|
Conversion of Tracheotomy to SCOOP
Transtracheal Oxygen
| I |
Possible SCOOP Planned Before Tracheotomy |
|
A. |
Select tracheotomy site |
|
|
1.
2. |
Work with surgeon
Use standard SCOOP product with bead chain necklace |
|
B.
C.
D. |
Excise 1cm window of tracheal cartilage at time of trach
Downsize to No. 4 uncuffed trach tube
Insert SCOOP: |
|
|
1. |
Customize bead chain necklace to stabilize catheter |
|
|
|
a.
b.
c. |
Accommodate
2 fingers
Not excessively tight with cough or hyperextension
Allows 1-2 cm of catheter exposure on withdrawal |
|
|
2.
3. |
Let tract become snug against catheter before starting O2
When tract snug, titrate and begin Phase III |
|
|
|
|
|
| II |
Recent Tracheotomy but SCOOP Not Planned |
|
A.
B.
C. |
If cricothyroidotomy then let tract close, otherwise proceed
Downsize to No. 4 uncuffed trach tube
Insert SCOOP: |
|
|
1. |
Customize bead chain necklace to stabilize catheter |
|
|
|
a.
b.
c. |
Accommodate
2 fingers
Not excessively tight with cough or hyperextension
Allows 1-2 cm of catheter exposure on withdrawal |
|
|
2.
3. |
Let tract become snug against catheter before starting O2
When tract snug, titrate and begin Phase III |
|
|
|
|
|
| III |
Old (Mature) Tracheostomy |
|
A.
B. |
Downsize to No. 4 uncuffed trach tube
Insert SCOOP: |
|
|
1. |
Customize bead chain necklace to stabilize catheter |
|
|
|
a.
b.
c. |
Accommodate
2 fingers
Not excessively tight with cough or hyperextension
Allows 1-2 cm of catheter exposure on withdrawal |
|
|
2.
3. |
Let tract become snug against catheter before starting O2
When tract snug, titrate and begin Phase III |
|
C. |
If tract fails to tighten around catheter |
|
|
1.
2. |
Try AgNO3 (silver nitrate stick) cautery first
If AgNO3 fails, have ENT see patient to excise epithelium of tract under local |
|
D. |
If catheter is unstable because of improper location |
|
|
1.
2. |
Surgically close current trach
Create new tract at proper site for stability |
TRANSTRACHEAL
OXYGEN CATHETERS CAN BE SAFELY PLACE IN THE TRACHEOSTOMY STOMA IN PATIENTS REQUIRING LONG
TERM O2 THERAPY
D. Rollins, L. Findley. McKee Medical Center, Loveland Colorado
Transtracheal oxygen therapy (TTOT) may
benefit certain patients after weaning from prolonged mechanical ventilation.
However, the patient requires a surgical procedure to insert the TTO2
catheter. No previous study has attempted to place a TTO2 catheter in an
existing tracheostomy stoma, thus avoiding the need for an additional surgical insertion
procedure. We hypothesized that a TTO2 catheter could be placed in the
tracheostomy stoma after the tracheostomy tube is removed. We studied 7 patients (6
males and 1 female).
| Patient |
Age
(Years) |
Dx |
Duration
at TTO2 |
| 1. |
12 |
ARDS (SLE) |
4.5 years |
| 2. |
40 |
ARDS (Pneumonia) |
1 month |
| 3. |
48 |
ARDS
(Pancreatitis) |
3 months |
| 4. |
64 |
COPD
(Pneumonthorax) |
10 months |
| 5. |
67 |
COPD (Post Op) |
4 months |
| 6. |
68 |
COPD (Post Op) |
1 month |
| 7. |
72 |
COPD (Pneumonia) |
1 year |
TTO2 catheters were
placed in the tracheostomy stoma in all patients when the tracheostomy tube was
removed. The tracheostomy stoma healed around the TTO2 catheters without
complications in all cases. The TTO2 catheters functioned normally
without infections, excessive mucus plugging, or lost catheter tracts. Patients 1, 2
and 5 remain on chronic O2 therapy with TTOT. The remaining patients had
their catheters removed without problems when they no longer needed O2
therapy. We conclude that TTOT catheters can be safely and easily placed in the
tracheostomy stoma in patients requiring long term O2 therapy.
Published American Review of Respiratory
Disease, 1993; Vol 147, No. 4 |
 |
