First time with trached and vented kids
I have just been hired into Pediatric Respite- which I love- and have wanted this job for a few years since Nursing School practicum there.
Some new developments have a few kids that are trached and vented there regularly.
Help! We are receiving in depth training, but, I am so intimidated!
A few of the nurses said ( I am a LPN) that it takes a year to be comfortable with this.
Thank-you in advance,
Follow Your Bliss
0Jun 15, '12 by Ashley, PICU RNOnce you become familiar with the ventilators and gain some confidence with the kids, I think you'll find these patients much less intimidating than you originally thought. Chronically trached/vented kids are so much more stable than they sound. It's nothing like having an intubated patient, where if the vent becomes disconnected there is no way for the patient to get oxygen. All of these kiddos will probably be breathing at least partially on their own, but require the increased pressures from the ventilator to maintain adequate ventilation. They will be sitting up, playing, moving around, and pulling their own vent tubing. I've even had a 4 year old (tracked from birth) pull his trach out and I didn't even notice right away because he maintained his sats just fine without it. Just remember that these kids are stable enough to be cared for at home, where they are not receiving 24 hour observation and there is limited use of monitoring systems. While it's important to be vigilant in your assessments, these aren't the kinds of kids who are going to spiral into respiratory distress because their vent comes disconnected for a minute or two. Again, once you've cared for a few of them, you'll realize that they aren't really as scary as you thought.
0Jun 15, '12 by nursel56 GuideHi followyourbliss - I confess to being a bit iffy on what "respite care" means as it's not a common US term even though I looked it up. Is it like hospice or is it a place where the parents of chronically ill kids can get some relief?
Anyway, I was a nervous wreck at first working with ventilator patients, too. I see it as a good thing within reason because it is the complacent nurses who can really end up getting bit hard with an unforeseen circumstance. The machines are really amazing and reliable. What I would say is that every child is different, there is a pretty wide variety of trachs out there and some differences in the ventilators themselves, depending on the brand.
When I was oriented to a new patient I would draw a diagram of their trach and vent circuit to study at home, as well as any specific important points relating to that individual case.
Working in private homes we don't have the luxury of RT or rapid response, etc. - I found it helped me feel much more confident if I read the manual that comes with the brand of vent you've got over and over again with frequent reviewing. They are available online as pdf files for the most frequently used models. That way when the machine alarms you'll know what it's telling you and which of the many settings you need to look at first.
It also helps to run "what if" scenarios through your mind with each child such as what if the power goes out? What if there is damage to the tubing? What if everything checks out OK but your child is still desatting? etc. Do you know where all the emergency equipment such as ambu bag or spare trach and tubing so you can quickly switch those things out without wondering where it is. I had a patient who ended up in the ICU because the nurse forgot to bring his portable suction machine on an outing.
Anyway, not sure if this is applicable to your situation or not but best wishes in your new job!Last edit by nursel56 on Jun 15, '12 : Reason: to add something
0Thank-you Nurse156, and Ashley,
In the case of my new job, pediatric respite is medically fragile children with special needs coming for respite ( To a home like facility run by R.N, LPN, and care aids.
We have four at a time, each week a different mix of kids.
As a LPN I have had minimal exposure to trachs- this will be my first!
I agree in regard to the stability, being able to be at home etc; not having quick response team or R.T certainly plays in my mind.
I will certainly read the manuals, and spend the time with the equipment...so much stuff!
This is a very exciting time for me, part of me feels ready for the challenge, the other part of me wants to run!!!
The ventilator learning, readings, and interventions are scary to me, but as you both said it takes time. I suppose when you are new, you think it will all be codes and problems. Apparently the kids set off the alarms ALOT, for various reasons. Great learning is coming my way
Thank-you for taking the time to respond, I really appreciate it.
Keep Me posted,
Follow Your Bliss