Friday, February 04, 2005

Taking Your Breath Away: The Unlikely RN on Suctioning Tracheotomies

Today I had a patient with a "fresh trache" i.e. had a tracheotomy yesterday. A tracheotomy is the procedure wherein a surgeon cuts a hole in your neck and inserts a plastic tube that lets you breath when your mouth/larynx/pharynx region is obstructed, usually by a tumor. Your lungs continue to expand and contract normally but the air comes in and out of the hole in your neck. When I describe a trache, most people think of "those people who smoke out of that hole thingy in their necks." Exactly.

There are several problems that the nurse has to watch out for when caring for someone with a tracheostomy (tracheOStomy is the name of the hole, tracheOtomy is the name of the surgical procedure). First of all, the darn plastic thing might pop out of the hole and the hole will close up and the patient will die. Therefore, trache patients have Kelly clamps (scissor/clamp-type-thingies) taped to their bed rails so the nurse can hold open the hole and scream for help (or that's what I would do - I suppose other people (nurses, say) might be able to remember to press the panic button also at the bedside). Also, it's difficult for people with tracheostomies to cough up mucous or anything else that ends up in their lungs. Therefore, you have to "suction" them. This involves putting a plastic suction tube down their airway until it hits their lungs and then withdrawing the tube while applying suction to remove mucous plugs and any blood left over from the trauma of putting a hole in someone's neck.

For the patient, suctioning is pure hell. Babies turn blue when suctioned, children fight the nurse, cry and vomit and adults just gag and panic. It's so horrible because when the nurse suctions, s/he is taking away all of the air in your lungs and scraping a tube along your tender airway that goes into spasms when even a drop of water "goes down the wrong tube". My patient's eyes bulged, then the patient gagged and sputtered and coughed up about 3 tablespoons of bloody mucous. Terrible.

Also, patients with new trachestomies are susceptible to choking since it's difficult to swallow with a plastic tube jammed down your throat. Therefore, nurses sit with patients while they're drinking to ensure the patient doesn't choke and die. I sat at my patient's bedside and with every sip all of my muscles tensed and I was ready to untape those clamps and use them, suction out the offending liquid and then pass out.

Finally, patients with new traches can't talk (once they've had them in for a while, you can have a special one that allows you to talk or you can learn to whisper with a normal one). Therefore, you have to remember to ask "yes" or "no" questions ONLY. I have to be very careful about this as I will ask "You don't have any nausea, do you?" and then I get a "no" nodding response and then I'm not quite sure what I asked so I have to rephrase "Do you have any nausea" and luckily I get a "no" nod and probably an inward eye roll from the patient thinking "Who is this clown?".


Blogger Ilan Muskat said...

One of my best friends is trached. He needs to get suctioned pretty much every night before bed. That's been the case for his entire adult life (he's about my age). He deals! I think. I don't know how, necessarily, but I imagine that he finds some solace in his intellectual superiority, which lends credence to my theory from a couple of posts ago, what with the Messiah complex. Still, I didn't realize that it hurt like a bitch. And so, when in casual colloquy we mention that something "really sucks", it must have added dimension to him in the semantic interpretation of "being reminiscent of suction".

1:31 PM  

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