Transtracheal Oxygen Therapy

#1 Dee

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16 October 2007 - 11:07 AM

What is Transtracheal Oxygen Therapy?

There are many of misconceptions about transtracheal oxygen therapy, probably because the word "transtracheal" sounds a bit like "tracheotomy". We would like to reassure you that the two procedures are as different as night and day. The tracheotomy is normally an emergency procedure, whereas transtracheal oxygen therapy is a scheduled procedure involving the support of an entire team that includes you, your family, your doctor, your respiratory therapists, and your home care company, among others. Transtracheal oxygen therapy is a superior method of delivering oxygen directly into the lungs by a small, flexible catheter which passes from the lower neck into the trachea or windpipe. Most patients can have the small catheter installed in 15 to 20 minutes with only local anesthesia and without being hospitalized. The procedure is safe, causes little discomfort, and for many individuals is more effective in getting oxygen into the blood than nasal prongs. More oxygen in the blood means more activity, more energy and better health for most patients.

The best thing about transtracheal oxygen therapy is that it is completely reversible. If for any reason you wish to return to nasal prongs, it is as simple as removing the catheter and putting the prongs back on. The catheter tract closes itself (kind of like an ear piercing if you don't wear earrings) with no additional procedures required. We strongly recommend that you consult with your physician before removing your catheter permanently. After a tract has closed, the only way to restart transtracheal oxygen therapy is to redo the procedure.

The Transtracheal Program extends over a period of about eight weeks. In the course of this program, you will pass through four phases:

Phase I. During this phase you will have an opportunity to learn about the pros and cons of transtracheal oxygen before you decide to go ahead with the procedure to place the catheter. You can visit with the doctors, nurses, and respiratory therapists, as well as patients who have already begun transtracheal oxygen and ask all the questions you want. A history, physical examination and several laboratory tests will be done to determine if transtracheal oxygen can be recommended for you. If your doctor feels you are medically stable your procedure will probably be scheduled as an outpatient. Some people will need to be observed in the hospital overnight, based on physician recommendation.

Phase II. You will need to arrive early on the morning of the procedure. You should arrive with an empty stomach and with an escort to drive you home. After checking in, you will take some medication by mouth to make you feel comfortable and to protect against infection. About an hour later the simple procedure is performed while you are sitting in a chair. Most people have reported that the local anesthetic makes the procedure more comfortable than a common blood gas. After another hour of observation, you will probably be sent home with a small tube in the newly formed tract. Oxygen is not given through the tube which serves to form the tract for the transtracheal oxygen catheter. A mild to moderate tickle cough is normal for the next day or two. You may also have mild to moderate pain around the tube which usually responds to plain Tylenol. Your doctor will give you instructions on your specific medications and what to do for possible problems.

Phase III. About a week after the procedure, you will return and the non-functioning tube will be exchanged for a functioning transtracheal catheter. Oxygen is then connected to the catheter, and the nasal cannula is removed. You will be instructed about proper care of your tract opening, catheter and hose. Learning how to do these things is simple and takes about an hour. Because the tract is still healing (immature), you will clean the catheter in place for the next 5-7 weeks. Your doctor, therapist or nurse may remove the catheter several times to strip mucus away.

Phase IV. After about 6-8 week, your doctor will determine if your tract is fully healed (mature) You will receive instruction on how to remove your catheter for cleaning. There is a great deal of flexibility built in to the SCOOP program of care. Early in phase 4 your doctor will customize a cleaning program that meets your specific cleaning needs. Your SCOOP transtracheal catheters must be replaced every 90 days, and your doctor will need to see you periodically for check-ups.

What are the Benefits and Risks?

As with any other medical procedure, there are both benefits and risks associated with transtracheal oxygen therapy. It is important that you discuss the benefits, risks, and your concerns with your physician or respiratory therapist, they can provide more insights and information relating specifically to your situation than we possibly could here. Remember, this is only a guide. Always follow your doctors instructions and immediately notify your doctor of any concerns or difficulties you may experience.

Potential benefits of transtracheal oxygen therapy include:

Improved Comfort and Convenience: The catheter is usually a great deal more comfortable than nasal prongs. Unlike the nasal cannula, it avoids the irritation of the ears and nose, and doesn't get in the way when you're eating, shaving, putting on makeup, talking on the phone or even kissing

Improved Self Image: Everyone likes to look their best, and sometimes that can be hard to do with a nasal cannula. The small catheter and connecting tube can be easily hidden under your clothing, and eliminates the unsightly nasal cannula from your face.

Lower Oxygen Requirements: Because the transtracheal catheter delivers the oxygen right where it's needed, it reduces resting oxygen requirements in most patients by 50-60%. Transtracheal oxygen allows individuals to use their portable oxygen system more frequently and for longer periods of time. Therefore, the total amount of oxygen consumption may not decrease as much as projected.

Increased Mobility: Lower oxygen requirements allow most most transtracheal oxygen patients to use lighter and more compact oxygen sources. Although smaller, these sources often last longer, allowing more time away from home. Many people also report increased mobility because of better endurance while walking. The ability to be away from home for shopping, socializing with friends, doing errands, or working allows enjoyment of a fuller life.

Greater Exercise Capacity: Since transtracheal oxygen delivery is more efficient, patients that use transtracheal oxygen tend to be more active and usually recover more quickly from activities that require exertion. We don't promise that you'll be able to run the Boston Marathon, but day to day activities involving walking, lifting, moving, even dancing might just become a little easier.

