CLINICAL PRACTICE GUIDELINE 43 Appendix I: Criteria for Decannulation of Trach Patients The following protocol is a policy/procedure used by Craig Hospital, Englewood, Colorado (undated). Rationale: To establish guidelines and criteria for the decannulation of trach patients. Procedure: I. The physician writes an order for respiratory therapy to evaluate a patient for decannulation. Scope: Respiratory therapists. II. A copy of the criteria is placed in the patient’s chart until completed and then removed and placed in the respiratory department file. III. Each respiratory therapist treating the patient in the following 24-hour period evaluates the patient for decannulation using the following criteria. Policy Statement: The following criteria will be used when evaluating a patient for decannulation. Criteria for Decannulation • Negative sputum culture • Clear CXR • Mobile, out of bed • No pending procedures • Not pressed to extubate • No aspiration problem FVC >15cc/kg ideal body weight Sat’s ≥92% on room air Suctioning ≤ 3 times/day Effective quad cough Afebrile X3 days Stable X24 hours Three shift evaluations by therapists Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No No No No No No NA NA NA NA NA NA NA NA NA NA NA NA NA • Should have 5 of 6 of these. After Extubation: Stretch IPPB 1 week post decannulation with 0.5cc Albuterol x 20mg Cromolyn sodium. Continued meds—Slow taper Patient name: ____________________________________________________________________________________ Injury level: ______________________________________________________________________________________ Date: __________________________________________________________________________________________ Respiratory Therapy: Day shift:________________________________________________________________________________________ Evening shift: ____________________________________________________________________________________ Night shift: ______________________________________________________________________________________