Wednesday, February 29, 2012


I just fully aspirated half my cup of coffee. Granted, it wasn't a full cup of coffee, but 20 minutes later I am still coughing and sputtering.

This brought some thoughts to my mind. I just spent 3 night shifts at the hospital, 2 of those nights I was on the floors assessing one patient Q4. This particular patient has severe kyphoscoliosis which is in fact nearly occluding his airway. To solve this problem he received a trach, but it needed to be a certain trach in order to mold to his anatomy - enter the Bivona. This trach has no inner cannula - which makes me increasingly nervous. Especially since the quality of this patient's secretions have been becoming sticky and thick. We keep an emergency crycoid kit in his room. Seriously. Part of the problem is that while in the ICU we were using the Optiflow device on this patient in order to keep his secretions loose and flowing. Once he got transferred out to the floors he was switched over to a cold neb/ trach cradle. It's not that we don't use the optiflow on the floor - but we were trying to wean him to a device he would be likely to go home with. Given the permanent nature of his trach. Anyway.

The cold neb was definitely not doing the trick and although we were instilling his trach with normal saline Q4 to keep the goodness flowing - we were having more and more difficulty even passing a 14 fr catheter. At all. Luckily this was during day shift (when I wasn't around) and using some force they were able to get the catheter through. We went right back to the Optiflow and everything cleared up. Amazingly.

The point of this all was my realizing that having normal saline poured directly into your lungs (instillation) must feel like absolute crap.


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  2. Ill have to admit, when I have vent pt's or trach pt's with lots of thick secretions I lavage regularly. I know it must feel like crap but you have to assess the benefits. Coffee lavage is no good, saline... maybe.

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