The Patient Chart for

SCOOP®

Transtracheal Oxygen Therapy

Utilizing the FastTract Technique

 

 

Transtracheal Systems, Inc.
109 Inverness Drive East
Englewood, Colorado 80112-5105
(303) 790-4766    (800) 527-2667
www.tto2.com

Copyright Transtracheal Systems
 

Contents

            Phase I -     Preprocedure Data Base
                    Social History
                    Oxygen History
                    MOC & SAL Tables
                    Pulmonary History
                    Past Medical History
                    Allergies & Medications
                    Hospitalizations
                    Physical Examination
                    Laboratory Data
            Phase I -     Preprocedure Review

            Phase II -     Transtracheal Procedure

            Phase III -     1st Scheduled Visit
            Phase III -     2nd Scheduled Visit
            Phase III -      3rd Scheduled Visit
            Phase III -      4th Scheduled Visit

            Phase IV -     1st Scheduled Visit
            Phase IV -     2nd Scheduled Visit

            Phase IV -     Health Maintenance Visit

 
SCOOP Transtracheal Oxygen
Phase I - Preprocedure Data Base
Patient:
Date:

Social History

Age             years

Sex        [ ] male         [ ] female

Employment    [ ] full time    [ ] part time    [ ] unemployed    [ ] disabled    [ ] retired

Living with    [ ] spouse    [ ] family member        [ ] friend         [ ] alone

Distance    [ ] < 1 hour    [ ] 1 - 4 hours    [ ] >4 hours

Transportation    [ ] can drive self    [ ] other can drive        [ ] transportation is difficult to get

Referred by    [ ] physician    [ ] brochure    [ ] radio or TV    [ ] transtracheal patient     [ ] other

Patient Goals    [ ] mobility    [ ] comfort    [ ] cosmesis    [ ] convenience     [ ] better oxygenation

        [ ] other:

Other biographical data:

 

 

Oxygen History

Time on oxygen                   months

Current device        [ ] nasal cannula        [ ] face mask         [ ] both

Flow rates (L/min)    resting         walking         sleeping

O2 prescription        [ ] 24 hr/day         [ ] sleep             [ ] walking         [ ] prn

Noncompliance        [ ] short walks         [ ] socializing         [ ] work or meetings    [ ] kissing & sex
during                        [ ] bath or shower   [ ] toliet                 [ ] shaving                    [ ] putting on makeup
                                  [ ] eating                 [ ] telephone         [ ] discomfort               [ ] other:

Noncompliance                          hours/day (average)

Complications of    [ ] ear sores or irritation                             [ ] nasal sores or irritation
nasal cannula         [ ] nasal crusting and blockage                   [ ] recurrent epistaxis
                                [ ] impaired sense of smell & taste             [ ] chronic dry throat & hoarseness
                                [ ] cannula or face mask fire                      [ ] other:
                                [ ] no problems with cannula

Stationary oxygen source        [ ] compressed O2 gas    [ ] liquid O2    [ ] O2 concentrator

Portable oxygen source             [ ] compressed O2 gas     [ ] liquid O2

Other oxygen history:

 

 

 
SCOOP Transtracheal Oxygen
Patient:

MOC Score

Category                                                      0                                       1                                       2
Mechanical Reserve                         M0: FEV1 > 1.0            M1: FEV1 = .50 - .99        M2: FEV1 < .50


Oxygenation                                      O0: PaO2 > 55               O1: PaO2 = 50 - 55          O2: PaO2 < 50


CO2 Retention                                 C0: PaCO2 < 40            C1: PaCO2 = 41 - 50        C2: PaCO2 > 500


Observation in the hospital after the SCOOP transtracheal procedure should be considered in any patient with an individual source of 2 (e.g. M2 or O2 or C2) or sum of 3 (i.e. M1 + O1 + C1).
M =                   O =                     C =           

SAL Score

Score for Activity Level
    1 = Bedridden

    2 = Housebound except for doctor visits; out of bed less than 12 hours per day

    3 = Housebound except for doctor visits; out of bed more than 12 hours per day

    4 = Leaves home for shopping and periodic necessities other than doctor visits

    5 = Routinely leaves home for socializing or work

The SAL score is designed as a simple means of following changes in activity level in patients who have a pulmonary disability.
SAL =            

