Frequently Asked Questions (FAQs):
Q. What is the difference between the Fast Tract procedure and the Modified Seldinger technique?
A. The Modified Seldinger technique is the original procedure used since 1986 to create the tract that will eventually accommodate a SCOOP transtracheal catheter within the trachea. In 1996, a new procedure called Fast Tract was developed in concert with the surgical community. It is a true surgical approach that must be performed by a qualified surgeon.
Q. What is the length and diameter of the SCOOP catheter?
A. The internal segment of the standard adult length catheter is 11 centimeters. The diameter is 9 french. Outside diameter is 3.3mm or .131 inch. Inside diameter is approximately 3.0 mm or .118 inches. SCOOP catheters are available in 9 cm, 11 and 13 cm lengths. A perfectly positioned catheter is normally 2-4 cm above the carina. The post procedure chest x-ray is used to determine which length catheter is best for each patient.
Q. What material is the SCOOP catheter made of?
A. Polyurethane, with thermoplastic properties. That is, at body temperature it will take a “set.” This occurs approximately one hour after insertion, and explains why the vast majority of patients report that they cannot even feel the catheter in their trachea.
Q. What is the highest liter flow permitted through a SCOOP catheter?
A. SCOOP catheters (Part Numbers C-9, C-9-2, C-11, C-11-2, C-13, and C-13-2) are FDA approved up to 12 L/min. Be aware of increased humidification requirements at flow rates much above 6 L/min.
Q. Where do most transtracheal catheters lie in the trachea relative to the carina?
A. A properly placed catheter is normally 2-4 centimeters above the carina.
Q. How can you tell if transtracheal tract is fully mature?
A. When the catheter is introduced into the tract opening, there is no snugness, tightness, or any unnecessary manipulation required to get the catheter to enter the trachea. Other than twirling the catheter, it should not require any extra effort or take an inordinate amount of time. There should be no pain or tenderness associated with catheter insertion or removal. The catheter should feel as if it were “dropping into air.”
Q. Why was the SCOOP-2 catheter discontinued?
A. For the past 15 years Transtracheal Systems has provided two different catheters for transtracheal oxygen administration. They have been identified as SCOOP-1 (LF for low flow) catheter, and SCOOP-2 (HF for high flow) catheter. They are identical in length and diameter, but the SCOOP-2 differs from the SCOOP-1 in that the SCOOP-2 has 6 extra hoses or side ports drilled near the tip of the catheter. Conceptually, the SCOOP-2 catheter was designed with the extra ports as it was originally thought that the ports would provide greater comfort and perhaps better efficiency at higher flow rates. It is our belief that there is no significant advantage to using the SCOOP-2 catheter over the SCOOP-1 catheter and therefore have elected to phase out the SCOOP-2 catheter.
The SCOOP-1 catheter is FDA approved for liter flows up to 12 liters per minute, and provides greater flexibility than the SCOOP-2. The SCOOP-1 catheter can be cleaned in place and/or removed for cleaning. This allows for more “customization” and individualization of catheter cleaning protocols. If you have any specific questions regarding the phase-out of the SCOOP-2 catheter, please contact Transtracheal Systems and ask to speak with one of our respiratory therapists (800-527-2667), or visit our website site at www.tto2.com.
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Q. How is the actual Phase III cleaning protocol determined for each patient?
A. All patients begin Phase III by cleaning their catheter in place with saline instillation and the cleaning rod two times per day. This is established during the first scheduled visit of Phase III. When the patient subsequently returns for their next visit, a careful history is taken with regard to mucus balls. If the patient reports that they have been producing mucus balls, two steps are immediately taken. First, they are told to increase their cleaning frequency to four times per day. Second, they are started on the mucoevacuent per the physician’s prescription. (They may already be on this medication).
The patient is scheduled for their next scheduled visit which will include a catheter stripping. Encourage the patient to increase their intake of systemic fluids (assuming no contraindications). It is very likely that over the time period that covers Phase III, you will further customize the patient’s cleaning regimen. Patients with weak cough and higher flow rates are more likely to get in trouble. Weekends are particularly suspect. Trust your clinical instincts. It is always better to bring a patient in on a Friday afternoon for a catheter stripping, then to find out the patient was admitted to a local hospital over the weekend.
