The use of a short-length transtracheal oxygen catheter in patients of small stature with restrictive lung disease.

Transtracheal oxygen therapy is being used with increasing frequency because it is an effective mode of oxygen delivery and is well tolerated by patients. An increase in cough and mild intermittent hemoptysis are not uncommon in the early postinsertion period but usually resolve spontaneously. Herein we present two individuals of short stature with restrictive lung disease who had persistence of excessive cough and mild hemoptysis after insertion of a standard catheter (SCOOP). Bronchoscopic evaluation in one revealed erosions of the mucosa over the carina and take-off of the right main-stem bronchus. Symptoms resolved in both individuals following placement of a shorter catheter. We suggest that greater consideration be given to matching transtracheal catheter length to patient lung size, particularly in the face of severe restrictive lung disease.

Nasal cannula and transtracheal oxygen delivery. A comparison of patient response after 6 months of each technique.

The purpose of this study was to compare the efficacy of transtracheal (TT) oxygen delivery to that of nasal cannula delivery in subjects with chronic obstructive pulmonary disease (COPD). Twenty subjects (14 men, 6 women) were followed for 6 months during nasal cannula delivery. A TT catheter was then inserted, and measurements were repeated during TT use. With TT delivery, subjects required 45% less oxygen at rest and 39% less during exercise (p less than 0.0001). Oxygen use, measured by pounds of oxygen delivered to the home, also decreased, but the magnitude of change was less than anticipated (mean, 14%; range, +4% to -32%). Hospital days decreased from 12 +/- 10 during nasal cannula use to 4 +/- 6 during TT use (p less than 0.002). Exercise tolerance, as measured by a 12-min walk distance, was greater during TT use (p less than 0.0001). No change was seen in spirometry or acid-base balance. Also, no change was seen in Profile of Mood States, Sickness Impact Profile or Katz Adjustment Scale scores. Some problems were encountered relating to use of the catheter (displacement, mucus balls), but they were minor, and most were confined to the initial 2 months of TT use when the tract was immature. Our experience suggests that, in addition to decreasing oxygen flow rate, use of TT delivery may confer benefits that result in improved exercise tolerance and decreased hospitalization in patients with COPD.

Transtracheal delivery of oxygen: efficacy and safety for long-term continuous therapy.

Transtracheal (TT) oxygen delivery involves administration of oxygen percutaneously through a catheter inserted in the suprasternal trachea. Transtracheal oxygen delivery has been proposed as a means of overcoming the high visibility, inconvenience, and discomfort associated with nasal cannula use. This report describes our experience using TT delivery in 40 patients with chronic obstructive pulmonary disease (n = 32) and other types of lung disease (n = 8). Overall acceptance of TT catheter use was high and only 5 subjects elected to discontinue use. We believe the TT route is a relatively safe approach for oxygen administration and a promising method of improving patient compliance. It also offers the potential of more adequately oxygenating patients with refractory hypoxemia.

Exercise tolerance during nasal cannula and transtracheal oxygen delivery.

Previous studies have reported that exercise tolerance improves with transtracheal oxygen delivery. However, patients were not blinded to the delivery technique used, introducing a potential source of bias. The purpose of this study was to compare exercise tolerance during nasal cannula and transtracheal delivery using a randomized double-blinded technique. Subjects (n = 11) performed 12-min walks on the same day while receiving nasal cannula and transtracheal delivery. Nine of 11 subjects walked farther with transtracheal delivery, a significant increase (p less than 0.01). Mean increase in walk distance was 95 +/- 86 feet. In addition, a trend was seen toward greater improvement in walk distance with greater flows through the catheter (r = 0.58, p less than 0.06). Time into the walk when desaturation (SaO2 less than 90%) first occurred was not significantly different. We conclude that exercise tolerance improves when oxygen is delivered by transtracheal catheter. This improvement is unrelated to an increase in SaO2. We speculate that the increase in exercise tolerance may be related to other physiologic effects of flow through the catheter.

Smoking and attitudes toward smoking among clinical nurse specialists, critical care nurses, and medical-surgical nurses.

This study surveyed pulmonary clinical nurse specialists, oncology clinical nurse specialists, critical care nurses, and medical-surgical nurses to assess smoking prevalence, attitudes toward the educator and exemplar role, and reasons for smoking. Of the 120 questionnaires distributed, 114 (95%) were returned. Of the oncology clinical nurse specialists, 23.1% were former smokers and none reported currently smoking. Prevalence of smoking among the remaining groups was 28.5% for pulmonary clinical nurse specialists, 30% for medical-surgical nurses, and 46.7% for critical care nurses. More than 70% of respondents agreed with statements about the nurse as educator and exemplar (role model) in smoking cessation. This study provides evidence of a lower prevalence of cigarette smoking among nurses prepared as oncology clinical specialists and greater support for the educator and exemplar role than previously reported.

Interpreting your patient's oxygenation status.

Interpretation and comparison of arterial blood gases and oximetry readings provide data quickly about a patient's oxygenation status. Factors that alter normal values or interfere with accuracy of readings must be considered. The nurse can use this information to assess the patient's respiratory needs and make appropriate changes in the plan of care.

Using arterial blood gases to interpret acid-base balance.

Arterial blood gas (ABG) interpretation can be a source of concern. However with use of the review and principles discussed in this article, the nurse's role in blood gas interpretation can become much easier.