Conversion of Tracheotomy to Transtracheal Oxygen

I Possible TTO Planned Before Tracheotomy

  1. Select tracheotomy site
    1. Work with surgeon
    2. Use standard TTO product with bead chain necklace
  2. Excise 1cm window of tracheal cartilage at time of trach
  3. Downsize to No. 4 uncuffed trach tube
  4. Insert transtracheal catheter:
    1. Customize bead chain necklace to stabilize catheter
      1. Accommodate 2 fingers
      2. Not excessively tight with cough or hyperextension
      3. Allows 1-2 cm of catheter exposure on withdrawal
    2. Let tract become snug down around catheter before starting O2
    3. When tract snug, titrate and begin Phase III

II Recent Tracheotomy but TTO Not Planned

  1. If cricothyroidotomy then let tract close, otherwise proceed
  2. Downsize to No. 4 uncuffed trach tube
  3. Insert transtracheal catheter:
    1. Customize bead chain necklace to stabilize catheter
      1. Accommodate 2 fingers
      2. Not excessively tight with cough or hyperextension
      3. Allows 1-2 cm of catheter exposure on withdrawal
    2. Let tract become snug down around catheter before starting O2
    3. When tract snug, titrate and begin Phase III

III Old (Mature) Tracheostomy

  1. Downsize to No. 4 uncuffed trach tube
  2. Insert transtracheal catheter:
    1. Customize bead chain necklace to stabilize catheter
      1. Accommodate 2 fingers
      2. Not excessively tight with cough or hyperextension
      3. Allows 1-2 cm of catheter exposure on withdrawal
    2. Let tract become snug down around catheter before starting O2
    3. When tract snug, titrate and begin Phase III
  1. If tract fails to tighten around catheter
    1. Try AgNO3 (silver nitrate stick) cautery first
    2. If AgNO3 fails, have ENT see patient to excise epithelium of tract under local
  2. If catheter is unstable because of improper location
    1. Surgically close current trach
    2. 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

 

TTO catheters were placed in the tracheostomy stoma in all patients when the tracheostomy tube was removed. The tracheostomy stoma healed around the TTO catheters without complications in all cases. The TTO 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