| Tracheostomy Tubes | |
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The Problem: Tracheostomy tubes should not be removed for a week after their insertion because it can be difficult to reinsert a tube soon after the tracheostomy proceedure. The major risk is the passage of the tube into the pretracheal area. New bleeding from a tracheostomy site is usually harmless if it comes from the skin but there is an important rare and horrendous complication: erosion of the innominate artery by the trach tube. If the cause for bleeding around the trach is not apparent it is prudent to contact the surgical team for an assessment. A cuffed tube is normally inserted initially to help control aspiration and to allow mehcannical ventilation. Its replacement later on takes pressure off the trachea and allows weaning from the tube but keeps its utility as an aid to suctioning and airway protection. The non-cuffed tube also allows corking so that patients can phonate. |
What We Do: To change the tracheostomy tube a week or more after the tracheostomy procedure is usually very easy. The cuff needs to be deflated with a 10 cc syringe. The old tube slips out, usually inducing a cough. The new tube with its stylet is inserted, the stylet removed and the inner canula inserted, and the trach ties attached and the trach gauze placed over between the skin and the device. Any sutures that remain from the time of the original insertaion can be reomoved along the way. These tubes come in different sizes: for big people, a number 8 tube is usually used; for smaller people, use a number 6. The trach tube can be removed with confidence when patients tolerate corking for 24 hours and do not need suctioning during that time.The site will seal over within a few days and needs just a simple dressing in the meantime.
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| Authorship: Dr Valerie Taylor | Last Revised: 29 May 2002 |