[janetrn]

Hello. I'm a nurse with 11yrs of peds experience. I am sitting on a committe to form criteria for what vents may be admitted to the med/surg areas of our hospital. I would love to know if anyone one else has a policy about vents on a peds floor. I would love any written info as well. As it stands now we are admitting trached pts, who are not on CPAP at home, who get sick and place on CPAP/BiPAP. Or CPAP kids to vent with a rate. Do you have CO2 requirements? Amount of supplamental O2 requirements. We are not a step down unit and were originally vent trained to handle chronically vented children. Does anywhere else even take chronic vented children onto their med/surg floors? HELP I want to know what other places are doing and why. It seems as though only 2 of us on the committe are concerned about the rising acuity of our pts. Our hospital is reasonable and any input I could supply about what the standard other hospitals have would be great.

------------------
janetrn

[melliejh]

I am a nurse from the UK and have worked with ventilator dependent children since qualifying in 1996 - not long I know but in my short experience through various counties and health authorities, many general paediatric wards do not want to take children on CPAP or BiPAP unless the child's home care team are willing to care for the child's ventilatory needs. I know some children are not lucky to have a home care team and their parents have to manage on there own. Also hospices are reluctant to take ventilator dependent children also unless the home care team go in. The majority of ventilator dependent remain on PICU until they can be discharged home or go to Transitional Care Unit's.


There are lots of issuses surrounding this topic, if the child has a home care team why do they did admitting to a ward?

Hope this has been helpful in some way!
I do not know if I have helped you here or not?

[janetrn]

melliejh, thanks for the reply. Any info is helpful. I pretty much feel we are the only ones doing this, as one of our docs means well but is an expert on finding a back door to get kids in and is not fond of intensive care. As an FYI alot of our vented kids are in right now for failed home care (ie no homecare nurses to be found) It's the sick ones that scare me, because not all our staff is vent trained so backup is not always as readily availble as you would like. Thnaks again! Janet

[realnursealso/LPN]

Hi Janet, I'm an LPN who does homecare on vent dependent children. The vents that are used in the home are alot less complicated than the typical hospital models. The models we use are LP6's and LP10's. From your post I'm assuming you mean that the children would be on their own vents. The settings are determined by their respiratory drs. In my experience the children who are on vents at home know alot about their own care and needs, plus the families are very involved in the care they recieve. Most of the moms I deal with stay with their children 24/7 when hospitalized. It may not be as difficult to maintain these patients as you thought. Also I feel that your staff could be fully trained without much trouble. I have been caring for vent dependent patients in the home since 1985 and most care is given to these patients by LPN's. Sorry I can't help with your policy writing, but I guess this is just a pep talk from one nurse to another. But if I can be of any assistance just ask. Good luck

[MollyJ]

I am a former peds tech dependent case manager. I cannot think of a time when my vent or bi-pap dependent kids DIDN'T go to the ICU or to the regular peds unit on "ICU status" (in hospitals that don't have peds ICU's) however I wasn't always sure that it was the best use of an ICU bed.

I think you are correct to question this procedure carefully. My trach vent kids were sturdy kids in the face of their fragility but they go in to the hospital specifically because they are de-satting and the "usual" things don't bring up their sats OR they are septic OR something is happening that the usually resilient parents cannot handle OR the _parents are pooped or sick themselves_.

Last time I knew (and this could have changed since I've been out for a couple years), use of bipap on children was a use of the equipment in a non-FDA approved way and was therefore experimental. The alarms have been known to fail. I knew of a home DME that refused to do home bipap on kids on the basis of an incident with a child in a hospital where an alarm had failed to alarm when the kid popped off and the kid died and the hospital was sued. Apparently the child was laying on the hose in such a way that it failed to pressure alarm even though he was popped off. the moral of this story to me is that nothing substitutes for close observation of a child on technology and you and I both know that perhaps in the midst of winter when the unit is overflowing with RSV's and r/o meningitis cases, it might be hard to do close observation on a child like this.

Keep asking your questions. Bring in your best and sharpest peds respiratory therapist and include a doctor on your committee. I cannot say that I have an opinion on what your hospital should decide but I think a main point is that these kids need close observation even though they don't have the moment to moment acuity that some ICU patients have. When they are sick, they can get sick and crash fast as I am sure you appreciate.

I don't think technology of any type--co2 monitors etc--substitutes for the ability to do close observation of the child in the setting of their care. In the very olden and golden days of nursing, ICU's used to adhere to a standard that there needed to be enough personnel around to bag a patient on a ventilator if electricity failed. (ergo nurses weren't supposed to have more than one vent dependent patient at a time and I think that is probably out of the window these days.) This is an old-fashioned standard in many ways but if your unit was full and the lights went out, how could you fulfill that obligation?

Good question and a problem that is only likely to increase in frequency.