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Respiratory Therapist/Cough Assist in ventilator trach patient

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Question
Hi Stephanie,

What is your knowledge on the safest way to use in line suction with ventilator patient while performing cough assist? One of the nurses I was talking to about this said there is a fear of keeping the cough assist going and suctioning intermittently with an in-line to the prescribed depth; since the cough assist is continually going, perhaps there isn't time to suction up all the secretions and they will be pushed further into the lungs with the following inhale. On top of this, I read another professional article from a university saying just suctioning with the in-line at the opening of the trach, during the exhale phase, will be enough to clear the secretions safely.

Answer
Hi Kari,

I am very sorry for the delay in response I did not see your question until today.

I have not used any cough assist devices so I cannot speak from personal experience but from what I have read I agree that suctioning with in-line catheter tip positioned at the opening of the trach would normally be adequate and would also be less likely to interfere with the effectiveness of the therapy and be more comfortable for the patient. I also noted that several long-term ventilator- dependent individuals  indicated that this is the method used for them as well.

Excerpt from Equipment Options for Cough Augmentation, Ventilation, and Noninvasive Interfaces in Neuromuscular Respiratory Management      Louis J. Boitano, MSc, RRT
http://pediatrics.aappublications.org/content/123/Supplement_4/S226.full

"Secretions can be removed from the circuit during exsufflation by incorporating an inline suction catheter. Place the tip of the inline suction catheter immediate to, but not into, the tracheostomy tube while applying catheter suction during exsufflation to clear secretions and maintain a clean breathing circuit (Fig 14www.pediatrics.org/content/vol123/Supplement_4.)"

This may be the article you also found; it is quite clear, regarding this matter, unlike the manual and most other references and gives a good picture as well.

Sorry that I could not be of more help in this matter and again I apologize for the delay. If I do get more information regarding this I will forward it to you.  

Respiratory Therapist

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Stephanie Tyrrell

Expertise

Respiratory Therapy is a very diverse field encompassing many specialty areas. I have experience in many of these areas and I am willing to answer any question I feel competent to answer within the scope of my experience in the following areas: neonatal ICU and transport, pulmonary rehabilitation, sleep studies, BiPAP/CPAP therapy, Holter monitoring, EKG, ventilator management, chronic and acute respiratory diseases,(i.e. COPD, asthma, restrictive disease, ARDS (acute respiratory distress syndrome), pneumonia, etc) and therapeutics, arterial blood gases, and others. Please see my profile under Experience for a full listing of areas of experience.

Experience

I have worked in respiratory therapy for over 25 years in all facets of patient care including level 4 neonatal ICU and neonatal transport, Director of Cardiopulmonary, community health fairs and networking, staff therapist, pulmonary rehabilitation, sleep studies and BiPAP/CPAP therapy, Holter monitoring, EKG, cardiac clinics, pre and post cardiac surgery education and patient care, emergency and long-term ventilator management, chronic diseases such as COPD, asthma, cystic fibrosis; acute respiratory distress syndrome, emergency room, home and nursing home respiratory care. I also provided temporary staff to area hospitals through an allied health business I owned and managed, while also working as a staff therapist for the business.

Education/Credentials
Certified Respiratory Therapist, Registered Respiratory Therapist, Licensed RT, NRP ((Neonatal Resuscitation Program) certified, BS Biology/Botany, MS Environmental Sciences - Toxicology

Past/Present Clients
Thousands of in-patient and out-patient clients in the hospitals I was/am employed by as well as a number of local hospitals that utilized the services of my allied health business. I currently work as a respiratory therapist at a general hospital and a rehabilitation hospital.

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