Quick Answer
Yes, it is possible to go home with a tracheostomy and ventilator with proper planning and support. The key requirements are having a stable airway and ventilation, ability to operate the ventilator, a caregiver trained to manage the tracheostomy and ventilator, an environment prepared for medical equipment, and support from a home care agency or care team. With the right conditions met, many patients are able to return home and resume daily activities with a tracheostomy and ventilator.
What is a Tracheostomy?
A tracheostomy is a surgical procedure to create an opening in the neck that goes directly into the trachea (windpipe) through a stoma. A tube is inserted through the opening to allow air to enter the lungs (1).
Reasons for needing a tracheostomy include:
- Bypass an obstruction in the upper airway
- Deliver oxygen when a person can’t breathe normally after an injury or illness
- Provide long-term mechanical ventilation
- Remove secretions from the airway
With a tracheostomy, air no longer passes through the nose or mouth to the trachea. The tracheostomy tube stays in place to maintain the airway and make suctioning secretions easier (2).
What is Mechanical Ventilation?
Mechanical ventilation is used to help a person breathe when they are unable to adequately breathe on their own. A machine called a ventilator (or respirator) pushes air into and out of the lungs through a tube inserted into the trachea, often via a tracheostomy (3).
Reasons someone may need mechanical ventilation include:
- Respiratory failure
- Chronic obstructive pulmonary disease (COPD)
- Lung diseases like pneumonia or pulmonary fibrosis
- Spinal cord injury
- Brain injury
- Drug overdose
- General anesthesia and sedation for surgery
The ventilator can fully take over breathing or just assist the work of breathing if the patient has some respiratory drive. Oxygen levels, breathing rate, and pressure can be adjusted based on the patient’s needs.
Requirements for Going Home with Tracheostomy and Ventilator
For a patient to be able to go home with a tracheostomy and ventilator, several important criteria need to be met:
Stable Airway and Ventilation
The tracheostomy tube type and position should be optimal for the individual patient’s needs. Ventilator settings need to be properly adjusted for the patient to be stable without complications. Going home is not recommended if the patient has frequent emergency airway interventions or ventilator setting adjustments.
Ability to Operate Ventilator
The patient, caregivers, or both need to demonstrate competency in operating the ventilator correctly and troubleshooting minor problems. This includes tasks like turning the device on and off, setting the proper controls, monitoring oxygen levels, clearing secretions, changing tracheostomy ties, replacing equipment, and identifying equipment malfunctions.
Trained Caregiver
The patient must have at least one caregiver, but ideally multiple people, trained to manage all aspects of the tracheostomy and ventilator. Caregivers include family, friends, or hired healthcare workers who can perform needed skills, are available 24/7, and can get help in an emergency.
Prepared Home Environment
The home needs electrical outlets, generator backup, space for supplies, and environmental adjustments for the medical equipment. Temperature and humidity should be controlled for proper device function. Safety issues like falling risks or home oxygen rules must also be addressed.
Home Care Support System
A home care agency should be selected to provide nursing, respiratory therapy, equipment and supplies, and emergency assistance. Having a coordinated care team improves the chances of a successful home transition.
Back-up Arrangements
Plans should be made in case the primary caregiver is unavailable or equipment fails, including back-up power, extra tracheostomy tubes, emergency generator, and nearby acute care facilities that can provide ventilation support if needed.
Financial Coverage
The patient must have insurance, Medicare/Medicaid, or personal funds to cover the costs of home care, medical supplies and equipment. This should be confirmed before the patient is discharged home.
The Tracheostomy and Ventilator Home Transition Process
Preparing to go home with a tracheostomy and ventilator involves careful coordination and planning between the patient, family, and healthcare providers. Key steps include:
Assessing Readiness
The care team determines if the patient can breathe adequately on the ventilator, is free of infection, and meets other medical criteria for discharge readiness. Mental capacity, caregiver availability, and home environment are evaluated.
Selecting Durable Medical Equipment (DME)
The necessary ventilator, tracheostomy supplies, and oxygen equipment are ordered from a DME provider to be delivered and set up at home.
Caregiver Education
Nurses, respiratory therapists, and other staff provide extensive education and training to caregivers on tracheostomy care, operation of the ventilator and suction machine, how to handle emergencies and equipment alarms, CPR, and creating a care schedule.
Coordinating Home Care Services
A home health agency is contacted to arrange skilled nursing, therapy, medical social work, and aide services to assist with the transition home and ongoing care needs. Supply shipments are coordinated.
