Pediatric trach size

[doodlebuttRN]

I have a private duty case with a pediatric patient who is vented, with a Bivona #5.0 (Ped) trach. I received report that he was not satting well overnight, and when my shift started he was satting 93-95% on room air; secretions were normal for him. He started crying, his face was red, and I immediately started him on 02 to maintain his sats above 95%. Then I noticed that the trach he had was his stepdown size (4.5). I told the parents, who said that they were already aware of this... so we changed the trach to the ordered size, and immediately he is satting 97-98% on room air. The parents say that it wasn't the trach size. I was very concerned, and I felt like they thought I was being irrational.

How much of a difference does that one-half size change make? I was very surprised that they didn't think it was a big deal. I am hoping that a nurse more knowledgeable than myself can help me out here.

Thanks, all!

[meanmaryjean, DNP, RN]

93-95% sats are not an indication to give supplemental oxygen. And most kids DO turn red in the face when they cry. I agree with the parents here- no indication for oxygen. Changing the trach to the correct size? Sure.

[doodlebuttRN]

My question is whether or not having a half-size smaller trach could cause distress. Because the airway is narrower, he would be having a harder time moving air, right?The parents were adamant that having the wrong size trach had nothing to do with his distress. In this case, supplemental O2 was indicated (and ordered- to maintain Sp02 above 95%) as this patient desats very quickly, especially when he gets upset.

I was just surprised how the parents insisted that there was no way having a too-small trach could have anything to do with his distress.

[meanmaryjean, DNP, RN]

The difference in size is not that great.