Race for the 3.5

Never has a trach change been so dang stressful!

After the fiasco a couple of days ago when she decannulated herself and turned hypoxic and blue, we have been on a race to replace the smaller 3.0-sized trach with her normal 3.5 size.  Even though it may not seem like a huge difference, it really turns out to be.  The 3.0, because it is smaller, plugs more easily which is not great when you have a gooky girl!  Even the suction catheter seems to be tight towards the end of the trach.

We failed at our first attempt that first night as you recall:  “After we returned home from the pediatrician, we decided that since Hannah was calmed down that we try switching out the 3.0 backup for her regular size 3.5 trach.  Not a good idea.   Once we pulled the 3.5 out, she started screaming, crying, and breath-holding again.  Daddy then couldn’t get the 3.0 back in either.  Finally, I tried and was able to get it in.  Again, blood-tinged secretions blowing out of a trach is a very welcome thing after an event like that.”

We knew we were running out of time because her stoma (hole) was starting to close up around the 3.0, as if that was her new permanent size.

Last night, we decided to try again.  Really, we had no choice.

Taking out her trach was no issue at all.  But as soon as Daddy attempted to put the 3.5 in, Hannah immediately clenched up and had a breath-holding spell.  We saw some blood coming out of her stoma again (not enough to make us worried but enough to know her sore throat was scraped).  Back went the 3.0 in again.

We tried singing to Hannah as he made the second attempt.  But yet again, same exact thing.  Back to the 3.0, and we let her calm down for a few minutes.

Even though we knew she was upset and uncomfortable, we had to try again.   The third attempt failed, but it was different because we were able to keep Hannah completely calm while Daddy was trying to get the 3.5 in.   Picture Mommy and Daddy singing Elmo songs in a fun and lighthearted voice while internally freaking out because we need to get this trach changed out.

Because she was not freaking out on this third attempt and completely calm (and even smiling), we were able to slow down and really assess what the problem was.   She was breathing normally through her nose and mouth at this point, even though the stoma was closed.  We cleaned off the blood and extra water-based lube that was around her stoma and got ready to try again.

With Elmo songs being sung to a completely calm and smiling Hannah, the fourth attempt was a success!  The 3.5 is now back in, and I can’t tell you how relieved we were to see it slip in.

It seems that the third attempt was the key because it gave us a chance to try and get the stoma to stretch just a bit more so the bigger size could get back in.

Bottom line: Tantrum and breath-holding spell, can’t breath without trach.  Just being Hannah, can breathe without trach.

Bottom, bottom line: I don’t think this trach is ever going to come out…by our choice.  The risk versus rewards are definitely starting to tilt at this point, and this last few days really opened our eyes up to this.

Maybe this trach was a blessing in disguise?  (Did I just say that?)  As much of a pain in the butt that it is (and believe me, it is), it has kept her out of the E.R. because of her breath-holding spells and hypoxia spells (remember, we had 2 ER visits before the big one in May).