Sleeping with HMEs (Trach noses) safe?

  1. 0
    I'm new to caring for tracheostomy patients and just started caring for a 4 year old with a trach in her home. We were trained that the patients should never sleep with an HME (heat moisture exchanger), but per mom she sleeps that way every night... What have you all seen with regards to that, whether in a home or hospital setting? The mom looked at me like I was crazy when I told her it wasn't safe for the patient to sleep with it.

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  2. 19 Comments...

  3. 0
    I certainly am no expert, but we only let our NICU babies wear their HMEs for a few hours at a time during the day. Obviously this kid is probably less sensitive, but I would be afraid that she could plug off during the night (very common amongst our NICU grads). We always had our trach pts hooked up to at least a humidifying collar during the nighttime. Now I'm curious...
  4. 0
    Is this pt on the vent?? Every vented pt I have ever had via ETT or trach had a HME attached. I don't work HH or peds so maybe someone has some more information.
  5. 0
    Is she on a pulse oximeter? If so, I don't see where this would be a problem.
  6. 1
    If patient a straight trach, no ventilator, the hme is generally used during wake periods as the replacement for a moist, humidification system. Remember no two patients r the same, thus what may work for one might not for another. Also, in homecare parents often call the shots, sometimes the best u can do is educate with whatever resources r available.
    antania31 likes this.
  7. 1
    I know of several trach/no-vent children and adults that are HME or PMV 24/7. I think in all of those cases, the mist collar is just too moist.

    My son was trach/vent. We used the HME when he was on the "portable" vent (ie. the one not on the stand with the humidifier) during the day and the one with the humidifier when he was in bed.
    bb007rn likes this.
  8. 2
    Yea I have known several trach kids who just drown on the humidifiers. Or they don't keep them on and dry out. So they use HMEs around the clock. I have also seen kids who's spO2 is better on HMEs I'm assuming because of the increased peep. I would have your clinical manager contact ENT or pulm and just get an order that it's ok, or if it's not let them slogg it out with the parents. In the mean time I don't think it's so far off the wall as to cause a great stir. The child has done well with the HMEs overnight for some time I assume. It should be low risk especially since your their to monitor overnight.
    NunyaBizzness and KATRN78 like this.
  9. 0
    I think the big objections to trach collars are the chance of 'drowning' from the condensation in the tubing and the obnoxious amount of heat in the tubing that lays- at some point -across their chest.
  10. 0
    I've had 2 peds trach patients. 1 wore the HME 24/7 with no issue. The other wears it while off the most collar. I will let him sleep with it on for a couple hours if necessary. I supervise of course. He never has an issue.
  11. 0
    I work w a now-2-year-old who stopped w the humidity collar at about age one, purely due to client intolerance. The second you'd try to pop it on as she slept, she'd wake up cranky. She also flipped a lot, so if we'd get it on during deep sleep, it would be tugged at soon enough and that would also wake her. So she uses an HME and also they run a room humidifier full blast. Not ideal but she does have the POX on continuously and she's not overly moist or dry anyway, so in her case it's not much of a problem.

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