"Dry" versus "Thick" and when to use saline?

[KJKK8437]

All this talk about humidity and saline has me intrigued. (You know me -- think too much.)

I'm wondering about our use of terms and whether we mean the same things by what we say.

When your child is underhumidified or "dry" (however you do humidity -- machine, HME, au natural) is that the same as being "thick" in your house?

We've switched to the PMV all waking hours. At first when we started, Alex was thicker than normal. Secretions were still there, just stickier and a little whiter -- less runny and clear. Now, he is just plain dry. There are very few secretions in his trach at all. It was the first time I ever thought about how you could have both reactions to drying out -- thicker secretions and less secretions. I never thought about it much before because when Alex thickened up a little bit (provided he wasn't sick, that is), his suctioning needs were less. The slightly thicker secretions were much easier to deal with then the thin, watery stuff that just gurgled in his trach.

So -- what happens when your child "dries out"? And when do you use saline -- for thicker secretions or just plain dryness?

Oops ... Ann, Cindy ... help. I posted this in the wrong forum! So sorry!

Finally -- what happens when your child is dry? Do they have any symptoms, or do they just go on as normal?

[Mom2TwinsPlus1]

We have thick and we have dry in our house. Very rarely do we have dry because Emma is vented on humidity or hme all the time, but hey I admit she has had Mom Dad or nurse accidently let her humidifier run dry on occasion. Thick we have off and on, sometimes when we are sick, and sometimes just to be diffrent she does it LOL so we turn up the humidity.

I use saline everytime I suction. I know the whole controversey with that, but Emma usually isn't watery thin so I will suction first squirt a little saline to clean the gunk that I pull up into the trach out and then suction one more time. I would say normally on a scale 1-10 1 being like water and 10 being thick like pudding or something Emma is about a 4 or 5 normally. The little bit of saline and one extra suction seems to keep her trach really clean. We do weekly changes and normally it looks so clean you can't tell its been used at all.

When Emma has gone dry we have had no symptoms from it except for after and we have had a little blood tinged suctioning after. We haven't let her go dry in years I don't think.

[twintotwin]

I consider my guys "dry" when I hear a whistle from the trach. Or when they cough and can't get anything out. At this point, and I was also taught not to dump saline down the trach, but, I do. It works and they haven't drowned yet.
But every kid is different. I wouldn't have ever dumped saline down their trachs back in their ventilator days. Both twins have a good hearty cough now, and they can manage with a few saline drops.


In the earlier days I would just go with saline nebs when they were dry. I might also increase their water intake a little. Parents need to be careful when increasing water intake because it can upset the level of potassium...something of that nature. In other words, ask your doc what amount is safe if needed.

As far as thick secretions...we have them with long-term PMV use. I give them a few saline drops every couple of hours. If not, the PMV tends to become practically cemented to the trach and if the boys try to pull of their PMV the trach will come with it. (we learned this the hard way).

I don't know if I answered your question Karin...hopefully you got something out of my jibberish.

[saywhatyouwill]

same here, we have think and we have dry. dry sounds like a whistle, thick sounds - hard to describe - a bit like when you have lots of gunk in your nose with a cold and it blocks off the back of your throat a bit. does that make sense? thick is probably worse than dry. saline works for thick.

[Baby1107]

Originally Posted by saywhatyouwill

same here, we have think and we have dry. dry sounds like a whistle, thick sounds - hard to describe - a bit like when you have lots of gunk in your nose with a cold and it blocks off the back of your throat a bit. does that make sense? thick is probably worse than dry. saline works for thick.

ditto.

[drct1245]

Karin,
When Ayden was on the PMV, we actually just did "routine" suctions where we made sure and sux him when he woke up in the morn, before his nap, and before bed. He was never dry, but we would put drops of saline down the trach periodically to make sure he didn't get dry - it was hard for me to tell how sounded b/c he was screaming half the time.

[alizesmom]

We also call it dry when we hear the whistle and hacking nonproductive cough. It seems to really irritate the airway. Thick means secretions that run from a jelly-like consistancy to rubbery. After that comes plugs. We saline with the first two but just do a trach change with the last. Karen

[Ainsley's Mom]

When Ainsley's trach gets dry her breathing has a distinctive sound. I will use some saline drops and pop on an HME if she hasn't been wearing one. Sometimes I'll get nothing back other than the saline. At other times when she's drier I'll actually get thick secretions which have their own sound. Since Alex and Ainsley share some similarities I'm going to guess you are finding the same thing to be true. Sometimes dry means literally dry and other times it means the secretions have dried up some and become thicker. I think they can be dry with almost no secretions or dry with thick secretions.

We used an HME the entire time in the hospital (instead of the warm mist). Their air is super dry and I went through about 20+ saline fish and drained the whole tube. At home one saline fish will last me an entire week or longer. Some weeks I might never even crack one open.

I think this difference is the same thing we deal with when they're wet. Inconsistent secretions. I hope that makes sense.

[KJKK8437]

Originally Posted by Ainsley's Mom

When Ainsley's trach gets dry her breathing has a distinctive sound. I will use some saline drops and pop on an HME if she hasn't been wearing one. Sometimes I'll get nothing back other than the saline. At other times when she's drier I'll actually get thick secretions which have their own sound. Since Alex and Ainsley share some similarities I'm going to guess you are finding the same thing to be true. Sometimes dry means literally dry and other times it means the secretions have dried up some and become thicker. I think they can be dry with almost no secretions or dry with thick secretions.

We used an HME the entire time in the hospital (instead of the warm mist). Their air is super dry and I went through about 20+ saline fish and drained the whole tube. At home one saline fish will last me an entire week or longer. Some weeks I might never even crack one open.

I think this difference is the same thing we deal with when they're wet. Inconsistent secretions. I hope that makes sense.

Makes perfect sense, Susan. Yes, we do see two different kinds of "dry" just like you describe.

Like you, I am wondering when dry means "too dry" now that Mr. A wants the PMV all waking hours. I've decided to just ride with it as long as he can still cough and can produce suctionable secretions within 3 minutes of putting on an HME.

[Ainsley's Mom]

Originally Posted by KJKK8437

Makes perfect sense, Susan. Yes, we do see two different kinds of "dry" just like you describe.

Like you, I am wondering when dry means "too dry" now that Mr. A wants the PMV all waking hours. I've decided to just ride with it as long as he can still cough and can produce suctionable secretions within 3 minutes of putting on an HME.

I think if you find the PMV dries him out you could just add a few drops of saline throughout the day and problem solved. I think if he "sounds" dry then that's too dry. Hope that makes sense.