Physicians advised patients to reuse supplies for as long as possible. “We told parents, ‘Don’t throw away any trach tubes until you’ve gotten a replacement. Keep cleaning them as you’ve been taught to clean them, according to manufacturers’ instructions,” said Romaine Johnson, MD, MPH, professor in the department of otolaryngology–head and neck surgery and director of quality and safety for the Department of Otolaryngology at UT Southwestern Medical Center in Dallas.
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November 2022As the pandemic continued, COVID- 19 patients who’d had tracheostomies placed during hospitalization were discharged into the community, sometimes with little support.
“In some cases, ENT teams weren’t even consulted,” said Jonathan Bock, MD, an assistant professor, division of laryngology and professional voice in the department of otolaryngology and communication sciences at the Medical College of Wisconsin in Milwaukee. “The trachs had been done by the pulmonary team or trauma surgery, and patients were sent home without a supply hookup or follow-up for trach care.”
With no system in place to prioritize silicone for medical needs over other usages, manufacturers can still produce only a fraction of the needed tracheostomy supplies. Adding to the crisis is the 2021 recall of Philips Respironics ventilators. Although the company initially planned to complete the repair and replacement program by December 2022, a more recent report said they expect to complete “around 90%” of the production and shipment to consumers in 2022.
Real-World Impact
Kimberly Holmes didn’t know there was a pervasive shortage of tracheostomy supplies until a few months after her medically complex daughter underwent a tracheotomy in January 2022. The Shiley trach her daughter received in the hospital “rubbed her chin raw,” Holmes said, and the ventilator circuit kept popping off. When she reported these difficulties to her daughter’s pulmonary/ otolaryngology team, they ordered a custom Bivona trach for her.
Months passed. Holmes looked online and connected with another mom whose child’s trach tubes were the exact diameter Holmes’ daughter needed. The mom had a few extras and sent them to Holmes. The tubes were too long, but with few other options, Holmes “carefully snipped them down to the appropriate length” and began using them.
Her daughter’s custom trach arrived six months after it was ordered.
“Just the one,” Holmes said. “No backup trach to change it out and no emergency size down trach either.” The family is currently getting only half of the suction canisters they’re allotted and washing and reusing trach tubes well past the manufacturer’s recommendations.