Tuesday, August 28, 2007

Doc Visit Report!

Peggy had a telemed doctor visit with Dr. Davis today. She wore her new crab hat and bubble eye shades from Pat Gamble. Her main concern was the cuff. She told Dr. Davis that she thinks that she is losing up to 1cc/day. Dr. Davis, however, still feels strongly that this is normal and not something that is worth the risk of a trach change. He talked with her again about tracheal malasia and said that some leakage is normal.

Dr. Davis stressed again that we should avoid manipulating the cuff as much as possible since this could compromise the integrity of the balloon. There is even the possiblity of the balloon bursting. Peggy asked what we should due in that situation and Dr. Davis said that we could up her tidal volume to 1000 and of course call Respiratory and HCA. Now, we know that not everyone would know how to up the tidal volume...Catherine is finding out more about this. Also remember that in this scenario, Peggy should be yankaured continuously so as to avoid aspirating. But, let's just avoid this by touching the cuff as little as possible.

Remember, the best solution is not to put more in, but to adjust Peggy's position since this is mostly a positional issue. In fact, today when Catherine checked the cuff she found 17ccs! And the last time she did a 48 hour check she found 15ccs. This means that the leak is not significant and that most likely a lot of the problem occurs when the air is taken out and put back in by different people.

I know that this whole cuff thing is troubling to Peggy (and therefore all of us!) and I feel so bad that there isn't much of a solution for her discomfort. The best we can do is to help Peggy be as comfortable as possible by adjusting the trach. You guys are all doing a great job.

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