Pediatric Trach/Vent Issues PLEASE HELP!!!!

[NurseBarbiRN]

Quick rundown... I'm a new nurse working in home care for pediatric patients on the midnight shift. I have a patient who is 8 months old and trach/vent dependent. For the past hour and a half the "Low Min Pressure" alarm has been sounding on the vent. I have checked EVERYTHING, replaced what I can (tubing etc...) and it's STILL going off every minute. Her vitals are WNL for her, if on the low side of normal (O2 sat is 92%, but has been slowly decreasing for the past hour from 95%). I have now transfered her to her portable vent, O2 is up to 96% HR is 111 RR 43 (all her norms). My question(s)...

1. WHAT THE HECK IS GOING ON WITH HER VENT?!?!

2. Is it possible that her trach isn't in the "right" spot? How would I check that?

3. What can I do that I haven't already done to help the little bit? (Throw EVERYTHING at me, I may have ditzed out and not tried it)...

Thanks!

[jadelpn, LPN, EMT-B]

Per TOS we can't give medical advise. But it is probably not the best idea to seek answers in this forum for something that could be critical.

A call directly to your charge nurse, do not pass go--whenever there's an issue, go to the higher authority for guidance.

[Jory, MSN, APRN, CNM]

If you cannot figure out what to do, do what you would do in a hospital...call the on-call respiratory therapist.

There are several reasons why the alarm can be sounding, the worst of which is that the device is not working properly.

EITHER WAY, it needs to be changed out ASAP.

That baby shouldn't be left alone AT ALL with the parents until it is.

[xoemmylouox, ASN, RN]

Those darn vents can make you crazy!!!!! Always call your on call agency staff/nurse and the R/T when there is an issue. Homecare can be nerve wracking sometimes.

[JustBeachyNurse, LPN]

You need assistance that we cannot provide on an anonymous message board. If you cannot troubleshoot the issue based upon your clinical experience and training, you need to do one of the following:

1. Call your on call clinical manager or respiratory therapist as THIS is what they are there for, midnight troubleshooting calls are what they are there for.

2. Call 911 if sats do not improve or your clinical manager cannot troubleshoot over the phone.

If you do not know how to check trach placement then you shouldn't be doing it, please ask for additional in-service training from your agency until you are proficient in handling vent/trach emergencies. Infants and children are NOT small adults, things can go bad VERY quickly. This is why most agencies will not permit new graduate nurses to work in home care, and especially not pediatric high-tech home care with trachs & vents. Most agencies that hire new grads in private duty will only permit new grads to work in basic care (g-tube, medication administration, basic wound care, basic respiratory (monitoring sats, oxygenation, nebulizer treatments, etc.), enteral feeding, etc.)