1. Adam Turigliatto RRT Respiratory Therapy Supervisor Portland VA Medical Center ©AAHCM

2. Receiving the Tracheostomy Introduction to the mechanical ventilator Receiving daily education and hands on training Ordering the proper equipment and supplies Discharging home ©AAHCM

3. What happens after the pt receives the tracheostomy? Pt transitioned from the PACU to ICU Pt is placed on the home ventilator and is monitored in the ICU for complications (first night) RT bedside education starts immediately(family present) Transitioned to the Ward Continue with education both day and noc shift. Education period can last up to 14 days or longer if needed. ©AAHCM

4. Ventilator Education: The family/caregiver is supplied with an introduction to mechanical ventilation packet. Topics include ‣Basic functions and features of the ventilator. ‣Definitions of the controls/alarms. ‣Patient values/baseline. ‣Troubleshooting the ventilator. ©AAHCM

5. RT bedside education(daily tasks) The assigned RT provides daily education that includes: ‣Daily trach care/how to change an inner cannula. ‣How to properly suction both inline and sterile. ‣How to manually ventilate the patient. ‣How to handle an emergency decannulation. ‣How to assess for complications. ‣Educating the family/caregiver on what should be at the bedside at all times. (obturator, manual resuscitation device, spare trach) ‣How to operate/use any other RT equipment (suction, humidification, assisting devices) ‣Family members/caregivers responsible for providing care must complete an overnight competency stay at the hospital. ©AAHCM

6. Home ventilator both primary and back-up(external batteries supplied in-case of a power failure). Family members are encouraged to contact the local power company. Is 02 needed, has a home 02 evaluation been completed. If no 02 is needed it is a safe practice to order a couple of 02 tanks for emergency needs. DME equipment such as sxn, humidification, assisting devices and disposables for the equipment. Daily disposables, such as trach supplies, inner cannulas, suction catheters, etc. Families should be set up with enough quantity to assure daily care can be completed. ©AAHCM

7. This is a multidisciplinary duty. All services should be in constant communication. (Example: who is arranging the travel, the bed, lift, power chair?) Has the DME company completed the home inspections? Have the family members/caregivers successfully completed the training and overnight stay?Any patient safety concerns.If all has been completed RT transports the pt’s first initial DC home (courtesy provided to the pt). ©AAHCM