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5. I coughed the PMV off my tracheostomy tube because I had
secretions that needed to be removed and now my tracheostomy tube and/or mouth
have been suctioned and the PMV is put back on my tracheostomy tube. As soon as
the PMV is put back on my tube, I start to cough very hard and cannot seem to
stop and/or the PMV pops off again. What should I do?
Initial placement of the PMV may stimulate a cough due to the reintroduction of
airflow through the upper airway. When airflow is absent, as with an inflated
cuff, there is a tendency for secretions to pool due to the lack of sensation.
When secretions are not felt in the upper airway you may not spontaneously
cough or swallow, therefore the secretions will pool in the airway. Placement
of the PMV redirects air through the upper airway moving secretions upward. A
cough is triggered due to the sensation caused by this movement of secretions.
Coughing will continue until the secretions have settled or have moved into a
position that will allow you to remove them. This is beneficial as you now have
a more effective secretion clearing mechanism in place with PMV use. Usually,
coughing subsides and use of the PMV becomes more comfortable. Keep in mind
that more than one suctioning attempt may be required.
When coughing persists and is not improved by suctioning or if it is
uncomfortable to breathe while using the PMV, remove the PMV immediately and
speak with your doctor regarding possible causes. There could be several causes
affecting your ability to tolerate using the PMV due to persistent coughing and
can include:
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Thick, tenacious secretions that may require more aggressive pulmonary hygiene.
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Changes in your airway that can cause air trapping making it difficult to
breathe easily and stimulate a dry cough. Airway changes may be due to scar
tissue development or narrowing of the airway and should be checked by a
physician.
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The tracheostomy tube is too large or the presence of a cuff on your tube takes
up too much room in your airway. You may want to discuss with your physician
downsizing the tracheostomy tube or changing to a cuffless tube.
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Hypersensitivity that may benefit from medication to desensitize the
airway. Continued >>
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