The Patient Workbook and Guide for
SCOOP®
Transtracheal Oxygen Therapy
Utilizing the Modified Seldinger Technique
 |
Transtracheal Systems, Inc.
109 Inverness Drive East
Englewood, Colorado 80112-5105
(303) 790-4766 (800) 527-2667
www.tto2.com |
Copyright 1995-2001 Transtracheal Systems |
Important Phone Numbers
Family Doctor
Pulmonologist
Surgeon
Hospital Emergency Room
Hospital Respiratory Therapy Dept.
Homecare Provider
Local Rescue Squad
Relative/Friend
|
Table of Contents
Orientation
What is Transtracheal Oxygen Therapy?
Terms You Should Know
Potential Benefits of Transtracheal Oxygen Therapy
Potential Risks of the Procedure
The SCOOP Transtracheal Oxygen Therapy Program
Procedure Instructions
Pre-Procedure Instructions
Post-Procedure Instructions
Transtracheal Oxygen Therapy
SCOOP Catheter “Cleaning in Place” Instructions
SCOOP Catheter “Removal for Cleaning” and Reinsertion
Instructions
SCOOP Oxygen Hose
Serious Symptoms
Ten SCOOP Rules
|
Orientation
What is Transtracheal Oxygen Therapy?
Terms you should know.
What are the potential benefits of this therapy?
What are the potential risks of this therapy?
The SCOOP transtracheal program utilizing the Fast TractTM procedure.
|
What is Transtracheal Oxygen
Therapy (TTOT)?
Transtracheal oxygen therapy is a superior method of delivering oxygen directly into
the lungs by means of a small, flexible catheter which passes from the lower neck into the
trachea or windpipe.
For many individuals transtracheal oxygen is more effective in getting oxygen into the
blood than nasal prongs. It is also more efficient, because it gets the oxygen right into
the lungs where it is used.
Most patients can have the small catheter installed in 30 minutes or less with only
local anesthesia and without being hospitalized. The procedure is safe and causes little
discomfort. This patient workbook was developed to help support you as you go through the
four phases of the SCOOP transtracheal oxygen program.
|
Terms You Should Know
Nasal Cannula or Prongs. (kán-u-la) The common green or clear plastic
hose which passes over the ears, across the face, and into the nose for delivering
supplemental oxygen.
Catheter. (kath-á-ter) A small plastic tube inserted into the body.
Esophagus. (uh-sof-á-gus) The tube through which food passes into the
stomach. Located behind the trachea.
Immature Tract. A newly created tract which is not fully healed.
Mature Tract. A tract that has fully healed. Approximately six or more
weeks old.
Mucus Ball. An accumulation of mucus which may cling to the tip of the
catheter. It may cause excessive coughing, shortness of breath or wheezing until it is
coughed up.
SCOOP Catheter. The SCOOP catheter is designed to be used while the
newly-created tract is healing and after the tract has completely healed. The SCOOP
catheter has a single hole at its tip. A SCOOP catheter is held in position by a bead
chain necklace, and can deliver oxygen at flows up to 12 liters per minute.
SCOOP Cleaning Rod. A wire rod slightly longer than the SCOOP catheter
which is passed through the inside of the catheter during the cleaning procedure.
SCOOP Oxygen Hose. A clear plastic hose which connects the SCOOP catheter
to the oxygen source. It has a security clip which is attached to the clothing at the
right waist to absorb accidental pulls on the hose. Hoses are available in several sizes
to accommodate all patients.
Stent. A specially designed tube that is placed in the trachea after the
Modified Seldinger procedure. It helps to form the tract and is not for oxygen delivery.
Stripping of Catheter. Using a wire guide and topical anesthetic to
safely remove the transtracheal catheter from the tract. This enables the catheter to be
cleaned and reinserted into the tract in a controlled environment.
Trachea. (tráy-key-ah) The windpipe. A tube about 4.5 inches long, which
extends from the voice box (Adam’s apple) to the lungs.
Tract. An opening or pathway made into the trachea allowing the insertion
or removal of a transtracheal catheter.
Transtracheal. Passing directly into the trachea. A transtracheal
catheter passes through the skin of the lower neck, through a tract, and directly into the
trachea.
|
Potential Benefits of
Transtracheal Oxygen Therapy
Transtracheal oxygen therapy offers significant advantages over nasal prongs. Patients
using SCOOP transtracheal oxygen have reported the benefits listed below. Although you may
not experience each of these, we are confident you will be satisfied with transtracheal
oxygen therapy.
