Your thoughts please!

[SexyLatinPaNurse]

hello all,

just writing to get some advice and opinions..

I am a Sort of new (3 years post grad) LPN I am currently working as a pediatric home care nurse working through an agency.

I was asked by the agency to do a vent/trach training course to which I obliged. The course consisted of playing with a vent (in a classroom) reading a home made booklet with some definitions to vents and some of the set up of the tubing. we were given a post test to which we were given the answers. The class took approx 1 hour.

I was then asked to "train" and observe a vent case for two seperate occassions to which I mainly observed.. and both were done immediately after a full 8 hour shift. The child observed was a vent stable child.

I have only done one vent shift before tonight and don't feel very comfy with the machinery yet, which the agency is aware of.

The 8 month old vent dependent child that I was scheduled to watch this evening is very new to the agency and vents. He is using an LTV950 with a humidified heater and continuous pulse oximetry.His diagnosis is undefined yet. I arrived to my scheduled case and proceeded to do the normal routine of checking settings, vitals etc. The child was asleep and his mom notified me that he had been fine the whole day.

Post assessment I decided to sit and chart my findings. Shortly after the child began to wake and moved a little. I glanced at the monitors and noticed his bpm's were a little high at 33bpm (he is set to 18bpm) and his sats were a little low for him at 95. I put the chart down and went to his bedside. He seemed to be junky and the high pressure alarm sounded so I gloved and suctioned the trach for 10 seconds as ordered. I put the tubing for the vent back on and the low pressure alarm went crazy. I noticed that he wasn't getting any air - even though the machine was working. I quickly assessed the trach which was in place.. i laid the patient completely flat and ambu bagged him while i got the back up vent going.. I noticed that nothing was helping including the ambu bag until the patient was placed on his side. His sats had dropped to the 60's. while on his side they were fine.. but he was having retractions. The back up vent was working and his sats went back to 97 but only when he was on his side. so, I had the parents call 911 at this point and had the responding EMTs take him to the ER.

I realized that I probably panicked but would like to know if there was something else I should have checked.. or done.

I appreciate the advice = thanks!! I was scared to death watching this poor child gasping and knowing that all the "training" I was given was not helping.

[NRSKarenRN, BSN, RN]

one hour to learn about care of the ventilator dependent child is insufficeint without hands on training with experienced nurse guiding you during patient care; trach care, suctioning + ambu use; learning vent setttings, cleaning and assembling vent circuit, battery use in case power failure etc.... observation alone is insufficient.

kudos for recognizing when over your head, turning child to l side often will help maxamize blood return to heart, esp if pe, heart defect, pulmonary congestion, etc. then calling 911 when situation not improved.

these special children often have issues that go undagnosed until they they develop further along.

ton of helpful info: tracheostomy and vent information

[caliotter3]

I think you did a good job. You now know that you are capable of handling an emergency dealing with the trach and vent. You will gain confidence as you gain experience working with vent patients. Although you could use some more training, I doubt the agency is able to provide you with that. I certainly would ask though. My best training came from spending the better part of a shift with a nurse who showed me the ins and outs over more than an hour. Continue to ask the agency for training if you feel you need it.