TRANSTRACHEAL OXYGEN
THERAPY: PHASE IV
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MANUAL
SECTION
POLICY CODE
and NUMBER
Care of The Patient
Treatment
TX-273
PURPOSE:
To establish guidelines for Phase IV of the Trantracheal Oxygen Program: Transtracheal Oxygen with a Mature
Tract.
SUPPLIES NEEDED:
Two SCOOP – 1 catheters or Two SCOOP – 2 catheters, SCOOP oxygen hose, wire guide, 1% Lidocaine,
Chlorhexidine, facial tissues, water soluble lubricant, nasal prongs and oximeter.
GENERAL COMMENTS:
Phase IV begins six to eight weeks after the transtracheal procedure. A mature tract is fully lined with squamous
epithelium which grows inward from the skin and respiratory epithelium which grows outward from the trachea.
PHASE IV PROCEDURE:
FIRST VISIT
PERSON:
ACTION:
Respiratory Therapist
1.
Interview patient regarding any changes in cough,
sputum, mucus balls, dyspnea, wheezing, or any tract
problems. Discuss the patient’s activity level using the
SAL Score, appetite, sleep and anxiety level. Review
current medications and discuss need for any refills.
2.
Obtain vital signs, body weight, and check resting
oxygen saturation per oximetry. Assess pedal edema,
body weight auscultate breath sounds.
3. Evaluate tract opening for any erythema, granulation
tissue, or induration.
4. Check proper fitting of security necklace: two fingers
should fit comfortably up against the patient’s neck.
5. Place nasal prongs at the appropriate flow rate on the
patient arriving from behind.
6. Prepare new SCOOP catheter by placing a small
amount of water-soluble jelly on catheter tip and thread
patient’s necklace through the flange.
Note: Patients with resting flow rates of 2L/min or less
should continue with the SCOOP-1 catheter and
patients with resting flow rates of greater than 2L/min
may begin use of SCOOP-2 catheter.
TRANSTRACHEAL OXYGEN
THERAPY: PHASE IV
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7. Give the patient facial tissues and warn of incipient
cough.
8. Inject 2 ccs of 1% plain Lidocaine into SCOOP catheter
and remove the SCOOP-1 catheter assessing tract
maturity during removal.
9. Insert the new SCOOP catheter. If the catheter slips
easily into place, the tract is mature and the patient can
be advanced to Phase IV. If the therapist has any
difficulty inserting the catheter, the patient will remain
in Phase III for two more weeks.
Note: Questionable tract maturity may be one of the
follow: 1.) a ”gritty” sensation when removing or
inserting the new catheter, 2.) difficulty with the outside
hole not lining up with the inside hole, 3.) catheter
insertion requiring a wire guide.
10. If the patient’s tract is immature, follow the
instructions below:
a. Re-insert the SCOOP-1 catheter and have the
patient continue cleaning for two more weeks.
b. Have the patient return in one week for catheter
stripping if previous problem with mucus balls.
c. Make appointment for patient to return in two
weeks for Phase IV evaluation.
11. If patient can proceed to Phase IV, proceed as follows:
a. Titrate oxygen flow rate by oximetry at rest and
obtain arterial blood gas to confirm adequate
oxygenation and gas exchange. Check hematocrit
level.
b. Perform exercise oximetry to determine
appropriate oxygen flow rates during exertion.
c. Have patient view the removal for cleaning
segment in the SCOOP Patient Education and
Training Video.
d. Have the patient demonstrate the removal for
cleaning sequence using a second catheter.
Note: Some tips to help the patient on catheter
changing are listed below:
1. Have the patient hold the catheter at the tip within
the last inch so that it gives the patient more
control during insertion.
2. Instruct the patient to insert the catheter straight
back, not at an angle. It may help to have the
TRANSTRACHEAL OXYGEN
THERAPY: PHASE IV
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patient twirl the catheter during insertion.
3. If the patient starts to cough during insertion,
instruct him/her that this is normal, and to
continue advancing the catheter.
4. If necessary, instruct the patient’s significant other
to insert the catheter.
e. If necessary, instruct the patient to only remove the
catheter for cleaning at 8:00 a.m. the first week
and to clean in place for the second regular
cleaning at 4:00 p.m.
Note: Instruct the patient to clean in place over the
weekend.
f. Review the Ten SCOOP Rules with the patient and
Phase IV instructions in the Patient Workbook
and Guide.
g. Make an appointment for the patient to return in
one week.
h. Instruct the patient to call the physician with any
questions or problems. Instruct the patient to see
the respiratory therapist or physician immediately
if unable to reinsert the catheter within five
minutes.
Note: Make sure the patient knows to put on nasal
prongs at the prescribed nasal flow rate if unable to
reinsert the catheter. If the tract is declared
immature, the patient returns to cleaning in place for
two more weeks.
i. Document all data in the SCOOP Transtracheal
Patient Chart.
PHASE IV PROCEDURE: SECOND VISIT
PERSON:
ACTION:
Respiratory Therapist
1. Interview patient regarding any changes in cough,
sputum, mucus balls, dyspnea, wheezing, or any
problems with catheter removal or reinsertion.
2. Auscultate breath sounds, check vital signs, and
evaluate tract opening for any erythema, granulation
tissue, or induration. Check proper fitting of security
necklace.
3. Confirm adequacy of oxygenation by oximetry. If
significantly different from last visit, retitrate at rest
and with exertion.
4. Supervise catheter removal, cleaning, and re-insertion
by the patient. If no problems, advance patient to BID
TRANSTRACHEAL OXYGEN
THERAPY: PHASE IV
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removal for cleaning.
Note: BID removal for cleaning should always be
done at 8:00 a.m. and 4:00 p.m. Cleaning in excess of
BID should always be done using an in place method.
Excessive removal and reinsertion may traumatize the
tract and result in tenderness or chondritis.
(Respiratory Therapist)
5. Review the Ten SCOOP Rules with the patient and
Phase IV instruction in the Patient Workbook and
Guide.
6. Instruct the patient to call with any questions or
problems.
7. Schedule the patient to return for a Health
Maintenance Visit and new supplies in ninety (90)
days.
Note: Inform the patient that the HMV is optional
and that supplies are available from their home
care provider, but they must be replaced every
ninety (90) days.
8. Document all data in the SCOOP Transtracheal
Patient Chart.
PHASE IV PROCEDURE: SPECIAL CONSIDERATIONS:
GENERAL COMMENTS:
Cleaning protocols can be customized in certain cases depending on a patient’s anxiety level, dexterity, or living
situation. Some options are listed below:
1. Patients may continue to remove the SCOOP catheter once a day and clean in place once a day.
2. Patients may continue to remove the SCOOP catheter three times weekly with BID cleaning in place on other
days, i.e., change the SCOOP catheter on Monday, Wednesday, and Friday.
3. For patients who are very anxious and do not have a problem with mucus, the SCOOP catheter may be removed
and reinserted twice a week, i.e., Tuesday and Friday removal.
4. Patients using the SCOOP-2 catheter must remove their catheter at least once a day due to potential obstruction of
the side ports with mucus.
References:
JC-HAS:
OTHER:
Original Date
01/02/01
Review/Revision Date
04/28/03
 Supersedes all Previous
Approved: _____________________
Date 05/28/03