Read Before 1st Training- Important Trach Information

DRT 
I would like to start by saying that I’m glad that I made the decision to continue to fight this horrible disease by getting a trach. A few of my friends (PALS-People with ALS) when confronted with the inability to breathe, decide to hang it up. I choose to LIVE!

WATER MANAGEMENT
Every time you come, do water management on both vent tube at 11 AM and 7 PM.

The key points are:

• Empty both tubes of excess water. Always empty water AWAY from me, NOT into me.
• Remove clear tube from PEEP valve and drain water into wash cloth. NEVER allow the PEEP valve to get wet. 
• Separate the white tube from the peep valve. Don’t twist the peep valve. Hold the white tube in two places, up by my belly and down by the peep  valve. 
• Pull hard on the white tube while holding the other end that will empty the water out. Do it twice. 
• The blue tube is different. Tap the blue tube starting up at my chest and continue down to the bottom.
  Never pull the blue tube because of the wires. 
• Carefully drain water from the blue tube into the humidifier.
• When doing the clear tube act quickly, I can't breathe. 
• Always hang the peep valve so it is pointing up so water does not drain into it and clog it.
• The goal is that I have a steady setting of 4-5 PEEPS. Learn how to set the PEEP on the valve.

LUNG SUCTION
When I ask for lung suction-

• First suction my mouth- do each cheek, then push wand between teeth to roof of mouth and allow me to suck it. Flip the wand over to do under my tongue. Do under my tongue once to get the saliva out. Then cheeks again. The trick is to do it well enough in my cheeks so I don’t have to use up energy during the suction process. 
• Setup the red worm to the suction tube, ask me if I want a bullet. If so put it in and then turn clear tube up. As shown in video. 
• Squeeze bullet into my throat. It helps to produce a more effective lung  suction. 
• Lung suction take so much energy and air out of my lungs, it’s hard to recover. 
• Remove the left head rest. 
• Turn on the suction machine.
  

• Then use red catheter with clean glove, Turning my head to the left allows the catheter to go into my right side bronchia. Go deep and don’t stop when you hear fluid until you get deep. The reason that you don’t want to waste suction up top is because you don’t want to fill up the tube just yet. 
• It's important that you turn my head back to center otherwise my neck cramps. 
• Use your thumb to plug the white valve. This causes the suction.
• Also squeezing the worm next to the white valve produces a more powerful suction! 
• Twist the catheter when you find a juicy spot. 
• Slide catheter out straight, sucking as you go out.  Twisting the catheter when you find a juicy spot. 
• If needed, turn my head right and do the other side. Don’t take off the right head rest. 
• Do the same technique for the right side as you did for the left side. 
• You will be trained on the correct way of turning my head to the right and left.
• After you do lung suction, feel both sides of my chest for rattles. Ask me how I feel.
• If needed do either or both sides again.
• Important - if not put trach cap back on and burp me! 
• Then suction mouth again.

A trick that we learned is if I need mouth suction right when you are in the middle of lung suction, just use the use the white valve that you plug with your finger. Put the valve on my mouth while plugging the red catheter.

Only if Don is not on ERICA! To make it easier on you if Don isn't on ERICA you can tilt the wheelchair up to a level when you feel comfortable  (head back).

OTHER CONCERNS:

• My Respiratory Therapist (RT) says that you should never cover my trach with anything including bibs, spit cloths or coats. 
• It's very important to keep the yellow tube on top otherwise moisture could go into the yellow tube which causes a vent failure. Also the white tube must be lower than the blue tube above my chest. You must learn how to turn the blue tube to make it higher than the white tube. 
• Keep a rolled wash cloth under my trach tubes. My RT says keep the tubes as straight as possible. Imagine a line painted down the center of my face, the trach should be aligned with the imaginary line. If it’s not aligned properly, especially when I don’t have my brace on at night, it’s very painful. 
• This is important,  always keep the yellow tube on top. Also the white tube should be lower than the blue tube. Learn how to twist the blue tube so the white tube is the lowest. 
• I like to see the display on Bertha’s control panel, except when I go to bed. I get comfort in knowing what my peeps are set at. At bedtime make sure that you turn Bertha so I cannot see the lights from the display panel.