 
SCOOP Transtracheal Oxygen
Patient:
Date:

Pulmonary History

Cough severity         [ ] no cough                     [ ] mild (can ignore)
            [ ] moderate (interrupts activity)            [ ] severe (causes fatigue & dyspnea)

Sputum volume        [ ] none             [ ] teaspoon         [ ] shot glass         [ ] cup or more

Sputum color        [ ] clear             [ ] white             [ ] yellow         [ ] green

Hemoptysis        [ ] none             [ ] blood streaks         [ ] teaspoon         [ ] tablespoon or more


Body weight        current =             lbs         5 years ago =            lbs

Edema            [ ] none                         [ ] ankle edema at end of day
            [ ] ankle edema at all times            [ ] edema into calf or thigh

Bed clothes        [ ] tops & bottoms    [ ] bottoms only        [ ] nightgown        [ ] none


Anxiety            [ ] not anxious                     [ ] occasionally anxious & rarely panics
            [ ] often anxious & occasionally panics        [ ] always anxious & frequently panics


Dyspnea with walking    [ ] only a few feet     [ ] around house        [ ] about 100 yards    [ ] 1/4 mile or more

Leaves home for    [ ] doctor visits only     [ ] shopping        [ ] socializing & play    [ ] work

Time in bed        [ ] bedridden         [ ] 12 to 24 hours         [ ] less than 12 hours

Portable O2 source                  hours/day used

Rehabilitation program    Place:                                                                                 

            Dates:                                         to                                            

Referring pulmonary
diagnoses        Primary:                                                                     Secondary:                                             


Smoking                     age started                         packs per day                       date quit

Asthma or wheezing    [ ] no    [ ] yes     (explain)

Pneumonia        [ ] no    [ ] yes    (explain)

Phlebotomies        [ ] no     [ ] yes    (explain)

Pulmonary emboli    [ ] no    [ ] yes     (explain)

Mechanical ventilation    [ ] no    [ ] yes     (explain)

Other pulmonary history:

 

 

 
SCOOP Transtracheal Oxygen
Patient:

Past Medical History

Thyroid disease         [ ] no    [ ] yes     (explain)

Neck surgery        [ ] no     [ ] yes    (explain)

Arrhythmia        [ ] no     [ ] yes    (explain)

Myocardial infarction    [ ] no    [ ] yes     (explain)

Gl ulcers        [ ] no     [ ] yes    (explain)

Stroke             [ ] no     [ ] yes    (explain)

Bleeding disorder    [ ] no    [ ] yes     (explain)
(anticoagulants)

Diabetes        [ ] no     [ ] yes    (explain)

Alcoholism        [ ] no     [ ] yes    (explain)

Other Past Medical History:

 

 

Review of Systems


 

Allergies


 

Medications


 

Hospitalizations (past 5 years)

Hospital

 

 

 

 Year

 

 

 

 # Days

 

 

 

 Reason

 

 

 

 
SCOOP Transtracheal Oxygen
Patient:
Date:

Physical Examination

Observe vital signs after resting. Pulse and respiratory rates may decrease on transtracheal O2. Vital signs
Comment on use of accessory respiratory muscles, paradoxical and pursed lips breathing at rest. How do these change when the patient walks? General
Comment on condition of skin of columella and pinnae, appearance of nasal mucosa and septum, presence of serous or acute otitis media, dessication of oropharynx, thickness of the neck (thin, medium, fat), position of larynx (high, middle, or low), deviation of the trachea, position and size of anterior neck veins, and presence of any anatomic obstacles (e.g. scars or goiter). HEENT
Standard examination. Lungs
Comment on PMI, cardiac size and tricuspid closure sound (P2). Heart
Standard examination. Abdomen
Comment on kyphoscoliosis and cervical range of motion. Also observe dexterity (e.g. ability to unbutton and button shirt). Musculoskeletal
Comment on cyanosis, clubbing and edema. If edema is present, characterize its severity. Extremities
Comment on anxiety level. Does the patient know his/her primary doctor's name and address? Does the patient know what meds he/she is taking and doses? Mental status

 
SCOOP Transtracheal Oxygen
Patient:

Basic Laboratory Data

Transtracheal O2 is an alternative when accepted criteria for continuous O2 therapy are met. ABGs (room air)

PaO2 =        mm Hg    SaO2 =         %     PaCO2 =        mm Hg
pH =                         HCO3-=          mEq/L
Transtracheal O2 flow rates are about half nasal cannula rates needed for adequate oxygenation. ABGs (nasal cannula L/min    Face mask L/min)

PaO2 =        mm Hg    SaO2 =         %     PaCO2 =        mm Hg
pH =                         HCO3-=          mEq/L
Patients with greater than 15% reversibility after bronchodilator are at risk for bronchospasm with instrumentation of the airways. Patients with poor mechanical reserve are at risk for respiratory failure after the procedure. Spirometry    Pre Bronchodilator             Post Bronchodilator
            FEV1 =              L                         FEV1 =             L
            FEV1 =              % predicted         FEV1 =             % improvement
            FVC =                L                         FVC =              L
            FVC =                % predicted        FVC =              % improvement
            FEV1/FVC =                %         FEV1/FVC =               %
The hematocrit is a useful parameter in evaluating the overall adequacy of O2 therapy. Blood count

Hct =                %     Hb =               gm/dl
Comment on deviations of the trachea and herniation of the pleura into the procedure area. A bead chain necklace may be fitted before the xray to allow a clearer determination of these relationships. Chest xray (posteroanterior and lateral)

Additional Laboratory Data

Exercise oximetry on nasal or face mask oxygen may reveal serious desaturations. Exercise oximetry (nasal cannula        L/min    face mask        L/min)

Distance walked =         Duration =        minutes    Lowest SaO2 =       %
A study with 100% inspired O2 is useful in estimating the possible efficacy of transtracheal oxygen for refractory hypoxemia. ABGs (FIO2 = 1.0 using nose clip and demand valve)

PaO2 =        mm Hg    SaO2 =         %     PaCO2 =        mm Hg
pH =                         HCO3-=          mEq/L
Lung volumes and diffusion capacity measurements in patients with interstitial lung disease may help define the nature of the physiologic impairment. Lung volumes

RV =       L    RV =        % predicted

TLC =       L    TLC =        % predicted    RV/TLC =        %

Diffusion capacity

DLCO =       ml/min/mmHg    DLCO =        % predicted
Any history of a bleeding disorder or use of anticoagulants including aspirin should be evaluated. Coagulation

PT =       sec    PTT =        sec    platelets =        X 103    IVY =        min
Patients with an arrhythmia may require monitoring during the procedure when lidocaine with epinephrine is administered. Electrocardiogram
Other laboratory studies Results

 
SCOOP Transtracheal Oxygen
Patient:
Date:

Diagnoses

Primary pulmonary                                                            Secondary pulmonary

Other diagnoses

Indications

General indications                                                            Specific indiactions
[ ] PaO2 < 56 mm Hg on room air                                    [ ] Need for improved mobility
                                                                                       [ ] Patient preference (comfort, convenience or cosmesis)
[ ] PaO2 = 56-59 mm Hg on room air with                       [ ] Refractory hypoxemia (but responsive to 100% O2)
                                                                                       [ ] Complications of nasal cannula
    ( ) cor pulmonale: "p" > 3mm in II, III, AVF                     describe:
            or dependent edema                                             [ ] Poor compliance related to nasal cannula
    ( ) erythrocythemia: Hct > 56%
                                                                                       [ ] Other:

Contraindications

[ ] Pleura herniated into procedure area
[ ] Incompetence for catheter care (no one to assume responsibility)             ( ) physical
                                                                                                                  ( ) mental
[ ] Uncompensated respiratory acidosis (correct then reconsider)
[ ] Disabling anxiety
[ ] Vocal cord dysfunction

[ ] Other:

