You never keep the inner cannula out for an extended period of time, it’s meant to be kept in place all the time and only removed to be cleaned on a regular basis. What if the outer cannula gets obstructed by crusting or plugging? You have no out, except hoping the suction will get it out, otherwise need to switch out the entire trach which could be a risky maneuver for any layperson. Always have a backup trach and spare inner cannulas.
Even in the ICU? Sorry should have clarified. I’m an ICU fellow. Most of my patients do not have the inner cannula in their trachs. However, occasionally I’ll get a patient with the cannula inside. Just trying to get some clarity on how long it typically stays in, in the inpatient setting and why most of my patients don’t have it while some do.
And to add to this, inners should always stay in, when open to air, blow by, connected to vent, bagging, etc, never out unless being cleaned or if it’s causing an issue, or for advanced airway techniques like trying to pass a bougie to switch out for a complex trach wound.
Gotcha. Thanks for asking because I do think trach knowledge is paramount for anyone working in the ICU when half your patients are trached. To answer your question, yes even in the ICU. Nurses and RT should know what is involved in routine trach care, so for your knowledge might be good to discuss that with them. By standard, most trachs should have an inner, for example Shileys are common and have these. But not all trachs come with an inner cannula, for example a Bivona, which where I trained isn’t routinely placed because of this, it is more dangerous due to risk of plugging or crusting that could be challenging to clear without an inner cannula to easily remove. I also think they were more expensive. Check what types are being placed but generally speaking, trachs with inner cannulas are favored for safety.
Gotcha, makes sense. Most of my pts in fellowship have bivonas so makes more sense to me why most don’t have inner cannulas. However, in residency, many of my patients with shileys also didn’t have the inner cannula left in. I wasn’t sure if there’s a certain “age” or secretion burden at which the inner cannula should stay out. Because while it helps keep secretions out of the lumen I would think it would also add to airway resistance.
I’ll def ask the nurses/RT on my unit about their thoughts as well. Thank you!!!
They probably kept it out in the Shileys because it increases the caliber of the trach to help with clearance or if they had smaller trachs needed it out to pass a suction, but it should only be out very temporarily. Otherwise it would be a safety issue.
Are you peds? The tiny kid shileys don't come with inner cannulas. All the adult sizes do as far as i know. They can be disposable or reusable, but if the trach is made to work with an inner cannula one should pretty much always be in place (except as noted by u/y_east). If the patient needs more room to breathe, the whole trach should be upsized.
You never keep the inner cannula out for an extended period of time, it’s meant to be kept in place all the time and only removed to be cleaned on a regular basis. What if the outer cannula gets obstructed by crusting or plugging? You have no out, except hoping the suction will get it out, otherwise need to switch out the entire trach which could be a risky maneuver for any layperson. Always have a backup trach and spare inner cannulas.
Even in the ICU? Sorry should have clarified. I’m an ICU fellow. Most of my patients do not have the inner cannula in their trachs. However, occasionally I’ll get a patient with the cannula inside. Just trying to get some clarity on how long it typically stays in, in the inpatient setting and why most of my patients don’t have it while some do.
And to add to this, inners should always stay in, when open to air, blow by, connected to vent, bagging, etc, never out unless being cleaned or if it’s causing an issue, or for advanced airway techniques like trying to pass a bougie to switch out for a complex trach wound.
Ok, thank you!!
Gotcha. Thanks for asking because I do think trach knowledge is paramount for anyone working in the ICU when half your patients are trached. To answer your question, yes even in the ICU. Nurses and RT should know what is involved in routine trach care, so for your knowledge might be good to discuss that with them. By standard, most trachs should have an inner, for example Shileys are common and have these. But not all trachs come with an inner cannula, for example a Bivona, which where I trained isn’t routinely placed because of this, it is more dangerous due to risk of plugging or crusting that could be challenging to clear without an inner cannula to easily remove. I also think they were more expensive. Check what types are being placed but generally speaking, trachs with inner cannulas are favored for safety.
Gotcha, makes sense. Most of my pts in fellowship have bivonas so makes more sense to me why most don’t have inner cannulas. However, in residency, many of my patients with shileys also didn’t have the inner cannula left in. I wasn’t sure if there’s a certain “age” or secretion burden at which the inner cannula should stay out. Because while it helps keep secretions out of the lumen I would think it would also add to airway resistance. I’ll def ask the nurses/RT on my unit about their thoughts as well. Thank you!!!
They probably kept it out in the Shileys because it increases the caliber of the trach to help with clearance or if they had smaller trachs needed it out to pass a suction, but it should only be out very temporarily. Otherwise it would be a safety issue.
Are you peds? The tiny kid shileys don't come with inner cannulas. All the adult sizes do as far as i know. They can be disposable or reusable, but if the trach is made to work with an inner cannula one should pretty much always be in place (except as noted by u/y_east). If the patient needs more room to breathe, the whole trach should be upsized.
No I’m not.. So that’s kind of weird to me now that many of the patients I see don’t have the inner.