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Picture of GJ,RRT
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Has anyone used high flow scoop cath through a #6.0 portex trach on the hard to wean/co2 retainers/end stage copd's. I have lots of LTAC experience and i remember 1 patient that came to us from a well known center in Texas. They had tried to wean without success for nearly a month. They finally told the patient that he would probably be vent dependent, and he was being transferred to us since it was near his home. I admitted the patient and had his trach changed to a #9.0 portex for an inferior #8.0shiley trach within minutes. Had him weaning on a trach collar the next day, but noted his RR was higher than i wanted. Within the next couple of days transitioned to a #6.0 portex with TTAV(scoop cath at flows up to 12l directly above the carina). Noted a decrease in WOB, probably due to washout of anitomical deadspace. Within 2 weeks or so this gentleman was decannulated and on nasal O2. If you don't utilize portex, SCOOP caths, and TTAV and your an LTAC you are doing your patients a disservice. For more info on Trans Trach Caths google the "Transtracheal institute".


Chris Hanson RN, RRT-NPS, CPFT, AE-C
ER Registered Nurse
Grand Junction, Colorado
 
Posts: 66 | Location: Grand junction, colorado | Registered: August 21, 2006Reply With QuoteReport This Post
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Picture of GaryMefford
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GJ,RRT,
Thanks for bringing TTAV to the attention of this forum. This is certainly a very exciting modality. I have seen Dr. Yeager from Denver speak a couple of times, and his presentations are very compelling especially from the human perspective of nearly instant speech and ability to maintian off of mechanical ventilation for the patient. I don't think any LTACH will be completely equiped in a year or two unless they have the ability to provide this therapy. Respironics has a system that has received FDA approval, which inludes the device for administering the gas flow (basicly what Dr. Yeager called TTAV on a stick, a blender, a humidifier, and a presssure alarm)and a purpose built transtracheal catheter. This system is called the Cadence. Check out this link. Be sure to view the video behind the user opinion link on the left.http://cadence.respironics.com/ We don't have this going at my facility yet, but I am working on it. I share your opinion on trach selection. Are you using fenestrated trachs with TTAV?
 
Posts: 147 | Location: Buckeye Az | Registered: January 27, 2006Reply With QuoteReport This Post
<GJ,RRT>
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Never use a fenestrated trach. I am used to using a #6.0 portex with a cap with a hole drilled or drill a hole through a olympic button and insert your trans trach cath. I like the olympic use it opens up your airaway and removes the trach. I worked at vencor Denver with Dr. Yaeger as both Respiratory director and staff. Unless a specialty trach(i.e. bivona or special size portex) is needed the only trachs needed at an ltac is a #6.0,#7.0,#8.0,#9.0,and #10.0 PORTEX. Both fenestrated and shiley trachs should be thrown in the trash. Hope your facility gets TTAV soon, it has improved the life of many patients.
 
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<GJ,RRT>
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Gary,
I spoke before I viewed the Cadance site. The Cadance is the high tech version of what I used in 2000. It also appears that a fenstrated trach is recommended. Although I would like to hear from Dr.Yaeger why a fenestrated trach is used. I would go with what Kindred Hospital-Denver does. I believe that use and experience with high flow that Kindred-Denver has makes it one of if not the best "Weaning Facility" in the country.
 
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I am not really sure the Cadence and TTAV is really "high tech". Might be considered cutting edge, but the concepts of tracheal gas insufflation, transtracheal high flow, and the transtracheal catheter have been around for a while. I have had some real problems with fenestrated trachs and usually try to steer my docs away from them when the selection is not left up to me. I have had a chance to speak on the Cadence at some length with some of the folks from Respironics who have been working with it from very early on and they tell me they recommend the fenestrations for some additional safety incase flow is lost. I have seen the Denver weaning protocol that employs TTAV, and if I remember right it specifies a downsize to a 6 single cannula trach, but I don't remember it calling for a fenestrated. This may have been an addition to make it look safer for the FDA docs. I am with you I will follow the Respiroincs specs for use when I get my opportunity to put this system to use. I have to admit Kindred Denver has a solid program. I have met a previous RT director from there and understand Dr. Yeager is awesome to work with. I will say he is very passionate about this modality.
 
Posts: 147 | Location: Buckeye Az | Registered: January 27, 2006Reply With QuoteReport This Post
<GJ,RRT>
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If you saw the setup that was used before Cadance you would think it was high tech. I agree with you about the fenestrated use, i would prefer a non-fenestrated trach. High-flow will change weaning at LTAC's if it catches on with the rest of the country.
 
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