Nurse C.D. asks, “What type of emergency equipment should I have at the bedside?”
Answer: One must always be prepared for an emergency, and the key is to have essential items always available. These items include: extra tracheostomy tubes of the same size and type, as well as one size smaller, suction catheters (and a functional suction system), and the obturator.
The purpose of the obturator is to assist with insertion, and is especially helpful when the tube is partially or completely removed from the stoma. The tube can be easily guided into place when the obturator is handy.
Extra trachs should always be present and can be used if the tube comes out or if the tube needs to be changed. The smaller sized tube can be used if you encounter difficulty getting the larger tube in. For example: In one patient, the trach fell out during the night. When the problem was discovered, the larger tube could not be placed because the stoma had shrunk; and so, the smaller tube was inserted.
Your most important tool is the suction catheter. It should be used to suction as often as necessary. Suctioning is done for removal of secretions, but it also has other purposes:
- To stimulate a cough (especially important in patients who are unable to generate an effective cough).
- To ensure proper placement of the tube. (If you can only insert the suction catheter 2-3 inches, it may be in a false passage, or there may be a mucus plug.)
- The suction catheter can be used as a “guidewire” if there is difficulty in placement of the tube.In addition to the emergency supplies, I also recommend a bedside kit to include everyday items such as drain sponges, trach ties, saline, trach cleaning kit, 10-ml syringe, oropharyngeal suction catheter, and hydrogen peroxide and saline. It’s very helpful to have everything you need at your fingertips. In case of emergency, you will be glad you were prepared (and the patient will be, too!)