Mr. Bill Waters has had the trach for nearly a year due to a stroke that made his right side flaccid. He got to our facility in September 2019 where CRT Steve Browning placed him on an AIRVO for humidity and Oxygen. Mr. Waters was weaned off the Oxygen in 3 days but getting the trach out would not be as easy. Mr Waters was a challenging patient even before he left the hospital pulling out the trach many times and sometimes he would allow trach cleaning and other times not. CRT Steve Browning left to pursue other career opportunities in February 2020 but not before successfully downsizing the trach from a 8id to a 6id and starting him on a passy Muir valve. RRT Allen Williams then assumed care of Mr. Waters, who continued to allow trach cleaning and suction intermittently. The pt began refusing on a more consistent basis in April asserting it with thrown fist and colorful language. Mr. Waters even began to refuse the inner cannula insertion after cleaning. The decision was made from that point to attempt to wean him as soon as possible for his safety and the trach button was used. The pt could not tolerate the trach button so the pt was downsized to a 4id and that very night the pt pulled out the entire trach and was sent to the hospital, then was sent back with a size 8id. this set progress back significantly as we had to wait in supplies to attempt again. But over the course of months the pt was weaned down to a size 6 and then a 4 again with a plug and around the time that he got the size 4 it was discovered that he had a case of pneumonia this delayed decannulation by another week. However, at the same time proved that he could no only handle a plugged size 4 but with pneumonia as well provided that he wore 2L NC. He did not want to wear the NC either but once the pt had it explained to him with some patience he consented. Mr. Waters was decannulated on 8/24/20 proving that he could maintain a high sat on room air and regular Co2. He maintained his usual Stoicism but a smirk here and there betrayed his happiness with the event.
Speech Therapist Kim Peak Will now be working with him to try and get him off tube feedings.