I've received a couple of questions regarding speaking with a ventilator and trach that I wanted to answer. First, I'll talk about me and go over some basic 101 about trachs. The post after this will talk about speaking after my accident.
I'm considered a vent dependent quadriplegic; I require
the use of a ventilator 24/7. This is a result of the level my injury is at,
which is C-1 C-2. When an injury occurs at the C-1 level (the vertebrae closest
to the skull), most likely it will affect the person's breathing. In this case,
intubation is required. A tracheal intubation, commonly known as intubation, is
the insertion of a flexible plastic tube that goes down the throat to maintain
an open airway. Then with the use of a ventilator a person is able to sustain
breathing. While in the helicopter on a way to the hospital they had to
intubate me.
Two days later, after finding out the extent of my
injury, the doctors took me to surgery to remove the tube and do a
tracheostomy. A tracheostomy consists of making an incision in the neck and
opening a direct airway through an incision in the trachea. The stoma that
results from this can independently act as an airway for a tracheostomy tube
(trach) to be inserted, allowing the person to breathe without the use of his
or her nose or mouth. A ventilator can be attached to the trach or it can
become the actual place a person uses to breathe. People can have trachs for different
reasons, not just spinal cord injuries. An example would be someone with
muscular dystrophy, someone who had/has throat or lung cancer etc.
My trach stays in the majority of the time, unless it's
being changed. In that case, my nurses do a trach change by taking out the old
one and inserting a brand-new sterile one. Depending on the person (age and
size) depends on how often the trach gets changed. They change mine every three
weeks, or unless it's needed before that. An instance where I would have to
have my trach changed before the date would be if there was a mucous plug
inside of it blocking my airway. This has happened before to me in which
someone has had to do an emergency trach change (sometimes suctioning doesn’t
clear this secretions as fast as just changing it does). Trachs are pretty expensive, so many people
sterilize them again in boiling hot water and reuse them. Since I don’t do it very often, I just throw
it away every time it gets changed.
I rarely have to suction anymore; usually every couple
days or so. That’s not very much for
someone who has a trach and is vent dependent.
I don’t get big mucous plugs anymore and haven’t had to do an emergency
trach change in years. Now I just change
it during the scheduled times. Although
my situation is complicated, I try my best to say as healthy as possible. This includes staying away from smoky
environments along with avoiding others with colds or who are sick.
There is a machine that I have called a cough assist; it
attaches to the trach like the vent tubing does. I use that twice a day. It blows air into my lungs and then pulls it
back out. The cough assist has done
wonders for me, including clearing my lungs.
Usually it brings up secretions which I then either suction or cough
out. This is most of the reason why I
don’t have emergency trach changes anymore.
 |
| Cough assist machine |
There are many different types of traches. The one that I use has a cuff on it. The cuff is actually a balloon that gets
inflated using air or water. It is
around the stem of the trach. To better
explain this, I have posted a picture below.
 |
| This is a picture of my trach. The cuff is attached by a string (shown floating above the trach). The balloon is around the bottom of the trach. At this point it is not inflated. |
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| This is what it looks like when the cuff is inflated. It closes off the airway in the trachea so air cannot come out the mouth or nose. It all gets diverted back down the tubes, making it so that the person cannot speak. |
I don't keep enough water in my trach for it to completely close the air from coming out my mouth and nose. The balloon can hold at least 5 mL, however I only keep 3 mL. For me, I have a huge air leak around my trach so if the water is taken out, most of the air escapes around my trach. That's why I keep 3 mL of water in-to prevent air from escaping around my trach instead of out my mouth and nose like it's supposed to. That's how I'm still able to talk. When all or most of the air gets diverted out my mouth, it allows me to speak better and clearer.
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| *A tracheostomy is an opening into the trachea (windpipe) that allows air to be pumped directly into the lungs. Many trach tubes are fitted with inflatable cuffs, which, when deflated, allow air to pass over the vocal cords, making speech possible. When the cuff is deflated, air "leaks" up around the tube and less air gets into the lungs, but many people can tolerate this air leak with adjustments to their ventilation system. http://faculty.mercer.edu/summervill_j/jeanchiang/itisallaboutme.html |
Question:
Do you know why some people use a vent and a trach that
dowake up Dragon esn't allow them to speak? I heard of someone with muscular dystrophy who had
a vent and 'cuffed' trache which could be set to allow her to speak or not, but
she usually had it set not to (during an interview she had the cuff set so she
could). Is it a matter of money or of medical necessity?
Answer:
No, it is not a matter of money. It may be a matter of medical necessity or
just a preference. As I explained above,
I use water in my trach cuff to prevent leaking around my stoma and trach. In this case she uses a cuffed trach and
prefers (or needs) to have it inflated fully, which takes away her ability to
speak. Either way, not all people with
trachs have a cuffed one. Like I said,
there are many different types of trachs; I just named one kind.
Stay
tuned for the continuous to this post coming up soon!
Jenni
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