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Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.

So, today’s tip is about should a tracheostomy block in ICU. So, the question that we get quite frequently is, “Should a tracheostomy have a blockage in ICU, and if so, is that a medical emergency?” Yes, it absolutely is a medical emergency. Number two, it shouldn’t block in the first place. So, here is what needs to be done to avoid tracheostomy blockage.

So first off, it needs to be patent at all times, and ideally, it also has an inner cannula and inner tube. An inner cannula or an inner tube is almost like a safety valve in the tracheostomy. It needs to be changed quite frequently, and it needs to be inspected quite frequently to make sure there is no blockage. Because if a tracheostomy blocks, a patient can’t be ventilated, assuming they’re on a ventilator. But even if they’re not ventilated, they’re breathing spontaneously with a tracheostomy. If the tracheostomy blocks, patients can die because they can’t breathe, or they can no longer breathe.

Now again, with an inner tube or an inner cannula, this can be fixed reasonably easy or easily because you just change the inner cannula. But once again, the skill here is to not have it happen in the first place and making sure it never gets blocked in the first place.

Now, other steps ICU should be taking is (a) put patients on humidified oxygen or if they’re ventilated on a humidified circuit, that is very important because when someone breathes in through their nose, healthy person doesn’t have a tracheostomy, air gets humidified automatically. But with the tracheostomy, the nose is bypassed, and air doesn’t get humidified unless you put humidification into the air into the oxygen, either with a ventilator. Or if someone is on a trach mask, trach collar, trach T-piece, the air and oxygen need to be humidified to basically take over the function of the nose, so otherwise, sputum will dry up. Once again, there’s a high risk that a tracheostomy will be blocked.

Next, regular nebulization is going to be very important. So, regular normal saline nebulizers are important, 3-4 times a day, sometimes even more frequently than that. Once again, making sure the tracheostomy stays patent. But it’s also important, the nebulizer and humidified oxygen, that sputum can be mobilized, i.e. that it doesn’t sit in the lungs potentially causing a chest infection or worse, a pneumonia. So, it’s really important that sputum can get mobilized all the time. So, either the patient can cough up the secretions or the nurses can suction frequently, again avoiding a tracheostomy blockage.

Now, other things that are important in a situation like that or when someone has a tracheostomy, is simply the right size. For someone tall, you need a different size compared to a child, for example. So, there’s different tracheostomy sizes. It’s really important that the doctors choose the correct tracheostomy size for a patient.

Now, other things that go without saying, but I think I do need to highlight it here because families in intensive care, they don’t know what they don’t know. They don’t know what to look for. They don’t know what questions to ask. They don’t know their rights and they don’t know how to manage doctors and nurses in intensive care.

So, other things that are important, that go without saying in intensive care, a tracheostomy patient with or without ventilation needs an intensive care nurse, 24 hours a day, because it’s an unstable and an artificial airway. If the tracheostomy blocks or comes out, there’s not much time, really less than three minutes to manage that airway and establish a secure airway again. So that’s why it’s so important that you have a critical care nurse, 24 hours a day, at the bedside with a tracheostomy patient, with or without ventilation. So, if all is done correctly and then, the tracheostomy should not block.

Has it happened? Yes, it has happened, but it happens very rarely in a hospital environment, when in intensive care environment, but certainly something that can happen. Also, tracheostomy emergency equipment needs to be at the bedside, i.e. if someone, for example, has a size 8 tracheostomy, they need to have another size 8 at the bedside, another size 7 at the bedside, in case you can’t get the size 8 in. In case of an emergency, there needs to be a tracheostomy dilator at the bedside. There needs to be an Ambu bag at the bedside with a face mask, also with an adhesive dressing. In case you can’t reinsert the tracheostomy, you have to then occlude the tracheostomy site and start bagging with a mask. So, emergency equipment in a situation like that, having it handy, having it next to the bedside is also critically important.

Now, I have worked in critical care for nearly 25 years in three different countries where I also worked as a nurse manager for over 5 years in intensive care. We’ve been consulting and advocating for 11 years here since 2013 at intensivecarehotline.com. We have saved many lives with our consulting and advocacy. You can verify that on our testimonial section when you go to intensivecarehotline.com and you click on our testimonial section, or you go to intensivecarehotline.com and you click on our podcast section where we have done some client interviews.

Because we get so many questions from families in intensive care, that’s why we created a membership for families of critically ill patients in intensive care. You can become a member if you go to intensivecarehotline.com and you click on the membership link or you go to intensivecaresupport.org directly. In the membership, you have access to me and my team, 24 hours a day, in the membership area and via email, and we answer all questions intensive care related. In the membership, you also have exclusive access to 21 eBooks and 21 videos that I have personally written and recorded. All of those resources, access to me and my team, the eBooks and the videos will help you to make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment.

I also do one-on-one consulting and advocacy with you and your families. I also talk to doctors and nurses directly, if that’s what you want me to do. I do that over the phone, WhatsApp, Zoom, Skype, whichever medium works best for you. I talk to you and your families directly. I handhold you through this once-in-a-lifetime situation that you can’t really afford to get wrong. I talk to doctors and nurses directly and I ask all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care.

I also represent you in family meetings with intensive care teams, and all of that is with the goal of making informed decisions, having peace of mind, control, power, and influence making sure your loved one gets the best care and treatment.

We also do medical record reviews in real time so that you can get a second opinion in real time. We also do medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

All of that you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or send an email to [email protected] with your questions.

Now, if you like my videos, subscribe to my YouTube channel for regular updates for families in intensive care. Click the like button, click the notification bell, share the video with your friends and families, and comment below what you want to see next or what questions and insights you have from this video.

I also do a weekly YouTube live where I answer your questions live on the show and you will get notification for the YouTube live if you subscribe to my YouTube channel, or if you become a subscriber to our email newsletter at intensivecarehotline.com.

If you want your video done and your question answered quicker, just leave a small donation on the super chat button here or you can leave a small donation or big donation. Anyway, it helps us to create content and help as many families in intensive care as possible. I have so many emails sitting in my email inbox still from January that I’m reading out here, I can’t keep up. So, if you want yours done quick, leave a donation and I’ll talk to you very soon.

Thank you so much for watching.

This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.

Take care for now.

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