Long term vented babies

  1. What does everyone do for infants that have a trach and need long term volume ventilation? We have an infant that is 5 months old with severe subglottic stenosis and has to have reconstructive surgery when she is 20 lbs. She's only 11 lbs so far! The family situation is horrible....the mother we have problems day in and day out with, She is not capable of taking her home and our home care services around here have a hard time finding nurses. Who wants to do home care for $18/hour? No thanks. So, we need advice. We don't have a PICU and we'd have to transfer her to SICU. They currently have one of our other babies that we discharged and went home for 7 days and got readmitted. We're not sure they'd be willing to take this one also. The nearest children's home that could take her is Indianapolis or Chicago. I'm not sure her mother would let her go that far. She has milked us for all it's worth.

    Any advice would be greatly appreciated.

    Christine, RNC, BSN
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  2. 5 Comments

  3. by   BittyBabyGrower
    Actually, our parents don't have a choice, the baby gets sent to the nearest children's rehab home. If the baby is stable and doesn't really require much, then they are shipped out. Our PICU wouldn't take this baby. And I don't think that sending kids to the SICU is the best thing either....adult bugs! Why do they bring them back there instead of sending them to a facility for that has peds? I know our SICU nurses would pitch a fit.
  4. by   Sweden
    We actually have a 2,5 years old ventilator dependent patient in our nicu.....
    Not the best place for a child but we dont have anywhere to send her except home and thats proven to be a lengthy process....

    Anna
  5. by   Jolie
    Is there any possibility of foster care for the child?

    We once had a little one approaching his 2nd birthday still vent dependent in the NICU. Sending him home with his parents and homecare wasn't an option, either. Our social worker researched the possibility of a foster placement with homecare, and it looked quite promising.

    We were terribly concened about developmental delays caused by the NICU environment, such as insufficient quiet time, no family-like atmosphere, no opportunity for normal activities such as tub baths, outings, socialization with other toddlers, no where for him to play on the floor, etc.

    Fortunately, his condition began to improve rapidly, and we were able to DC him home before the other option was worked out, but it was one worth researching, in my opinion.
  6. by   Deidre Shiobhan
    Quote from nicumom75
    What does everyone do for infants that have a trach and need long term volume ventilation? We have an infant that is 5 months old with severe subglottic stenosis and has to have reconstructive surgery when she is 20 lbs. She's only 11 lbs so far! The family situation is horrible....the mother we have problems day in and day out with, She is not capable of taking her home and our home care services around here have a hard time finding nurses. Who wants to do home care for $18/hour? No thanks. So, we need advice. We don't have a PICU and we'd have to transfer her to SICU. They currently have one of our other babies that we discharged and went home for 7 days and got readmitted. We're not sure they'd be willing to take this one also. The nearest children's home that could take her is Indianapolis or Chicago. I'm not sure her mother would let her go that far. She has milked us for all it's worth.

    Any advice would be greatly appreciated.

    Christine, RNC, BSN
    We normally don't discharge babies when they still require volume ventilation unless on very low PEEP ( CPAP ) and FIO2 at 25% and below. Kinda weaning off. It's not easy to talk about home care as most parents are not keen. Currently I have a baby whose already with us for 1 year and infact we've just celebrated her 1 yr old birthday in September - currently she's still on CPAP of 5 PEEP but FIO2 of around 30%. We are planning to discharge her soon hopefully by 3rd week of this month , she's trying out the equipment she's suppose to use at home. This plan doesn't come easy it takes us a long time to reach this propose, besides oxygenation she's also on gastronomy feeding. Her mom's currently pregnant with her 3rd child - not easy for her.
    Hope she's able to be discharged successfully.
  7. by   Gompers
    Usually our babies are ready to leave the unit before they're a year old - we've never actually sent one to the PICU, though of course if they come back at some point then that is where they get admitted. If the parents are unwilling or unable to care for the baby at home, we send the baby to a pediatric nursing home. If the baby is actually going home, we get the baby on a laptop vent ASAP and try to find the proper volume ventilation settings needed. We'll send babies home on full vent support, but usaully we prefer less than 30% oxygen and less than 35 breaths per minute. For either type of discharge, the baby MUST be stable on the same vent settings (including Fi02) for 30 days beforehand. So we have a lot of disappointing days when things go back to square one...but on the upside, most of the kids end up doing really well because we're so picky.

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