Trach change went bad

[Tally Sue's Mommy]

I have a question. My daughter is 16 months old and has had her trach for 1 year now. The nurse and I went to change her trach and we could not get it back in. She had clamped down and we were unable to acess her airway. She droped her O2 sats to 13. We bagged her by her face but we were still unable to oxygenate her. Finally the nurse got the trach in and we got her oxygenated. Please tell me that this doesnt happen all the time. She has never fought us the way she did. Has this happened to any one????

[drct1245]

Oh how scary. I wish I had more insight. Ayden is 20 mo (16 1/2 mo adjusted) and the only thing he has done to us is turn his head - nothing as serious. I guess always having a smaller trach size and the ambu bag ready at all times is a must. Do you have one that is connected to oxygen - the green ones that anesthesiologist use? We have gotten a little lax at our house during trach changes and although both kinds are bedside, your post makes me start thinking.

[TommysMommy]

Holy crap! This is the kind of thing I NEVER want to hear! Since we are without nursing, 9 times out of 10 trach changes are done with my 9 year old son holding Tommy's hands above his head so he can't roll or grab. I don't even want to imagine what would happen to Tommy if I couldn't get the trach back in.

[Isaac'sMomandDad]

I'm with Rene, how scary.

I don't know enough about your daughter to really comment. Definitely keep extra supplies, smaller trach tube and ambu bag at bedside for any future changes. I wonder if there is something blocking the trach from going in, like a granuloma (scar tissue). How long since her last bronch? Why does she have a trach?

My thought would be to call her ENT who knows her better and see what they want to do, push to have her seen for a check.

Good luck!
Lara

[Kara Beth's Mommy]

Glad to see you came by! Not for the reason though. Do you have a trach 1-2 sizes smaller than what she wears? If not have Tally's Dr write a script for it for cases like this. I am sorry you have such a hard time. We have only had one time the entire time Kara has had a trach that we had a tough time getting it in. How is school going? How did you guy's do with the weather? By the way Tally is looking SO grown up! I love the new pictures.
Rachel

[Gretchen(Celia's mom)]

i know how scary that can be! my daughter has had a trach all her life and she is almost 10 years old. i have never had problem with changing her trach (changed once a week all these years) until about 6 months ago when we had the same experience that you just described!! i had gotten really lax about trach changes after doing it for so many years and have been doing it for years without anyone around, no emergency supplies at hand ,that day changed that. now i only do her trach changes when someone is here with me and supplies at hand! i have not had any prolems since though so i have no idea why it went that way that time. hang in there and hopefully it won't happen again!

[alizesmom]

How frightening for you. I'm glad you got it back in. Calling the ENT sounds like a good idea. Karen

[JWorthington]

Ooh that sounds pretty scary. Do make sure you have a smaller trach to hand in case this happens again. I would definitely talk to your ent, there could be some granulation tissue preventing you from getting the trach in. That has happened to us a couple of times. Once, when Sam was first discharged and my dh couldn't get the trach in - thankfully I managed to get it in. The second time was around 6 weeks ago when Sam decided he wasn't going to lie still, he was gonna get up and run around the room just after we had taken the old trach out! Sam has had his trach for 3 years! Both times all worked out fine and we've never had to use the smaller trach.

Good luck
Julie

[TommysDad]

We had two changes go bad, although one not quite as bad as that. We also had three tie changes (two in the hospital and one at home) go really bad. Always have a downsize trache handy, we keep the two next lower sizes handy because this is Tommy's only airway. After the first change went bad, Maggie was pretty freaked out. Our surgeon who kept a close eye on Tommy reassured her that if they clamp down, you will eventually be able to get the trache back in (maybe the smaller size). It is a matter of remaining calm.

On the change that went bad, I panicked and tried getting it in. Maggie told me to calm down, and I did and you could see the stoma relax and the trach went right in. Changes after that were a challenge until recently. Besides having backups handy and the ambu bag there with oxygen, a couple of things that we found were...

1) If you are not using a flexible trache, see if you can get the OK to insert it without the opterator. Cincinnati is adament that you do not need it and it can cause problems. Going back to not using the opterator was probably our number one factor in getting back to a clean change. Tommy would panick when he went to breath with it in.

2) Instead of counting one-two-three when changing, (we do a two person change which should be done if at all possible) we change it up with A-B-C, Uno-Dos-Tras.

3) Try to have a convenient distraction handy.

4) Be confident with yourself, and have someone confident helping you if possible.

5) If it does not seem to be a good time to do the change, it probably is not. If the child is already fussy, they are not going to get better. We have taken the phylosophy that we are better going 15-16 days on the sam trach than taking a chance. Same goes for ties, if he is too fussy, we might defer to the next morning and just do basic care. Obviously, if the trache absolutely must be changed, (plugged) you have to do what you have to do.

[suzanne2545]

Nice advice, Tom.

We don't count but I can see how changing it up would be a real added benefit for kids who know what is going on. I don't know why we don't, we just never got into it with our "choreograph."

Suzanne