Improved Comfort and Convenience. The transtracheal catheter is more comfortable than
nasal prongs. It avoids the common irritation of the ears and nose, and it doesn’t
interfere with eating, shaving, putting on makeup, talking on the phone or kissing.
Lower Oxygen Requirements. Because the transtracheal catheter delivers oxygen directly to
the lungs where it is needed, it reduces resting oxygen requirements in most patients by
50-60%*.
True 24 Hour Oxygenation. It is difficult for many patients to wear nasal prongs every
minute of the day, due to the discomfort. Transtracheal oxygen eliminates this problem and
allows patients to receive oxygen 24 hours per day, as prescribed by the doctor.
Increased Mobility. Lower oxygen requirements allow most transtracheal oxygen patients to
use lighter and more compact oxygen sources. Although smaller, these sources often last
longer, allowing more time away from home. Many patients also report increased mobility
because of better endurance while walking. The ability to be away from home for shopping,
socializing with friends, doing errands or working allows for a better quality of life.
Improved Appearance. The small catheter and connecting tubing can be hidden under
clothing. People often won’t notice you are receiving transtracheal oxygen.
Transtracheal Oxygen is Reversible. If for any reason you wish to return to nasal prongs,
it is a simple as removing the catheter and putting the prongs back on. No additional
procedures are required, but we recommend that you consult with your physician before
removing your catheter permanently.
Other Benefits:
Transtracheal patients appear to use oxygen more regularly and seem to enjoy additional
medical benefits related to better oxygen delivery. Among these medical benefits are more
normal red blood cell counts and decreased fluid retention. Better oxygen levels in the
blood may mean fewer hospitalizations. Clinical studies have shown that increased activity
levels and more continuous use of oxygen are associated with improved longevity and
quality of life. Some patients have also reported improved sense of smell, taste and
appetite, as well as improvements in quality of sleep.
| * Transtracheal oxygen allows a patient to use a portable oxygen
system more frequently and for longer periods of time. Therefore, the total amount of
oxygen consumed may not decrease by 50-60% as stated above. |
|
Potential Risks of the
Procedure
Some minor side effects of transtracheal oxygen therapy are normal and really
aren’t complications. It is normal, for example, to have some discomfort around the
tract and coughing temporarily after the initial procedure. Typically, plain Tylenol plus
a mild cough suppressant are enough to make you comfortable. Your doctor will take care of
all your prescriptions following the procedure.
Some patients develop collections of mucus on the tip of the catheter for the first few
weeks after the procedure. This may cause an increase in coughing. Catheter stripping by
the physician, respiratory therapist or nurse is normally scheduled several times during
the first two weeks. After your tract has fully healed and you start removing your SCOOP
catheter daily to clean it, mucus collections become much less of a problem.
Occasionally, as you are inserting the catheter into your tract or with excessive
coughing, the catheter might pass upward through your vocal cords, rather than its normal
path downward into the trachea. If this happens, you will experience a mild to moderate
cough and may be unable to speak. You will be taught what to do should this situation
occur.
Common, but usually minor, complications are:
1. Wheezing triggered by the catheter in patients
with an asthmatic tendency
(bronchospasm)
2. Bubbles under the skin of the face or neck
(subcutaneous emphysema)
3. Low grade infection of the cartilage of the
windpipe (chondritis)
4. Small growths of scar tissue around the tract
opening (keloids)
5. Formulation of granulation tissue
Rare complications which are possible include:
1. Pneumonia
2. Infection of the tract (abscess)
3. Collapse of a lung (pneumothorax)
4. Serious bleeding
5. Lung failure
6. Death
Any questions regarding these potential complications should be discussed with your
doctor.
|
The SCOOP Transtracheal
Oxygen Therapy Program
The transtracheal program that you have entered extends over a
period of about eight weeks. In the course of this program, you will pass through four
phases:
Phase I During this phase you will have the opportunity
to learn the pros and cons of transtracheal oxygen therapy before you decide to go ahead
with the procedure to place the catheter. You can visit with the doctors, nurses, and
respiratory therapists, as well as patients who have already begun transtracheal oxygen
and ask all the questions you want. A history, physical examination and several laboratory
tests will be done to determine if transtracheal oxygen can be recommended for you. If
your doctor feels you are medically stable, you can have the procedure as an outpatient.
Some patients will need to be observed in the hospital for a short time after the
procedure.