Q. Do all patients have to remove and reinsert their catheter twice a day for cleaning?
A. No. This is part of the customization process. Most patients do very well with BID removal. Other patients may only need to remove their catheter once per day or every other day. Each patient’s ultimate cleaning regimen is based on a number of factors. These include: baseline secretions, oxygen flow rate, cough effort, medications, as well as environmental factors. Many patients will need to clean their catheter in place several times per day in addition to catheter removal and reinsertion. There is a great deal of flexibility in the recommended cleaning protocols for SCOOP patients. After a period of time, all patients determine which cleaning schedule works best for them.
Q. Is there a convenient way to categorize mucus balls?
A. According to size. It is convenient to categorize them a rice sized, pea sized, marble sized etc. No mucus ball should ever be allowed to get to the size where they could potentially obstruct the airway. Proper adherence to published protocols will prevent even the possibility of life threatening mucus ball episodes. See our clinician and patient manuals containing cleaning protocols.
Q. How does Mucinex (Guaifenesin) help in the treatment of mucus balls?
A. The active ingredient in Mucinex is Guaifenesin. It is not a true mucolytic like Mucomyst or NACL. Mucinex makes mucus less “sticky”, and therefore easier for the patient to cough up and out. It does take approximately 12-24 hours to get to a therapeutic blood level. Correct adult dosage is determined by physician’s prescription, but the recommend dosage to start is 1200 mg twice a day. That’s two (2) 600 mg tablets twice a day. Mucinex may not eliminate mucus ball formation in all patients, but it will positively impact the majority of patients and make mucus management much easier for most patients. Mucinex is quite expensive. Ask your pharmacist for the generic Guaifenesin if cost is an issue.
Q. If a patient has a positive response to Mucinex, how long will they need to take it?
A. First as a trial, and then most likely for as long as they are on transtracheal oxygen.
Q. Can the patient substitute generic “Guaifenesin” for Mucinex to loosen secretions?
A. Substitution of any generic drug should be discussed with your physician. A number of patients have reported gastric distress taking Guaifenesin, This may be due to uneven breakdown and distribution of the generic variation. The cost, however, of the generic will be substantially less.
Q. Is it okay to use Mucomyst (Acetylcysteine) either as an aerosol or by direct instillation with my SCOOP catheter to help manage mucus problems?
A. It is not okay to use Mucomyst either by aerosol or direct instillation with any SCOOP catheter. The reason is mechanism of action of Acetylcysteine. Acetylcysteine is a powerful enzymatic agent. Experience obtained over the past 25 years has shown that the enzymatic action will affect the polymers in the polyurethane material of which the SCOOP catheter is made. This causes the catheter to begin to break-down; in effect, the catheter gets "gummy". This can certainly become problematic as the catheter surface gets roughened and may cause tract trauma or difficulty with removal and reinsertion.
Q. What do you tell a patient who has just called and says they “can’t get their SCOOP catheter back in?”
A. Ask them how long it has been out. If more than 5 minutes, have them put their nasal cannula back on at the prescribed flow rate and come in to the transtracheal follow-up unit as soon as possible. Time is critical, as a “fresh” transtracheal tract can close in less than an hour.
Q. How do you convert a tracheostomy stoma to a usable SCOOP tract?
A. Downsize the patient to a #4 trach tube. Insert the SCOOP catheter into the stoma. Consider the patient to be in Phase III. After a few days, the stoma should “snug” down around the catheter. Advance the patient per standard published protocols. See our manuals containing the appropriate protocols.
Q. What is Chondritis?
A. An inflammation of the tract, probably secondary to colonization of cartilage at the base of the tract. It results in a swollen, reddened, knot of tissue around the tract. They almost never contain pus, and do not typically drain. Treatment consists of a 2-3 week course of antibiotics. Cephalexin 250mg TID has worked very well over the years, but any anti-staphylococcal antibiotic that the physician orders should work. Chondritis usually appears early in Phase III, but may occur at any time. Chondritis is much more common with the MST procedure.
Q. Why must SCOOP products be routinely replaced every 90 days?
A. SCOOP products are made of plastic. All plastics are subject to oxidation, exposure to light, and the action of patient body oils and secretions. They may become discolored and brittle. This may certainly cause tract trauma. For comfort and safety reasons, all SCOOP catheters and hoses should be routinely replaced every 90 days.
Q. Can I suction a patient through the SCOOP catheter?
A. No! The catheter cannot be configured to suction the patient; furthermore the catheter cannot be advanced any further into (towards) the lungs to promote vigorous suctioning.