We have a patient that has a metal trach tube and the doctor ordered bipap via face mask and had the nurses cover the trach tube with gauze to help prevent a leak but I think there has to be a better way of providing this. Are there better ways of doing this or could you attach the bipap to a metal trach tube, it seems there would be a huge leak thru upper airway and causing voice noise thru vocal cords.

I have to admit, I have never seen this done quite this way. Is the BiPAP for an acute issue? If so my suggestion would be, in order to get control of the airway and not risk loss of all therapy from the machine to execute with a cuffed trach and humidify. If the patient's problem worsens, you will need to go this route anyway to provide full ventilation. It doesn't sound too acute or your patient probably would have destabilized. If this is continuing, it would probably be a positive thing to establish with the physician what his goals are and what he has in mind if the patient worsens, and what criteria he is looking for to end the support. It is hard to say what if any serious side effects might occur. If the trach is tight fitting to the stoma and the mask fits well, the leak might be manageable. The additional questions for me is how much of the pressure is being transferred to the lungs as support past the trach, and is the machine able to sense him breathing around the tube. He must have a pretty competent upper airway if this is working. Perhaps decannulation could be explored with the doc when the BiPAP comes off. As always if you are uncomfortable with a therapeutic application particularly that is not expressly covered in your departments PnPs, make sure you discuss it with your supervisor/manager/director/medical director. If you feel it puts the patient in any danger have those discussions STAT.
Good luck

I agree with Gary. The other thing you can do if it is a tight fitting trach is to plug the trach and use the BiPAP via mask(s) or pillows just like a non-trached patient.

II wonder like Gary is it possible to decanulate. This patient must have a fairly intact upper a/w if you are to allow for M or Ncpap. There will be issues if you attempt to BiPAP with a trach insitue. 1) Jackson trachs are hard to occlude though plugs do exist the I/C tends to leak because it is a metal on metal loose fit. 2) If the trach is large you will find the patient having difficult on exhalation. 3) If the trach is small you will find the patient has difficulty on exhalation because the in Raw will cause increase air trapping. 4) If you attempt to NPPV through a trach which is cuffless you will always get a huge leak to the upper a/w.

I had an MD ask me once to adapt a fitting to put over the trach itself(a Jackson) and do trach BiPAP. I did manage to convince him I didnt think it was appropriate since we have a range of home vents to do the task more safely. We were able to downsize the trach, to a poly trach with a cork, and attempt BiPAP with full face mask and then decanulate. Even with an occlusive dressing the BiPAP wasn't overly effective until the wound healed enough for a tight seal. It did work though.

I also fully agree with the notion of speaking to your supervisor, chief, or manager if you are having to concockt a new form of Respiratory Therapy. Just as a CYA

Well, while I was off the patient ended up in the ICU with a changed out to cuffed shiley and on bipap via trach. Don't know what exactly happened but I guess that is where the patient needed to be since probably needed the monitoring anyway. Just seemed to me that metal trach was not neccessary although I have heard that for some patients feel is more comfortable.