Precautions

[ ] Poor mechanical reserve
[ ] Profound hypoxemia (on oxygen)
[ ] Severe hypercapnia (without acidemia)
[ ] Bronchial hyperreactivity (by history or greater than 15% reversibility on spirometry)
[ ] Viscous or copious sputum (e.g. cystic fibrosis or bronchiectasis)
[ ] Serious cardiac arrhythmia
[ ] Bleeding disorder
[ ] Mild or moderate anxiety

[ ] Other:

Preprocedure medications

Sedation (one hour before):             [ ] one Tylox     [ ] one Tylenol #3    [ ] Benadryl 25 mg [ ] Benadryl 50 mg
                                                      [ ] Other:

Infection prophylaxis (one hour before):        [ ] Keflex 500 mg    [ ] Dicloxacillin 500 mg
                                                                    [ ] Other:

Vagolytic (one hour before):             [ ] Atropine 0.6 mg i.m.
                                                       [ ] Other:

Inhaled bronchodilator (30 minutes before):    [ ] Bronchodilator administered                                                     
                                                                                                              time                                                     

Signature

Preprocedure data base completed by:

 
SCOOP Transtracheal Oxygen
Phase I - Progress Notes
Patient:

 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
SCOOP Transtracheal Oxygen
Phase II - Transtracheal Procedure
Patient:
Date:

 

PREPROCEDURE ROUTINE

Primary Diagnosis

Interval History

new cough?
new sputum?
increased dyspnea?
fever?

Interval Physical Exam

T=
P=
R=
B/P=
SaO2=

chest exam:

anxiety:

Is the patient stable?

[ ] yes, proceed with procedure
[ ] no, defer procedure

Premedications per Physician Order    (circle if given)

Sedative

                                                                  
           Time

Antibiotic

                                                                  
            Time



                                                                  
            Time


                                                                  
Inhaled bronchodilator        Time


    Initial box when done

 

PROCEDURE NOTES

Chain Length =        cm

Puncture Site

[ ] cricothyroid
[ ] 1st interspace
[ ] 2nd interspace
[ ] 3rd interspace
[ ] lower

Procedure Observations

[ ] no unusual observations
[ ] cartilage exposed





Acute Complications

[ ] no acute complications

[ ] bronchospasm

[ ] excessive bleeding =       ml

    extravasated air:
[ ] I - neck only
[ ] II - neck and face
[ ] III - mediastinum
[ ] IV - small pneumothorax
[ ] V - large pneumothorax (chest tube)

[ ] excessive cough











                                                                   Time Completed

                                                          M.D.

                                                          M.D.
Assistant

POSTPROCEDURE ROUTINE

Chest Xray

Catheter tip             cm above carina

Oximetry on Nasal Cannula

SaO2 =       % on                 L/min

Degree of Cough 1 Hr After

[ ] none
[ ] mild (can ignore)
[ ] moderate (interrupts activity)
[ ] severe (causes dyspnea & fatigue)

Treatment Plans

Antibiotic Prophylaxis:
[ ] one week (cartilage not exposed)
[ ] two weeks (cartilage exposed)
[ ] other

Cough Suppression:
[ ] Tessalon Perles
[ ] Tussionex
[ ] codeine
[ ] instill lidocaine 1% (1cc q 1 hr prn)

Transfer Orders:




Return VIsit:
[ ] 3 days after catheter insertion
[ ] other

 

Review Patient Workbook & Guide and
postprocedure videotape segment.

Special Instructions:




                                                                  
Time Discharged


    Initial box when done

 

 
SCOOP Transtracheal Oxygen
Phase II - Progress Notes
Patient:

 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
SCOOP Transtracheal Oxygen
Phase III - 1st Scheduled Visit
(Post Procedure Day One; Stent to SCOOP Catheter Exchange)
Patient:
Date:

Interval History & Physical

Comment on cough, sputum, dyspnea, wheezing, tenderness, bleeding, hemoptysis and anxiety. Interval Hx:
Comment on tract opening (e.g. erythema, tenderness, edema, pus), air leak and chest exam. Interval PE:
 

PreSCOOP Stent to SCOOP Catheter Exchange

Comment on any problems. Notes:
 

