Tracheostomy

Tracheostomy: Providing the Supplemental Oxygen via Tracheostomy

Some patients need supplemental oxygen via their trach. This will add a few more pieces to the setup. In order for oxygen to be added to a patient’s trach, it will first need to be indicated and ordered by a physician. Once the doctor or healthcare provider orders the oxygen, it may be added in a couple of ways. The two most common ways it is added are via nipple adaptor or via a venturi (aka as a venti).

The nipple adaptor is very simplistic. It is a plastic adaptor with a nipple to attach the oxygen. It will be added to the trach mask or somewhere in line and run at whatever liter flow has been ordered by the healthcare provider. There are HME’s that can be purchased that also have a nipple for patients who are using a heat/moisture exchanger and oxygen.

The other common way to add oxygen to a tracheostomy is via a venturi device.

What is a Venturi Device?

A venturi is an oxygen device that gives the patient exactly the amount of oxygen needed and is expressed as a percentage. This device is normally ordered from a hospital or rehab facility where it has been trialed and titrated to the patient’s needs. It is usually added to the trach mask, up close to the patient’s trach. There are two types of venturis that are commonly seen in the hospital and home care settings.

High flow venti devices use different colored adaptors that tell what percentage of oxygen the patient will get and how many liters per minute the oxygen has to flow at in order to achieve the exact amount needed. These can have liter flows as high as 12 liters per minute for patients who need higher oxygen percentages. This is difficult to use in the homecare setting as it may require several oxygen systems (concentrators) put together to achieve these higher liter flows. The low-flow venturi devices can achieve higher oxygen requirements with lower liter flows of oxygen. On these devices, it is imperative that you make sure it is set properly. The highest liter flow on this device is 6 liter per minute, which makes it more practical for home use.

Tips to keep in mind while using Venturi Device

• When using a venturi device on an oxygen concentrator, you may see the liter flow indicator (the ball) bounce up and down and not remain on the liter flow you set. This is caused by the backpressure from the device. To make sure that the oxygen is still set at the proper liter flow, remove the oxygen tubing from the concentrator and set the ball at proper liter flow. When in doubt, remove the tubing to see where the flow meter is set.
• If a patient is able to “close” their trach up, they can employ a standard nasal cannula for oxygen. In order to close the trach up by covering it with the red cap, you will need to have a physician’s order to “close” the trach and when and under what conditions (ie: daytime)
• You cannot use a humidifier on the concentrator with a venturi device. A venturi has a specific humidification setup.
• Oxygen is a prescription. An order will be needed by your physician to dispense.
• Change your oxygen disposables weekly to keep bacteria-free and in working condition.