True 24 Hour Per Day Oxygen Therapy: It is difficult for many oxygen patients to wear their nasal prongs every minute of every day because they are so uncomfortable. Transtracheal oxygen therapy eliminates the sore nose, sore ears, sinus problems, dry eyes at night, nasal congestion and runny nose associated with the nasal cannula and makes it possible to receive oxygen 24 hours a day. You may find that getting your oxygen 24 hours a day increases your energy, activity, thought clarity, helps you sleep better and makes you feel much healthier in general.

Improved Sense of Smell, Taste and Appetite: Without the difficulties of the nasal cannula, many patients report an improvement in these areas.

Physiological benefits include:

Reduced Red Blood Cell Count: For some patients with chronically low blood oxygen levels, the body increases the number of red blood cells in an attempt to compensate for the low oxygen levels. The excess of red blood cells causes the blood to get thicker, which places a strain on the heart. Transtracheal oxygen therapy can normalize this situation by delivering oxygen on a 24-hour basis. As the body's oxygen levels increase, it no longer needs those extra red blood cells to transport oxygen, and this decreases red blood cell count, reducing stress on the heart.

Improved Blood Flow Through The Lungs: When blood oxygen levels are chronically low, the small blood vessels in the lungs constrict, making it harder for the heart to pump blood through the lungs. Because transtracheal oxygen therapy provides oxygen on a 24 hour basis, it can raise blood oxygen levels which reduces the constriction effect. This ultimately reduces the workload and stress on the heart.

Improvements in Oxygenation During Sleep: Because the SCOOP catheter is never out of the windpipe, your oxygen will be delivered all night while you sleep. This is unlike the nasal cannula, which can fall out of place at night. Many SCOOP patients report sleeping better on transtracheal oxygen therapy.

Decreased Work of Breathing: Since transtracheal oxygen therapy delivers oxygen directly into the lungs, it bypasses the nose, mouth, and nearly all of the trachea (windpipe) Because it avoids those areas and goes directly to the lungs, many transtracheal oxygen patients experience a reduction in their work of breathing or shortness of breath (the amount of energy that must be used to breathe). This can make a big difference in how mobile and active a patient can be.

Reduced Hospital Days: Several studies have documented reduced hospitalizations when patient hospital days are compared before and after starting transtracheal oxygen therapy. A decrease in hospital costs has also been documented. A study done at a community hospital involving over 160 patients confirmed that transtracheal oxygen patients lived significantly longer (average of 24 months) than clinically similar (age, sex, lung disease, and lung function) nasal cannula patients. This is probably due to the fact that patients are truly getting their oxygen 24 hours per day, and better oxygenation is beneficial to the other organ systems of the body such as the heart, kidneys, liver, and brain.

Potential Risks include:
Some of the minor side effects of transtracheal oxygen therapy are normal and really aren't complications. It is normal, for example, to have some discomfort around the tract and coughing after the transtracheal procedure. Typically, plain Tylenol and a mild cough suppressant are enough to make you comfortable. Some individuals tend to get collections of mucus on the tip of the catheter for the first two to three weeks after the procedure, which can cause coughing. After your trachea gets used to the catheter, and when you start removing the catheter daily to clean it, mucus collections stop being a problem. Anyone who takes their catheter out and leaves it out will find the small tract closes very quickly, and the procedure will have to be repeated to create a new tract.

Complications which have been observed but were judged to be uncommon and usually minor or moderate in severity are:

Wheezing triggered by the catheter in asthmatics (bronchospasm)
Bubbles under the skin of the neck (subcutaneous emphysema)
Low grade infection of the cartilage of the windpipe (chondritis)
Small growths of scar tissue around the tract opening (keloids)
Complications which have not been observed to date but which are theoretically possible include:

Infection of the tract (abscess)
Collapse of a lung (pneumothorax)
Serious bleeding
Lung Failure

#2 eyejustam

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18 October 2007 - 03:20 PM

Hi Dee: Thanks for the great article! I have heard of this proceedure and the device several times and am somewhat interested about it for several reasons but I'm still having troubles (very minor ones) with my nose hose set up. Number one being my lack of patience with stuff. I've only been Dx'ed since early this year and need more time with it I suppose but I often get involved with something and forget about the hose and am soon reminded :unsure: :wub: when I run out of hose. I'll just bet with the scoop I'd learn very soon to behave myself :o . I don't mean to seem flipant regarding this but it kinda makes me nervous. What is your take on the scoop device? I'd like to hear from others about this very important subject. Thanks for your time. John.
"Be not forgetful to entertain strangers, for thereby some have entertained angels unaware" Hebrews 13:2

#3 Tim

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18 October 2007 - 04:04 PM

Hi John,

I'll jump in here.... I don't know a whole lot about this procedure, like you I have heard
alot about it since I was Dx. From what I understand, It seems to work well for people
who require higher settings of o2. It is suppose to be a better delivery method instead
of the standard nose canula. I don't think I would be interested in it at this time but if
my requirements where to go up, I might think about it. I would have to discuess this
with my Dr and find out everything I could about it before I had it done.

#4 eyejustam

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  • Interests:We love to ride our motorcycles. We haven't been able to do that lately due to John being so sick. We used to go camping, hiking, riding in the mountains, take off to the mountains of VA for lunch. Our main interest is each other. Playing with our 4 dogs (don't say dogs too loud they don't know they are dogs!). We have four children 2 boys and 2 girls ages 26, 27, 28, & 29. One grandson, Aiden, who is 3 years old and loves to ride the motorcycle with his Maw Maw. Susan loves to read. We both enjoy a good action movie.

19 October 2007 - 06:56 PM

Hi Tim. Yeh that's about it for me too. I'm on low o2 now so really don't need it at this time. Thanks. John.
"Be not forgetful to entertain strangers, for thereby some have entertained angels unaware" Hebrews 13:2

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