Oxygen Titrations

Titrate by oximetry at rest then obtain arterial blood gas to confirm adequate oxygenation and gas exchange. Then titrate by oximetry for walking. ABG on SCOOP at              L/min:
PaO2 =         mm Hg                 SaO2 =          %
PaCO2 =          mm Hg
pH =                            HCO3-=          mEq/L
Exercise Oximetry on SCOOP at            L/min:
Distance walked =                     SaO2 =          %		 Rx O2
SCOOP rest        L/min
SCOOP walk       L/min
Nasal Cannula rest
          L/min
 

Supplies

Necklace Fitting
Accommodates two fingers in neutral position.
Allows about 1 cm catheter withdrawal.
Not excessively tight with:
- hyperextension
- cough
Doesn't pull catheter up.

 Hose Fitting
Upper segment allows hyperextension of trunk.
Lower segment loops to 6" from floor.

 Humidifier Guidelines
< 1 L/min = none*
1-4 L/min = 2 p.s.i. pop-off Hudson nondisposable or
    6 p.s.i. pop-off black top Salter disposable
    humidifier
> 4 L/min = 2 p.s.i. pop-off Hudson nondisposable or
    6 p.s.i. pop-off black top Salter disposable
    humidifier**
portable = none

*unless secretions are copious as in
bronchiectasis, secretions are viscous
as in cystic fibrosis, or patient lives in an
arid climate.
**should have servo-controlled heated
humidifier immediately available.		 Catheter Length            cm

Necklace Length              cm

SCOOP Hose Size             

Humidifier Type
                                               

Patient Workbook & Guide

Patient Record Booklet
- all entries made
Other Supplies:   
1. Workbook & Guide
2. Patient Record Booklet
3. Broncho Saline
 

Education

Review Patient Workbook & Guide and 10 SCOOP Rules with patient.
Show SCOOP training video.
Supervise SCOOP cleaning in place by patient.
Comment on patient competence.		 Notes:
 

Plans

Antibiotic prophylaxis against Staph. aureus is recommended for one week if tract does not cross through tracheal cartilage and two weeks if it does.
Schedule patient for four routine post-op visits for catheter stripping and tract evaluation (i.e. Tues./ Fri. X 2).		 Antibiotic Plans:         [ ] stop         [ ] 2nd week
Notes:





Next Appointment:
 

Signature

All steps of this patient encounter completed by:

 
SCOOP Transtracheal Oxygen
Phase III - Progress Notes
Patient:

 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
SCOOP Transtracheal Oxygen
Phase III - Progress Notes
Patient:

 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
SCOOP Transtracheal Oxygen
Phase III - Progress Notes
Patient:

 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
SCOOP Transtracheal Oxygen
Phase III - 2nd Scheduled Visit
Patient:
Date:

Interval History & Physical

Comment on cough, sputum, dyspnea, wheezing, tenderness, bleeding, hemoptysis and anxiety. Interval Hx:
Comment on tract opening (e.g. erythema, granulation tissue, induration), air leak and chest exam. Interval PE:
 

SCOOP Removal & Reinsertion Over Wire Guide

Comment on whether or not a mucus ball was coughed up. (if yes - consider Humibid LA 1200 mg BID) Notes:
 

Oxygen Titrations

Confirm adequacy of oxygenation by oximetry. If significantly different than last week, retitrate at rest and walking. SCOOP at              L/min            SaO2 =          %
Notes:		 Rx O2
SCOOP rest        L/min
SCOOP walk       L/min
Nasal Cannula rest
          L/min
 

Supplies

Patients who have difficulties with mucus ball formation may need to clean the SCOOP catheter TID - QID.
Start using a humidifier or advance to a more effective humidifier (e.g. heated) or use a room humidifier (e.g. arid climate).
Humidifier Guidelines
< 1 L/min = none*
1-4 L/min = Hudson nondisposable or black top
    Salter disposable humidifier
> 4 L/min = Hudson nondisposable or black top
    Salter disposable humidifier**
portable = none

*unless secretions are copious as in
bronchiectasis, secretions are viscous
as in cystic fibrosis, or patient lives in an
arid climate.
**should have servo-controlled heated
humidifier immediately available.

