Our Hospital does not currently have a protocol for home cuffless trach patients on a vent who come into the hospital. At this time our surgical intensivist require all patients on vents to have cuffed trachs or if they come in cuffless...the trach must be changed to a cuffed trach. Anyone have a similar policy?? anyone ventilate cuffless trached patient on the vent??
Our hospital have lots of home patients on ventilator. I am following up patient/s on ventilator and also have suggested cuffed tube to maintain adequate and proper ventilation. I would suggest the minimum leak technique for cuff pressure monitoring or regularly monitor cuff pressure be done.
One question, does ur patient have home nurse while at home?.. they can be trained for this or a relative who is with the patient all the time.
Now for my opinion, patients sent home with uncuffed tube should be pediatric cases or if adult should have proper size trach and should be handled by a well trained RCP. I think there will be possibilities that RTs will be called for vent alarming due to leak caused by uncuffed tube in addition to patient desaturating due to hypoventilation. I think this is one reason why ur intensivist wants patients on home ventilator on cuffed tube. One thing more the tendency for patient to aspirate using uncuffed tube. now for alert and patient need to train to talk, i would suggest a fenestrated tube double lumen trach tube. Hope my suggestion will help u..
BTW what ventilator ur using for home care?
Our chronic trached/vent pt's for the most part do not require cuffed trachs when they come into the hospital. We usually maintain them on the same settings they are used to, unless needed as per ABG. I would even consider it a little cruel, as it takes their ability to speak away.
We don't intubate everyone that comes into Emergency for a/w protection.
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