Trachs 101

Anytime someone new comes to visit Colin, I give them a quick lesson in trachs, whether they want to know or not.  I know that if I were them, I would be very curious about how it all works.  I honestly had no idea what a trach was before the doctors started using that word early on when they had trouble getting Colin off the ventilator.  We were hoping that with a little more time and treatment, we would be able to get Colin off of the vent.  But, unfortunately, after Colin was re-intubated after a failed extubation, Matt and I decided to go ahead with a tracheotomy.

Colin during his attempted extubation

After being re-intubated

This decision wasn't easy, but Colin would self-extubate often, and our biggest fear was that he would do permanent damage to his airway and/or his vocal chords.  Also with the trach we could bring Colin home even while he was ventilated (this plan changed when we transferred to Columbus).  During rounds the day after he was re-intubated, I advised the doctors of our decision and to go ahead and consult ENT.  Not even an hour later, Trichelle, my favorite nurse practitioner, came and told me that ENT had an opening later on that day.  I called Matt and we both agreed to get it done, why delay the inevitable, and also, the hospitals best ENT doc would be doing the surgery (God's handiwork).  So, in comes Jan, trach teacher extraordinaire at Children's Hospital of UPMC Pittsburgh, to educate me about what was going to happen to my son.  I was in a bit of a haze when she was talking, so a lot of what she said went in one ear and out the other, but I got the important info.  Later on that day, Colin was taken down for surgery and our lives changed drastically.

Heading down for surgery (that's Trichelle with him)

During the surgery, they first checked out Colin's airway and then proceeded to cut a hole in his trachea and inserted a tube that the ventilator hooks right up to.  This is a trach (along with a couple of other accessories I will explain in a bit):

Colin's trach is a 3.5 Neo Shiley, 3.5 is the diameter of the tube and Shiley is the brand (the one in the picture is a 3.0, which is a downsize in case we have trouble getting the 3.5 into his stoma).  This gets changed once a month, unless there is an emergency such as a mucous plug, which is just a big booger that builds up over time (we've only had one emergency trach change).  We change the ties every other day unless they are gross, and these keep the trach from falling out.  I remember first getting trained and thinking how impossible it seemed and how much work it was.  Now, I could change a trach in the middle of the night, half asleep, and probably with one hand tied behind my back (not to sound braggy).  Colin makes it really easy too, he is such a good boy during trach changes.  The other accessories in the picture are a Passy Muir Valve (PMV for short) and an oxygen adapter.  Let me just say that the PMV is my favorite invention of all time.  Without it, Colin would not make any sound.  The trach is placed below the vocal chords, therefore, no air passes over them when the trach is in place.  The PMV is a one-way valve.  He breathes in through the trach with the PMV, but the valve then closes when he breaths out to allow the air to pass over the vocal chords and come out of his mouth.  This way, Colin can make all the noise that he wants.  We didn't hear him make noise for a long time, about three months, so this little piece was a God-send.

We very much look forward to the day that Colin is decannulated (taking the trach out).  We're hoping that it could be as early as March 2015.  It is an unwritten rule that trachs are not taken out during cold and flu season.  We could fight to get it out sooner, but if Colin were to get really sick and, for example, needed CPAP, we could treat him at home instead of having to be hospitalized.  So, we will be patient and do our best to keep the little man healthy during the winter months.  I will do more educating in the future, but for now I will leave you with Colin opening his Halloween present from Grammy from this morning: