As much as I hate to write this I want to share the trach change experience with everyone.
First let me explain something about Elizabeth's trach, when she first had her surgery they put a trach in that is cuffed. It has a small deflated ballon around the bottom of it and they put air or water in to inflate it and it adds pressure to hold the airway open. Elizabeth has had a cuffed trach since her surgery. Well today they decided they wanted to try and see how she does with an uncuffed trach, one without the ballon of air on it, since hers hasnt been inflated in a few days, and its better for her not to have something extra hanging from her neck.
So Matt and I do well with cleaning around the trach and suctioning/bagging her. And then its time to change the trach, and as much as I DO NOT want to do it, I know that I need to learn so I say I will do it. We get everything together and Matt takes the old trach out, I try putting the new non-cuffed one in and she starts crying, we can actaullly hear her crying (if you remember we havent been able to hear her since surgery). I have a little bit of a hard time getting the trach in and felt that it wasnt in all the way, and as I am telling the case manger this, Elizabeth is still crying. She starts turning really really red, and then starts turning really, really blue. She keeps getting bluer, and I watch her oxygen satruation dropping and dropping on the monitor (the monitor showed her oxygen saturation dropped from high 90s down to 10, granted she was moving alot so the sensor may not have been picking up, but for it to show that low, she had dropped alot). I froze for a second and then got the heck out of the way so the case manager could "fix her'. The case manager and nurse tried to bag Elizabeth but were unable to get any air into her.They tried adjusting the trach and after another failed attempt at bagging her, They then took the uncuffed trach out and put the old cuffed one back in and were finally able to get the bag to work to give her oxygen. After a few seconds her saturations began rising and she didnt look blue anymore! Once she was breathing well and her saturations were back up, I was finally able to calm down a little. Needless to say all of that happened alot faster than it sounds. And of course I felt awful because I felt it was my fault. But the case manager explained that even though it doesnt seem like a big difference that Elizabeth may need the small amount of pressure that the cuffed trach gives, and the uncuffed trach was the problem, not me. Granted she may be trying to make me feel better cause she knows Its gonna be a few days before I will try again, but I hope she was right. Today was NOT a good learning experience!
Other than the above issues for the day, Elizabeth continues to do well, she is now off of dilaudid. They plan to take her off the versed tonight or in the morning and the hopefully work on turning the ventilator settings down more. And I keep forgetting to mention they have started weaning her steriods down, very very slowly but hopefully she will be off of those within a few months, but that is something we can continue to wean/monitor at home.
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