  
 

Education

Review Patient Workbook & Guide and 10 SCOOP Rules with patient.
Supervise SCOOP cleaning in place by patient.
Comment on patient competence and compliance.		 Notes:
 

Plans

If patient has experienced mucus balls or produced a mucus ball at the time of removal (above), weekly removal and reinsertion by MD, RRT, or RN of the SCOOP catheter over a wire guide is recommended. Tracheal chondritis may present with tenderness, swelling and induration around the tract. It may be treated with prolonged oral antibiotic without surgical incision and drainage. Granulation tissue can be cauterized with AgNO3 sticks if small or excised and cauterized if more extensive. Notes:










Next Appointment:
 

Signature

All steps of this patient encounter completed by:

 
SCOOP Transtracheal Oxygen
Phase III - Progress Notes
Patient:

 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
SCOOP Transtracheal Oxygen
Phase III - 3rd Scheduled Visit
Patient:
Date:

Interval History & Physical

Comment on cough, sputum, dyspnea, wheezing, tenderness, bleeding, hemoptysis and anxiety. Interval Hx:
Comment on tract opening (e.g. erythema, granulation tissue, induration), air leak and chest exam. Interval PE:
 

SCOOP Removal & Reinsertion Over Wire Guide

Comment on whether or not a mucus ball was coughed up. (if yes - consider Humibid LA 1200 mg BID) Notes:
 

Oxygen Titrations

Confirm adequacy of oxygenation by oximetry. If significantly different than last week, retitrate at rest and walking. SCOOP at              L/min            SaO2 =          %
Notes:		 Rx O2
SCOOP rest        L/min
SCOOP walk       L/min
Nasal Cannula rest
          L/min
 

Supplies

Patients who have difficulties with mucus ball formation may need to clean the SCOOP catheter TID - QID.
Start using a humidifier or advance to a more effective humidifier (e.g. heated) or use a room humidifier (e.g. arid climate).
Humidifier Guidelines
< 1 L/min = none*
1-4 L/min = Hudson nondisposable or black top
    Salter disposable humidifier
> 4 L/min = Hudson nondisposable or black top
    Salter disposable humidifier**
portable = none

*unless secretions are copious as in
bronchiectasis, secretions are viscous
as in cystic fibrosis, or patient lives in an
arid climate.
**should have servo-controlled heated
humidifier immediately available.

  
 

Education

Review Patient Workbook & Guide and 10 SCOOP Rules with patient.
Supervise SCOOP cleaning in place by patient.
Comment on patient competence and compliance.		 Notes:
 

Plans

If patient has experienced mucus balls or produced a mucus ball at the time of removal (above), weekly removal and reinsertion by MD, RRT, or RN of the SCOOP catheter over a wire guide is recommended. Tracheal chondritis may present with tenderness, swelling and induration around the tract. It may be treated with prolonged oral antibiotic without surgical incision and drainage. Granulation tissue can be cauterized with AgNO3 sticks if small or excised and cauterized if more extensive. Notes:










Next Appointment:
 

Signature

All steps of this patient encounter completed by:

 
SCOOP Transtracheal Oxygen
Phase III - Progress Notes
Patient:

 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
SCOOP Transtracheal Oxygen
Phase III - 4th Scheduled Visit
Patient:
Date:

Interval History & Physical

Comment on cough, sputum, dyspnea, wheezing, tenderness, bleeding, hemoptysis and anxiety. Interval Hx:
Comment on tract opening (e.g. erythema, granulation tissue, induration), air leak and chest exam. Interval PE:
 

SCOOP Removal & Reinsertion Over Wire Guide

Comment on whether or not a mucus ball was coughed up. (if yes - consider Humibid LA 1200 mg BID) Notes:
 

Oxygen Titrations

Confirm adequacy of oxygenation by oximetry. If significantly different than last week, retitrate at rest and walking. SCOOP at              L/min            SaO2 =          %
Notes:		 Rx O2
SCOOP rest        L/min
SCOOP walk       L/min
Nasal Cannula rest
          L/min
 

Supplies

Patients who have difficulties with mucus ball formation may need to clean the SCOOP catheter TID - QID.
Start using a humidifier or advance to a more effective humidifier (e.g. heated) or use a room humidifier (e.g. arid climate).
Humidifier Guidelines
< 1 L/min = none*
1-4 L/min = Hudson nondisposable or black top
    Salter disposable humidifier
> 4 L/min = Hudson nondisposable or black top
    Salter disposable humidifier**
portable = none

*unless secretions are copious as in
bronchiectasis, secretions are viscous
as in cystic fibrosis, or patient lives in an
arid climate.
**should have servo-controlled heated
humidifier immediately available.

