What Is a Trach?

In a post I wrote about a week ago, I mentioned that Stacy had a bit of an emotional breakdown after James’ ENT brought of the subject of putting a trach in James. Since this was the second time a trach had been mentioned (the first was by a nurse in the NICU), I did a little bit of research to learn more about them and if it would make sense for James. I thought I would take a little bit of time and write up what I found.

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What is a trach?

Trach is short for tracheostomy, which is a surgical opening made in the front of the neck and into the trachea, or windpipe. A short tube is put into this opening in the neck. James would breathe through this tube instead of through his nose and mouth.

This picture should give you a better idea of what a trach looks like:

 

What are some reasons for having a tracheostomy?

There are several reasons why a tracheostomy may be done, but three of the most common ones are:

1. To bypass an obstructed upper airway
2. To clean and remove secretions from the airway
3. To more easily deliver oxygen to the lungs

With James being unable to manage his own secretions, and needing to be frequently suctioned, #2 above would be the reason that James should get a trach.

What are the benefits of tracheostomy?

Because James can’t manage his own secretions, the main benefit of getting a trach would be easier suctioning to clear his throat of those secretions. This, in turn, would improve his breathing and may reduce or eliminate his need for supplemental oxygen.

Are there any risks or complications with a tracheostomy?

As with most, if not all, medical procedures, there are some risks and/or complications that are possible with a tracheostomy.

Some complications that can occur right after the tracheostomy include:

• Nerve injury
• Bleeding and infection
• Air trapped around the lungs, in the deeper layers of the chest, or beneath the skin around the tracheostomy.

Other complications may occur later on, such as:

• Trachea scarring
• Infections
• Erosion of the trachea from rubbing against the tube
• Collapse of the airway above the trach

Is a tracheostomy reversable?

I was curious if a tracheostomy was reversible (temporary) of if James would be stuck with it for his entire life (permanent). Although it sounds like it would help us get to his secretions better, what if it introduced new issues? Would we be able to have it removed? The answer is yes, it can be removed. A trach can be either permanent or temporary, depending on why it is used.

I can’t remember if it was a movie or a TV show, but I remember a scene where a person was having trouble breathing. I guess they had something lodged in their throat which prevented them from getting enough air into their lungs. Another character performed an emergency tracheostomy. They used a knife to make a cut in the neck and then inserted a hollow pen barrel into the opening, which allowed the person to breathe. I know this is an extreme example, but this is the first thing I thought of when trying to come up with an example of a situation where a trach would be temporary. I would assume that the person would eventually go to the hospital to get checked out, and either have the pen barrel removed and have a real trach put in, or have it removed and have the hole sewn closed because they were able to breathe again on their own. For James, I think that a trach would probably be more permanent, assuming that it would help us get to his secretions better, and not cause any other issues.

How do we care for the trach?

Different websites have similar, but sometimes slightly different cleaning and care instructions. They all have the same goals in mind, however: to reduce the chance of infection and to keep the trach clear. To give you an example of what kind of care is required for a trach, the following is from Johns Hopkins:

Cleaning suction catheters at home

Suction catheters must be cleaned after each session of suctioning. This helps prevent infection as well as helps cut down costs by reusing the same catheter for one week.

After suctioning the trach tube:

1. Pour a few ounces of hydrogen peroxide into a small clean container.
2. Suction hydrogen peroxide through the catheter until it is free of mucus. Wipe the outside of the catheter with a cloth or gauze wet with peroxide.
3. Suction sterile salt water through the catheter until it is free of peroxide.
4. Suction air until the catheter is free of water.
5. Remove the catheter from the connecting tubing and let it air dry.
6. Wrap it in a clean dry towel.
7. Use it as needed with this cleaning process each time for up to 8 hours, then THROW IT AWAY.
8. Follow manufacturer’s instruction for cleaning and disinfecting your suction machine and humidifier. Do not allow water to stand in your humidifier when not in use.

Cleaning the tracheostomy inner cannula tube (for reusable inner cannulas only)

The tracheostomy inner cannula tube should be cleaned two to three times per day or more as needed. Please note that this only applies to reusable inner cannulas. Cleaning is needed more immediately after surgery and when there is a lot of mucus buildup.

Equipment

Trach care kit:

1. • Small brush or pipe cleaners
   • Half-strength solution of hydrogen peroxide (½ water, ½ hydrogen peroxide)
   • Saline or homemade sterile salt water
   • Two small bowls

Procedure

1. 1. Wash your hands.
   2. Place 1/2 strength peroxide solution in one bowl and sterile salt water in second bowl.
   3. Remove the inner cannula while holding the neck plate of the trach still.
   4. Place inner cannula in peroxide solution and soak until crusts are softened or removed.
   5. Use the brush or pipe cleaner to clean the inside, outside and creases of the tube.
   6. Do not use scouring powder or Brillo pads.
   7. Look inside the inner cannula to make sure it is clean and clear of mucus.
   8. Rinse tube in saline or sterile salt water.
   9. Re-insert it while holding the neck plate of the trach still.
   10. Turn the inner cannula until it locks into position.
   11. Double check the locking pulling forward gently on the inner cannula.

Final Thoughts

While I do see the benefits of giving James a trach, I am a bit concerned about the risks/complications and the care that would be required. Stacy and I will need to give this some serious thought. We obviously want to do what’s best for James, but we also have to be realistic. Taking care of a trach is a lot of work, and it would mainly by Stacy doing all of the cleaning. I would help out when I’m home from work on nights and weekends, but Stacy would be the one doing the cleaning when I’m not home, in addition to James’ feeds, meds, and diaper changes. We haven’t ruled it out; we just need some time to think it over.