Patient Workbook & Guide: FastTract Procedure - Potential Risks

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 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 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  99.5°F.
   
   
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:
   
   • Fever greater than 99.5o F
   • Increasing redness or pus around the tract site
   • Severe or increasing pain at the procedure site.

If you are experiencing any of the above symptoms, you should call your doctor immediately.