Planning Follow-Up
Follow-up appointments are made with doctors overseeing care. Lab work and imaging may be ordered to monitor progress. The care team remains available for questions and troubleshooting.
Addressing Financial Needs
Social workers and financial counselors assist in obtaining insurance approvals, filing claims, and finding resources to cover expenses not paid for by insurance.
Pre-Discharge Check
A team meets with the patient and family at home to inspect the set-up, test equipment, review the care plan, simulate care routines, identify issues, and provide more training. Safety steps like removing rugs or cords are addressed.
Transporting the Patient
When cleared for discharge, the patient is transported home by medical transport with proper equipment and monitoring. Supplemental portable oxygen tanks may be used.
Daily Life with a Tracheostomy and Ventilator
Caring for a tracheostomy and ventilator machine is a major commitment that impacts almost every aspect of daily life. Key considerations include:
Equipment Needs
All the necessary supplies must be regularly restocked, including trach tubes, ties, humidifier, suction catheters, sterile gloves, saline, dressings, ventilator circuits, and batteries. The home will contain a ventilator, power supply equipment, suction machine, oxygen concentrator or tanks, nebulizer, pulse oximeter, cough assist device, and other items depending on the situation.
Cleaning and Maintenance
Equipment must be kept clean according to the manufacturer’s instructions to prevent infection. Routine maintenance like replacing ventilator filters is essential for proper functioning. Air filters and humidity need monitoring to avoid particle buildup that could damage lungs.
Power Sources
A backup power source like a generator or battery packs is imperative in case of electrical outage since the ventilator must run continuously. Alarms notify caregivers if wall power is lost. Oxygen tanks can provide several hours of portable oxygen when away from a power source.
Care Schedules
Daily and weekly care schedules are created with tasks such as tracheostomy tube changes, ventilator setting checks, ventilation circuit changes, oxygen tank replacements, hygiene, positioning, and monitoring vital signs.
Emergency Plan
Clear emergency instructions must be posted with numbers to reach health providers, trach/vent information, power outage instructions, and procedures if the tracheostomy tube comes out or is blocked.
Infection Control
Diligent handwashing, surface cleaning, sterile techniques, and avoidance of ill contacts are crucial to prevent respiratory infections. Tracheostomy dressings and humidifier water must be changed per protocol.
Communication
Special devices, techniques, or aids may be needed since talking is difficult with a tracheostomy. Mouthing words, writing messages, text-to-speech apps, or talking valves can assist communication.
Comfort and Safety
Neck comfort, securing the tracheostomy properly, repositioning, oral care, and suctioning are key for patient wellbeing. The home needs safety steps like no area rugs, raised cords, and handicap-accessible features.
Psychosocial Support
Adjusting physically and emotionally to needing a tracheostomy and ventilator takes time for both patients and family. Counseling, support groups, depression screening, and social services can help with challenges, grief, and isolation.
Mobility
Portable ventilators and oxygen setups allow leaving home for doctor visits, errands, or excursions. Travel planning considers power options, bringing necessary equipment and supplies, and accounting for risks.
Cost Considerations
Even with insurance coverage, significant out-of-pocket expenses may arise for copays, lost work time, home modifications, special transportation, and other needs not covered by insurance. Identifying financial assistance early on is important.
Quality of Life with Home Mechanical Ventilation
Studies on home mechanical ventilation have found (4):
- At least 50% of patients dependent on ventilators can survive for months to years at home.
- Younger patients are most likely to transition to the home setting.
- Neuromuscular disorders have better outcomes compared to lung disease.
- In one study, trach vent users reported fair to good quality of life after 12 months at home.
- Depression scores improve after going home compared to prolonged hospitalization.
- Caregiver burnout is a risk requiring adequate family support and respite care.
With proper preparation and support, home mechanical ventilation allows many patients to enjoy greater independence, engage in community activities, avoid long healthcare facility stays, and improve their overall wellbeing.
Conclusion
Returning home with a tracheostomy and ventilator support is an achievable goal for many patients through careful planning and coordination. The key elements for success include having a stable airway and appropriate ventilator management, competent caregivers, necessary medical equipment and supplies, a home environment adapted for the equipment, ongoing skilled care through a home health agency, and backup systems for emergencies.
While requiring major adjustments to daily life, a tracheostomy and home ventilator do not preclude enjoying time with family, participating in community affairs, attending school or work, traveling, and finding purpose and meaning in life. With dedication from healthcare providers, caregivers, and patients, mechanical ventilation and tracheostomy care can often be managed safely and comfortably at home.