Availability of accessories is a crucial aspect in healthcare in addition to its affordability. Here is how we can easily cork tracheostomy tube of few types which has neck or extension either in inner or outer cannula.
Materials required: 5 ml syringe, Scissors
Patients status: The patient for whom you are going to try corking using this method should meet the following criteria.
The patient should have been able to withstand the cuff deflation non-stop for the last 24 hours
The patient should be able to block the tracheostomy tube using finger and count for more than 20 in one breath and this trial is repeated successfully at least for 5 times.
The patient should have no dependence on suctioning or minimal secretions.
The patient should have the ability take out secretions through the mouth - i.e. expectorate secretions orally.
The patient should have had adequate airway space for breathing at the level of larynx and pharynx as viewed by Videolaryngoscopy.
It is ideal to have passed color water test using blue dye test. However, there may be delay in clearance for oral initiation.
In some instances patient may be able to talk without corking of tracheostomy tube.
Patient should be cooperative.
You should have got clearance from treating physician.
Step 1: Check all the medical chart for any signs of distress and risk of corking failure.
Step 2: Carry out tracheostomy care
Step 3: Explain the patient the process and its expected outcome.
Step 4: Take 5 ml syringe and separate plunger out. Do not discard the barrel as it might be useful in a similar repurposing for insufflation test.
Step 5: Cut the plunger for about 2.5 cm/ 1 inch from the tip.
Step 6: Practice placing the cut plunger into the tracheostomy tube (a model but not the one on patient).
Step 7: When you are comfortable doing this, plug the patient's tracheostomy tube in the same manner.
This is not to replace the existing speaking valve of cork, but affordability should not be the reason for not progressing.
Note: This technique was described by an ENT and this is being followed in many places in India.
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