Phase II You will need to arrive early on the morning
of the procedure. You should arrive with an empty stomach and with an escort to drive you
home. After checking in, you will take some medication by mouth to make you comfortable
and to protect against infection. About an hour later, the simple procedure is performed
while you are sitting in a chair. Patients have reported that a local anesthetic makes the
procedure more comfortable than a common blood gas. After an hour of observation, you will
be sent home with a small tube in the newly formed tract. Oxygen is not given through this
tube which serves to form the tract for the transtracheal oxygen catheter. A mild to
moderate tickle cough is normal for the next day or two. You may also have mild to
moderate pain around the tube which usually responds to plain Tylenol. Your doctor will
give you instructions on your specific medications and what to do for possible problems.
Phase III About a week after the procedure, you will
return and the non-functioning tube will be exchanged for a functioning transtracheal
catheter. Oxygen will be connected to the catheter, and the nasal cannula will be removed.
You will be instructed about the proper care of your tract opening, catheter and hose.
Learning how to do these things is simple and takes about an hour. Because the tract is
still healing (immature), you will clean the catheter in place in the trachea for the next
5-7 weeks. Your doctor, respiratory therapist or nurse will have you come in periodically
to remove the catheter, clean it and put it back into your tract. This is done to strip or
clean off any mucus that may have accumulated on the catheter while it is in place.
Phase IV After about 6-8 weeks, your doctor will
determine if your tract is healed (mature) enough to begin removing your catheter for
cleaning. Your SCOOP catheter can deliver oxygen flow rates up to 12 L/pm. There is a
great deal of flexibility built into the SCOOP program of care. Early in Phase IV, your
doctor will customize a cleaning program that meets your specific needs. Your SCOOP
transtracheal catheters and hose must be replaced every 90 days, and your doctor will want
to see you periodically for check-ups.
|
Pre-Procedure Instructions
Follow these instructions BEFORE the transtracheal procedure.
1. Avoid taking aspirin and aspirin containing products (Bufferin,
Anacin, etc.) for two weeks
before your procedure.
2. If you are on prescription blood thinners (Coumadin, etc.), discuss
with your doctor whether or
not you should be taking these at the time of your procedure.
3. Your doctor may prescribe medications to be taken on the day of the
procedure. Fill these
prescriptions before the procedure and bring them with you the morning
of your procedure.
4. Do not eat or drink after midnight the night before your procedure.
Your doctor will instruct you
about which precautionary medications should be taken.
5. If you are allergic to any antibiotics, narcotics (codeine) or local
anesthetics (Novocain), tell the
nurses or doctor before you receive any medication.
6. The place of your procedure is
You should arrive at
Bring your spouse, a relative or friend to escort you home. Plan to
stay about three hours.
|
Post-Procedure Instructions
Follow these instructions AFTER the transtracheal procedure.
Caring for your new tract
1. Continue to wear nasal prongs or face mask for oxygen, and do not
connect oxygen to the small
plastic tube in the new tract.
2. Clean crusts around the tract twice daily using a cotton swab (Q-Tip)
and hydrogen peroxide
solution.
3. Do not block or plug the small plastic tube.
4. Do not use any ointments or lotions around the tract.
5. Take your temperature by mouth twice daily for one week. Call your
doctor if it is higher than
99.5o F.
6. Take the antibiotic as prescribed to protect against infection.
7. Take the cough medicine as prescribed and try to minimize coughing
both for comfort and to
avoid complications which may result from excessive coughing.
8. If you have discomfort, take only plain Tylenol or prescription pain
medication approved by your
doctor.
|
Post-Procedure Instructions
It is normal to experience:
1. Mild to moderate discomfort at the site of the
procedure. This may be more noticeable
over the first few days and should improve
thereafter.
2. Mild to moderate coughing caused by the tickle of
the plastic tube in the trachea, which
should disappear over the next several days.
You may also hear a bubbling sound from
the plastic tube during talking or coughing,
this disappears when the transtracheal
oxygen catheter is inserted.
3. Small amounts of blood and/or mucus which form
crusts around the plastic tube.
4. Small streaks of blood in the sputum.
It is not normal to experience:
1. Severe coughing which is not controlled with a
cough medication.
2. Swelling around the neck or the feeling of bubbles
under the skin.
3. Shortness of breath or wheezing that is more
severe than normal.
4. Extreme nervousness.
5. More than a few drops of blood around the tract
site or in the sputum.
6. Any of the following signs of infection:
a. Fever greater than
99.5o F
b. Redness or pus
around the tract site
c. Severe or increasing
pain at the procedure site.
If you are experiencing any of the above symptoms,
you should call your doctor immediately.
|
Transtracheal Oxygen Therapy
Cleaning in Place Instructions
Removal for Cleaning and Reinsertion Instructions
The SCOOP Oxygen Hose
Serious Symptoms
The Ten SCOOP Rules
Why is it important to clean and maintain your SCOOP catheter?
Keeping your catheter clean and functioning properly will allow you to enjoy all the
benefits of your SCOOP catheter. In some patients, mucus may accumulate around the
catheter tip just behind the opening. This is especially true during the first 10 to 14
days following the procedure (Phase III). These accumulations are called “mucus
balls” and can cause you to cough, wheeze or be more short of breath than usual. You
will be taught how to clean your catheter in place after it is first inserted. If you
think you may be having problems with mucus balls, call your doctor, respiratory therapist
or nurse. They may ask you to come in to get your catheter “stripped” over a
wire guide. Your doctor may prescribe medications to help thin and loosen your mucus.
Mucus balls are preventable in most cases and treatable in all. They are generally limited
to Phase III, when the catheter is left in place. They are rarely a problem when you
advance to Phase IV and begin removing your catheter for cleaning.
Once your tract is healed (mature) your physician, respiratory therapist or nurse will
help you determine which cleaning regimen will work best for you. Proper catheter care
involves both cleaning in place and periodic removal for cleaning. You will be taught both
techniques. Cleaning routines are customized for each patient. If you are using low flows
of oxygen (2 liters per minute or less), you may elect to clean your catheter in place
most of the time and remove it only periodically for cleaning. Through experience, most
patients find the cleaning regimen that works best for them.
|
Cleaning in Place
|
Instructions for Cleaning Your SCOOP Catheter in Place
Regular cleaning of your SCOOP catheter will ensure proper
functioning while the tract is healing. Cleaning twice daily is recommended; however, your
doctor may tell you to clean your catheter more often. Always use nasal prongs
when cleaning your SCOOP catheter.
Review all steps before you begin
1. Gather all your cleaning supplies and position yourself near a sink
and mirror with good
lighting.
2. Wash your hands with soap and warm water.
3. Using a cotton swab (Q-Tip) and water, clean mucus crusts from skin
around the catheter. If
soap is necessary, use an antibacterial soap and rinse the soap residue
off the skin. Do not use
creams or ointments around the tract opening. Blot the area dry with
tissues.
4. Wash the cleaning rod with antibacterial soap, and rinse well to
remove all soap residue.
5. Disconnect the catheter from the SCOOP oxygen hose and squirt 2.0
cc’s of saline into the
catheter. The squirts may cause coughing.
6. Run the cleaning rod down the inside of the catheter 3 times, all the
way down until the handle
prevents it from going any further.
7. Squirt 2 more cc’s of saline down the catheter. Reconnect the
SCOOP oxygen hose to the
catheter.
8. Wash and store the cleaning rod in a clean, dry place. Remember
not to stretch the rod but
just pat it dry.
9. Place strips of first aid plastic, paper tape or Op-Site (medical
grade) on both sides of the
SCOOP flange, over the bead chain necklace for added security. This is
especially important at
night and is normally done only during Phase III of the program.
|
Removal for Cleaning and Reinsertion
|
Instructions for Removal and Reinsertion of Your SCOOP
Catheter
It is recommended that you only remove and reinsert your catheter 2
times per day. If additional cleaning is necessary, your doctor may advise you to combine
catheter removal and reinsertion with cleaning in place. Removal and reinsertion requires
a clean second catheter. Use nasal oxygen at all times when removing and
reinserting your SCOOP catheter.
Review all steps before you begin
1. Gather your cleaning supplies, including a second SCOOP catheter, and
position yourself near
a sink and mirror with good lighting.
2. Wash your hands with soap and warm water.
3. Using a cotton swab (Q-Tip) and water, clean mucus crusts from the
skin around the catheter.
If soap is necessary, use an antibacterial soap and rinse all the
residue off the skin. Do not use
creams or ointments around the tract opening.
4. Apply a small amount of water soluble jelly (i.e. K-Y Jelly) to the
tip of the clean catheter.
5. Disconnect the bead chain necklace and SCOOP hose from the catheter.
Remove the first
catheter from the tract opening. The catheter should only be out
momentarily.
6. Insert the clean catheter. Place the tip into the tract opening and
gently push the catheter
straight back. If resistance is met, twirl the catheter as it is
inserted. Do not try to direct the
catheter downward...it will direct itself. It is normal to experience a
tickle cough as the catheter
enters the trachea. If you cannot insert the catheter within 5 minutes,
call your doctor
immediately and put your nasal cannula back on, at your prescribed flow
rate.
