The Patient Workbook and Guide for

SCOOP®

Transtracheal Oxygen Therapy

Utilizing the “Fast Tract™” Procedure

Copyright 1997-2001, Transtracheal Systems, Inc.

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 Fast TractTM Procedure

        The SCOOP Transtracheal Oxygen Therapy Program    
        Utilizing the Fast TractTM Procedure

    Procedure Instructions

        Pre-procedure Instructions   

        Post-procedure Instructions

    Transtracheal Oxygen Therapy Following the Fast TractTM Procedure

        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 (windpipe).

For many patients, TTOT is more effective in getting oxygen into the bloodstream, because it delivers oxygen directly into the lungs, where it is needed most. TTOT is much more comfortable than a nasal cannula, and therefore, it is easier to get your oxygen 24 hours per day, as prescribed by your doctor.

Your physician has recommended that your transtracheal tract be created using the “Fast TractTM” procedure. This patient workbook was developed to help support you as you go through the four phases associated with the SCOOP TTOT program, and the “Fast TractTM” procedure.

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.

Carina. The point at which the trachea branches into the right and left lungs.

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.

Fast Tract™. A surgical technique for creating a transtracheal tract. Performed by a qualified surgeon in the operating room. Requires an overnight hospital stay. A nonfunctioning stent is replaced the following morning with a functioning SCOOP catheter, and the patient is discharged home receiving transtracheal oxygen.

Immature Tract. A newly created tract which is not fully healed.

Mature Tract. A tract that has fully healed. Approximately two 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 catheter that is placed in the trachea during the Fast TractTM procedure. It stays in position overnight and is replaced with a SCOOP catheter the next day.

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.



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.

Potential Risks of the Procedure

Some of the 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 procedure. Your physician will order the appropriate medications to help alleviate any pain you might experience, as well as a cough suppression plan.

Some patients develop collections of mucus on the tip of the catheter for the first few days or weeks after the procedure. This may cause an increase in coughing. Routine 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.

While the tract is healing, some patients may experience some air leakage around the tract opening and may experience difficulty in speaking for a few days. As the tract heals more completely, this should disappear.

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 utilizing the Fast TractTM procedure that you have entered extends over a period of several weeks. You will most likely be the recipient of many of the benefits of the SCOOP TTOT program for the rest of your life.

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 Fast TractTM procedure. You can discuss transtracheal oxygen therapy with your family physician, pulmonologist, surgeon, respiratory therapist or nurse. Wherever possible, it is a good idea to speak with a patient who already has transtracheal oxygen to get a better understanding of what your commitment to the program will be. A history, physical examination and a number of laboratory tests will be done to determine if you are a good candidate for TTOT. If your doctor feels you are medically stable and you meet the basic requirements for TTOT, your doctor will refer you to a surgeon. After evaluation by the surgeon, arrangements will be made to schedule the procedure. The procedure is performed in the operating room and requires an overnight stay in the hospital.

Phase II    On the day of the procedure, you will arrive at the hospital at the time stated by your surgeon. You should arrive with an empty stomach having followed all the pre-operative instructions given to you. You will be seen by both the surgeon and the anesthesiologist prior to the procedure. An IV will be started in your arm for the administration of medications. You will be taken into the operating room where the procedure will be performed. The transtracheal tract will be surgically created, and a non-functioning catheter called a "stent" will be placed. The Fast TractTM procedure takes about an hour. You will continue to receive oxygen by mask and/or nasal cannula, and a humidity collar will be placed over the stent for your comfort. You will be monitored in the recovery room for about an hour after the procedure, and then you will be taken to your room for the overnight stay.

Phase III    In the morning, the stent will be exchanged for a functioning SCOOP catheter. Oxygen will be connected to the catheter, and the nasal cannula will be removed. You will be instructed about the proper care and cleaning of your tract and catheter. Learning how to do these things is easy and usually takes less than an hour. Because the tract is still healing (immature), you will clean the catheter in place in the trachea for the next 10-14 days. 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 maintained in place.

Phase IV    After 10 to 14 days, your doctor will determine if your tract is healed (mature) enough to begin removing your catheter for cleaning. You will be taught how to remove, clean and reinsert your catheter. 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.    When you will have to stop eating and drinking fluids will depend on the time of your procedure.
    Your doctor will instruct you when to observe these precautions, as well as when to take any of
    your regular medications or pre-operative medications.

4.    If you are allergic to any antibiotics, narcotics (codeine), local anesthetics (lidocaine) or
    general anesthetics, tell your nurse or doctor before you receive any medication.

5.    Plan on an overnight hospital stay.

6.    The place of your procedure is

7.    You should arrive at

8.    Make sure someone can bring your portable oxygen to the hospital and drive you home the next
    day.

Post-Procedure Instructions

Follow these instructions AFTER the transtracheal procedure.

Caring for your new tract

1.    Clean carefully around the tract with a cotton tipped applicator and hydrogen peroxide solution.

2.    Do not use any ointments or lotions around the tract.

3.    Take your temperature by mouth twice daily for one week. Call your doctor if it is higher than
    99.5oF.

4.    Take the cough medicine as prescribed and try to minimize coughing both for comfort and to
    avoid complications that may result from excessive coughing.

5.    If you have discomfort, take only plain Tylenol, Ibuprofen or prescription pain medication
    approved by your doctor.

6.    Take your antibiotic as prescribed.

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.

    3.    Difficulty speaking for a time while the tract is healing, due to air escaping around the
        tract. Place your finger or hand over the catheter site and apply gentle pressure when
        speaking. This should improve during the following days.

    4.    Small amounts of blood and/or mucus which form crusts around the plastic tube.

    5.    Small streaks of blood in the sputum.



It is not normal to experience:

    1.    Severe coughing that 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.    More than a few drops of blood around the tract site or in the sputum.

    5.    Blueness of the lips or fingernails.

    6.    Extreme nervousness.

    7.    Any of the following signs of infection:
            a. Fever greater than 99.5o F
            b. Increasing 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 Following the Fast Tract™ Procedure

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. 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. During those first 2 weeks, you will return to your doctor several times to have your catheter stripped over a wire guide to clean the catheter and help prevent mucus balls. 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 the 10 to 14 days of Phase III, when the catheter is left in place. They are rarely a problem when you advance to Phase IV and begin removing and reinserting 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

Clean mucus from tract opening.	Squirt saline into catheter.
Run cleaning rod down catheter 3 times.	Be sure “SCOOP” is upright and readable.

Regular cleaning of your SCOOP catheter using the “in place” method will ensure proper functioning while the tract is healing (Phase III). 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 light.

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, such as Hibiclens, and rinse it 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 a 2x2 or 4x4 gauze under the flange if necessary.

10.    Place strips of plastic, paper tape or Op-Site 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

Clean mucus crusts from tract opening.	Remove catheter from tract.
Insert clean catheter.	Clean soiled catheter.
“SCOOP” should be upright and readable.

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 its 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 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.

Serious Symptoms

Call your doctor if you experience any of the following:


1.    Your SCOOP catheter comes out of your tract and you can’t reinsert it.

2.    Severe or increasing cough.

3.    Severe or increasing shortness of breath.

4.    Extreme nervousness.

5.    Increased sputum production.

6.    Blueness of the lips or fingernails.

7.    Increasing tenderness of the tract.

8.    Fever greater than 99.5o F.

9.    Increasing swelling of the neck and face.



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.