Cuffed Trach at Night

[ParkerMama]

During Parker's right heart cath last Friday, the anestheologist made note that Parker has a pretty significant air leak around his trach.

He also had one around his trach for his last cath. They went in after that cath and removed a bunch of granulation tissue. My thought was they were going to up Parker's trach size, but they didn't.

Even though the granulation tissue was removed, there was still an air leak around the trach that you could easily feel.

So here we are again with the anestheologist saying that Parker's trach needs to be cuffed at night. Pulmo agrees. Both Pulmo and Anesthe. have talked to ENT about this.

Last time ENT said no because Parker's cap gasses have always looked so good. So he just got rid of the granulation tissue and left his trach at the same size....

But now Parker isn't holding his O2 sats on his usual levels when he's asleep on the vent and we have to crank up the O2.

We are ONLY having issues when Parker is on his vent. When he's on his trach mask or his nose he's holding his sats beautifully.

His lungs sound beautiful, and we know from his last cath that the PH is doing better.....not worse. The cath was just last Friday.

I'm waiting for a call from ENT now.

I'm open to any thoughts/experiences you guys may have. :)

[jarner79]

My son has a cuffed trach also. He has a custom size flextend bivona. But it is only inflated while he is on his vent, and one of the nurses will inflate while doing a trach tie change just to be safer than sorry. It's really not a bad thing at all in my eyes. He is uncuffed all day long, then once he goes on his vent, we inflate to 3.25ml of sterile water, and deflate when he comes off. (about 8 hours)

[ParkerMama]

Jessica,

Did it bother him when he first started on it? And you use sterile water to inflate it? They told us to just use air.

[jamie]

some use air and some water, go by what they told you. Evan also has his cuffed only when sleeping on the vent

[JandD]

Bivona TTS trach tubes are air porous. Air will diffuse through the cuff until it is deflated.

When Dovid had a serious leak, they looked not only at PaO2 and PaCO2 but also at volumes. He wasn't getting good volume so they increased the amount of water in the cuff.

Dovid was never off the vent but I am guessing that since your son has good sats off the vent it is because he is able to breathe deep enough to get the volume he needs. If the vent is set to only deliver a pressure/volume/length of inhale less than what he does off the vent, I could see why you have different results.

[jarner79]

Jessica,

Did it bother him when he first started on it? And you use sterile water to inflate it? They told us to just use air.

Of coarse he had to adjust when it first started. We could never put the vent on until he was in a nice deep sleep. But it does not seem to bother him at all. We were always told from the begining to use sterile water so thats all I have ever done. I even use it to check the balloon before a trach change to make sure there is no damage to it from cleaning and boiling. I was also taught to boil after we clean for roughly 3minutes in case you were wondering...only state that because some dont boil....i honestly do not think there would be any issues having a cuffed trach...it would only be inflated while on the vent anyways to avoid leaks. Hope you feel better about it.

[Ann]

Bivona TTS trach tubes are air porous. Air will diffuse through the cuff until it is deflated.



Yes - the Bivona TTS is considered a pressure cuff and should be filled with water. Bivona also makes a foam cuff which is supposed to be filled with air. Jack has used both. I prefer the TTS for ease of changing out the trach, but there is more risk of trauma to the trachea because it is a pressure cuff. The foam cuff is more difficult to get in and out, but it's softer (for lack of a better word) on the trachea.

[jarner79]

Yes - the Bivona TTS is considered a pressure cuff and should be filled with water. Bivona also makes a foam cuff which is supposed to be filled with air. Jack has used both. I prefer the TTS for ease of changing out the trach, but there is more risk of trauma to the trachea because it is a pressure cuff. The foam cuff is more difficult to get in and out, but it's softer (for lack of a better word) on the trachea.

Now this info I have never known about..nice to know now if I wanted to try that style bivona.