  
 

Education

Review Patient Workbook & Guide and 10 SCOOP Rules with patient.
Supervise SCOOP cleaning in place by patient.
Comment on patient competence and compliance.		 Notes:
 

Plans

If patient has experienced mucus balls or produced a mucus ball at the time of removal (above), weekly removal and reinsertion by MD, RRT, or RN of the SCOOP catheter over a wire guide is recommended. Tracheal chondritis may present with tenderness, swelling and induration around the tract. It may be treated with prolonged oral antibiotic without surgical incision and drainage. Granulation tissue can be cauterized with AgNO3 sticks if small or excised and cauterized if more extensive. Notes:










Next Appointment:
 

Signature

All steps of this patient encounter completed by:

 
SCOOP Transtracheal Oxygen
Phase III - Progress Notes
Patient:

 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
SCOOP Transtracheal Oxygen
Phase IV - 1st Scheduled Visit
Patient:
Date:

Interval History & Physical

Comment on cough, sputum (mucus balls), dyspnea, wheezing, and any tract problems. Also comment on activity level (use SAL p. 2), appetite, sleep and anxiety level. Interval Hx:                             SAL = 1    2    3    4    5
Comment on vital signs (resting heart rate and respiratory rate), body weight, edema, tract opening and chest exam. Air leak should no longer be present, but some patients may take longer for complete healing of stoma around catheter. Interval PE: T=       oF    P =          R =          BP =       /      
Wt =       lbs      Edema = 1+     2+    3+    4+

Tract Opening -

Chest -
 

Assessment of Tract Maturity

If the SCOOP catheter is difficult to insert without a wire guide, the catheter should be reinserted (possibly using a wire guide) for an additional two weeks of Phase III. Notes:
 

Oxygen Titrations

Titrate by oximetry at rest then obtain arterial blood gas to confirm adequate oxygenation and gas exchange. Then titrate by oximetry for walking. ABG on SCOOP at              L/min:
PaO2 =         mm Hg                 SaO2 =          %
PaCO2 =          mm Hg
pH =                            HCO3-=          mEq/L
Exercise Oximetry on SCOOP at            L/min:
Distance walked =                     SaO2 =          %		 Rx O2
SCOOP rest        L/min
SCOOP walk       L/min
Nasal Cannula rest
          L/min
 

Supplies

Because most patients will begin a trial week and remove the current SCOOP catheter at 8:00 am each morning, dispensing of new catheters and a hose should be deferred until the next scheduled visit. Patient should contact DME for replacement of 2 SCOOP catheters and a hose.
 

Education

[ ] Review Patient Workbook & Guide and Ten SCOOP Rules with patient.
[ ] Show removal for cleaning segment of SCOOP patient education video.
[ ] Supervise SCOOP catheter removal, cleaning and reinsertion by patient.
[ ] Comment on patient’s skill with removal for cleaning.
 

Plans

The first week of Phase IV should be considered a trial period.

During this first week, all patients should remove the catheter at 8:00 am for cleaning. The catheter should also be cleaned in place at 4:00 pm and prn.

Problems with reinserting the catheter need immediate attention and should result in the reinsertion of the SCOOP catheter and an additional two weeks of Phase III with cleaning in place.

If removal and reinsertion has been successful during the trial period, patients may continue removal only at 8:00 am or they may proceed to BID removal at 8:00 am and 4:00 pm with prn cleaning in place.

Removal for cleaning should not exceed BID with the SCOOP catheter because of the potential for tract trauma.		 Notes:









Next Appointment:
[ ] one week
[ ] other:
 

Signature

All steps of this patient encounter completed by:

 
SCOOP Transtracheal Oxygen
Phase IV - Progress Notes
Patient: