, the volume given by the vent is typically increased (and decreased again when the cuff is deflated again).

    Secretion removal -- basically, there are two options for removing secretions from the trach / lungs: suctioning and the CoughAssist. Some prefer suctioning, I much prefer the CoughAssist. I have lots of info on my website about the CoughAssist (formerly known as the in-exsufflator) available from this page:

    http://www.lookmomnohands.net/Life_with_an_SCI.htm

    The basic respiratory setup involves the trach, vent circuit (the tubing), and the ventilator. There are different types of vent circuits, e.g. disposable and non-disposable, heated and non-heated, and other characteristics. I don't know much about the differences in vent circuits.

    I don't think the actual ventilator type makes a huge difference, because they all do the same basic things, but some are smaller than others, some are quieter, etc, and hopefully your friend will like what she gets.

    Scaper1 mentioned the ambu bag, which is basically a manual ventilator. It can help in loosening secretions, and of course can give breaths if the vent fails, and if your friend is (for some reason) unable to breathe on her own. Ambu bags are roughly $20, and can be used with a trach or face mask attachment. I think anyone who has the potential for compromised breathing (e.g. high-level quadriplegics, whether vent users or not) should have an ambu bag, just in case they develop trouble breathing or have some problematic congestion. Just my two cents; sorry for the tangent.

    Feel free to ask questions -- and God bless!

    Bill Miller
    Wheelchair users -- even high-level quads... WANNA BOWL?

    I'm a C1-2 with a legit 255 high bowling game.

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