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[Dysphagia] trach button
Not sure I really know the answer to your question. I have not seen any pts
get granulation tissue from an Olympic Button, just heard it can occur. I
have seen many pts with granulation tissue from all sorts of trachs so the
risk may not be any worse with a button (of course I have seen many more
trachs than buttons so you can't go by that either :) From what I have been
told, if the button is sized & placed right granulation tissue should not
occur at all. If the pt does get granulation tissue, well then I don't know
if the button would have to be removed. My guess is that it may depend upon
the severity? Our pts usually get laser surgery for the granulation which
also is not 100% effective. Talk to your more experienced respiratory
therapists and pulmonologists. I'd love to know what they have to say about
it, and I'd love to hear what happens with your patient.
Janet
----- Original Message -----
From: "Balch, Lucy" <Lucy.Balch@hdmc.dmhmrsas.virginia.gov>
To: "'Janet Finger'" <justjanetlynn@msn.com>
Sent: Monday, September 20, 2004 12:32 PM
Subject: RE: [Dysphagia] trach button
> Yes, I do mean the Olympic Button. Thanks for the input about granulation
> tissue. I was wondering if there were any negative effects. If granulation
> tissue forms does the button then have to be discontinued? I'd hate to
> remove his trach tube and place the button, only to have to remove the
> button down the road and possibly go back to the trach tube.
> Lucy Balch
>
> -----Original Message-----
> From: Janet Finger [mailto:justjanetlynn@msn.com]
> Sent: Sunday, September 19, 2004 10:25 PM
> To: dysphagia@b9.com
> Subject: Re: [Dysphagia] trach button
>
> Not sure if you are talking about an Olympic Button? Those are placed in
> the
>
> stoma INSTEAD of a trach. They basically hold the stoma open, usually in
> case it is needed at a later time. The pt can still be suctioned if needed
> but usually these are used on pt's who do not need much if any suctioning.
> Negatives are that some pts end up with granulation tissue. Other
> physicians
>
> express fears that pts will inhale them or cough them out. I have never
> seen
>
> them come out but have heard that can happen if they are not properly
> sized
> & placed. They have been helpful for some of our patients. They do provide
> a
>
> closed system just as if the trach were plugged.
>
>
> ----- Original Message -----
> From: <dysphagiadude@mailcan.com>
> To: "Balch, Lucy" <Lucy.Balch@hdmc.dmhmrsas.virginia.gov>;
> <dysphagia@b9.com>
> Sent: Thursday, September 16, 2004 6:22 PM
> Subject: Re: [Dysphagia] trach button
>
>
> > If the button you're talking about is a cap, it is different from a
> > speech valve like the PMV. The PMV lets air in through the trach, but
> > not out. If the MD/pulmonologist thought the pt no longer needed the
> > trach, s/he probably thought the stoma would heal, but it would be
> > better for you to not count on that. A cap like the one you're talking
> > about would be an MD's call anyway. You could, if the MD gives the OK,
> > occlude the trach tube and watch a pulse ox to see whether there's any
> > change in saturation levels or the patient's comfort level.
> >
> > If the RT thinks the cap is a good idea, my bet is that he's right, but
> > you still need to run it by the MD. Maybe the MD is too busy to have
> > thought of it. Where I work, the ST would just write his request on the
> > physician's order form. If the MD thinks it's a good idea, the nurse
> > gets the OK to document the request as a phone order.
> >
> > Although the PM people have looked into this and published some
> > information on the topic, I haven't seen much other support for the
> > notion that a speech valve improves swallowing skills in trach patients.
> > Good luck!
> >
> > On Thu, 16 Sep 2004 10:38:02 -0400, "Balch, Lucy"
> > <Lucy.Balch@hdmc.dmhmrsas.virginia.gov> said:
> > > Does anyone have any experience with trach buttons? I have an adult MR
> > > pt.
> > > who was given both trach and PEG tubes after a life threatening burn
> > > accident in 4/00. After trials with plugging, his physician
> > > decannulated
> > > him
> > > in Feb '03, but his stoma never closed. Prior to his accident he was
> > > ambulatory and eating regular foods, but he has not eaten or walked
> > > since
> > > the accident (he refuses PT). His swallowing ability was tested a few
> > > months
> > > after decannulation and he proved to have unstable swallowing
> > > (intermittent
> > > choking if his positioning was crooked at all, bolus was too large,
> > > etc),
> > > probably d/t the open stoma/open respiratory system. He was seen by an
> > > ENT
> > > who agreed to surgically close the stoma, but the pt.'s LAR did not
> > > agree
> > > to
> > > the surgery. Mechanical closure with reinsertion of a trach tube with
> > > a
> > > PMV
> > > has stabilized the swallow. However, wondering if a trach button would
> > > work
> > > just as well. The RT where I work suggested it. I have never heard of
> > > one.
> > > Would it close the respiratory system as well as the PMV does? Is it
> > > something that can be maintained easily? The pt. is not yet off the
> > > G-tube,
> > > but that is the goal. He currently eats lunches under supervision of
> > > OT
> > > or
> > > ST, and does well with his PMV (no intermittent choking). I've been
> > > hesitant
> > > to progress him further (more meals) because our nurses are unfamiliar
> > > with
> > > the PMV and much training of staff is needed to keep him safe at
> > > meals.
> > > Perhaps the button could simplify things and get him weaned
> > > faster/safer.
> > >
> > > I'd appreciate any ideas, thoughts, information.
> > >
> > > Thanks,
> > >
> > > L Balch, SLP
> > >
> > > _______________________________________________
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> > > Dysphagia@b9.com
> > > http://lists.b9.com/mailman/listinfo/dysphagia
> > **If you think one person can't make a difference in today's world, just
> > light up a cigar in a crowded restaurant.**
> >
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