Hi there. I start a new job next week that involves a lot of tracheostomies and stable vents. I've never worked with them in pediatrics, and only seen them when working as a tech on an adult pulmonary rehab unit. I figured this would probably be the best place to go for advice as I'm sure vents and trachs are like pie to you PICU nurses by now.
I'm looking forward to this position and am excited to learn how to care for them, but trachs and vents are probably the two things that make me the uneasiest about it as I know the least about them. I know they'll supposedly be stable, but anything can happen. Any tips, tricks, or advice would be greatly appreciated!
Dec 28, '09
by NotReady4PrimeTime, RN Senior Moderator
You really should insist on a trach CPR class, and don't do a trach change alone until you've done several with help. Get in the practice of always securing the new ties before removing the old ones. When suctioning the trach the first few weeks, try holding your breath so that you'll have a sense of passing time. Know the distance from the opening of the connector to the tip of the tube so that you can properly gauge how far to insert the suction catheter... not more than 1/2 to 1 cm past the end otherwise you risk sucking up against the tracheal wall and causing trauma. Remember that babies have no necks and will obstruct their trach if they pop the ventilator circuit off. Since children are more sensitive to desaturation than older people and that's usually the cause of cardiac arrest, it's important to keep an eye on that. Never go anywhere without a spare trach and ties, portable suction and catheters, a self-inflating resus bag and a cell phone.
Ask if you can have a class on vents too. The usual home vent is pretty straight-forward and you can set the alarms as tightly as you're comfortable, but someone should show you how to do it. Find out how to change the battery in the vent, or to ensure that it's adequately charged so that you won't have to worry about it running out of juice when you're out and about. You'll quickly become used to the normal sounds of a properly-functioning vent, so you'll often hear and recognize a change in the sounds it makes before the alarms go off. It won't take you long to be comfortable with your new job. The day that you notice that awake kids need to be suctioned a LOT more often than sleeping kids, you'll be there!
Last edit by NotReady4PrimeTime on Jan 6, '10
I'm off orientation the second week of March. This week I'll be up to 4 patients, the max we're allowed to take. I absolutely love my job. Jan, you couldn't have been more right when you said I'm there when I realize children who are asleep usually need to be suctioned much less frequently than those who are awake! I feel much more comfortable with trachs and vents now, not 100% but I'm not sure I'll ever be. I feel like I can handle an emergency though, and can kick into gear automatically to know what to do whenever I walk in to a disconnected vent or a baby who's color is off. I also have a basic understanding of vent alarms and which require what kind of intervention. I'm challenging myself to know what kind of support each baby is on and making sure they're getting their volumes (most are on pressure control/support). It takes time to remember everything, but I'm getting there. It's not bad for 6 weeks in. I hope as I learn and grow my skills will get stronger. I've seen a lot of really interesting situations and a couple of emergencies in the past month alone which has helped me get a better understanding of how to prepare. My preceptor has given me a strong foundation to build on too. I will never take safety for granted because of her. Every morning always and forever the first thing I'll do is check on the kids and make sure they have a spare trach, ambu bag, suction, catheters, and scissors. I always calculate my meds out the first time and get a witness for narcs/controls even if they don't require one. I've learned it's these little things that take one extra minute but can make all the difference in the world for safety, especially on those crazy days when you're in a hurry. I've also learned to slow down and do one extra med check those days when I am crazy busy, just because the days my mind is going at warp speed are the days a mistake could happen, especially when almost all the meds are multi-dose liquids that we draw up into syringes, and there's no Pyxis or auto med dispense system. I never want to be the nurse that could've prevented harm if she just did those routine safety things. These kids are so fragile and are all one foot out of the NICU/PICU - some should still be in the ICU. It's amazing to see the little gains they make, to see their FiO2 needs decrease even just 5%, to watch them sit up for two seconds before they topple over, for their mist to be extended by a half hour. I really, really love my job!
Last edit by NeoPediRN on Feb 22, '10