7. Reconnect the bead chain necklace. When properly inserted, the SCOOP
label on the catheter
flange will be upright and readable.
8. Reconnect the SCOOP oxygen hose. The exchange procedure is now
complete.
9. Clean the soiled catheter. Start by cleaning all the mucus from the
catheter tip with plain warm
water. Use an antibacterial soap, such as Hibiclens, and water to
disinfect the catheter. Run the
cleaning rod through the inside of the catheter several times. Rinse
the catheter, outside and
inside, thoroughly to remove all soap residue and blot the catheter dry
with a paper towel. Do
not boil the catheter or place it in extremely hot water (over 120o F).
If the water is too hot for
your hands, it’s too hot for the catheter. Do not soak the
catheter in any disinfecting solution.
10. Store the clean SCOOP catheter and cleaning rod in original package
in a clean, dry place, out
of direct sunlight.
Replace your SCOOP catheters and hose routinely every 90 days. Longer use
of the catheter may result in the catheter becoming stiff or brittle. This can lead to
chronic tract discomfort. The catheter should be replaced immediately if the catheter
develops visible cracks, breaks, permanent kinks or foul odor.
|
The SCOOP Oxygen Hose
An oxygen hose has been specially designed to provide you with
maximum comfort and safety. A security clip connects the hose to your clothing. The clip
provides safety from tugging and pulling on your catheter, and it is designed to be worn
on the right side. The SCOOP hose is required to properly attach your SCOOP catheter to
your oxygen source. The upper segment of the SCOOP oxygen hose should be worn under your
shirt, blouse, sweater, etc. This helps to provide a more secure connection between the
SCOOP oxygen hose and the SCOOP catheter, and improved comfort and convenience. There are
9 different size hose combinations to accommodate all sizes of patients.
Hose Fitting
The hose length is measured in 2 segments. The upper length is measured
from the hub of the catheter to the right hip. The lower length is measured from the hip
to the portable oxygen source placed on the floor next to you. The lower length should
drape just a few inches off the floor.
Instructions
1. Attach the suspender clip to the top of your pants, shorts, skirt or
pajama bottoms on the right side.
2. Run the hose under your shirt, blouse, t-shirt or pajama top.
3. Insert the small male connector on the end of the hose into the
female connector on the SCOOP catheter.
4. Connect the large end of the oxygen hose to your oxygen supply. Be
sure that all connections fit tightly and are secure. If they are not, check with your
doctor or homecare dealer.
5. Replace your SCOOP hose every 90 days or immediately if it becomes
cracked, kinked, broken or develops a bad odor. |
SCOOP Oxygen Hose Fitting & Use
Checkpoints
|
|
Serious Symptoms
Call your doctor if you experience any of the following:
1. PreSCOOP Stent or SCOOP catheter comes out of your tract and you
can’t reinsert it.
2. Increased swelling of the neck and face.
3. Severe or increasing cough.
4. Severe or increasing shortness of breath.
5. Extreme nervousness.
6. Increased sputum production.
7. Blueness of the lips or fingernails.
8. Tenderness of the tract opening.
9. Fever greater than 99.5o F.
Be sure to record your doctor’s phone number in the front of this booklet.
|
Ten SCOOP Rules
1. The SCOOP catheter should never be out of your tract for more than
a few minutes, or the tract may begin to close.
2. Always keep the SCOOP catheter clean to ensure proper function.
3. If you believe the SCOOP catheter isn’t working properly, first
clean it. If you still believe the catheter isn’t working, put on nasal prongs and
call your doctor. Do not remove the catheter.
4. If your humidifier pop-off is making noise, clear any hose blockage
and clean the SCOOP catheter.
5. The SCOOP catheter must never be removed or inserted while oxygen is
flowing through it.
6. Always keep your tract opening clean and dry. Do not use any
antibiotic, ointment or cream around the tract opening.
7. Always keep the SCOOP oxygen hose under your shirt, blouse, t-shirt
or pajama top and clipped to the right side of your pants, shorts, skirt or pajama
bottoms.
8. Don’t pull, twist, crush, cut, glue, boil, alter or abuse any
SCOOP product. Treat your SCOOP transtracheal system like a lifeline.
9. Replace SCOOP catheters and hoses routinely every 90 days. Any SCOOP
product that is cracked, broken, develops a permanent kink or foul odor should be
immediately replaced and discarded.
10. When traveling, always take catheter cleaning supplies, your nasal
prongs and a spare SCOOP catheter and hose with you.
| PART NO. 80024 |
Rev. E Copy 08/01 |
|
