Home Vent Training for Parents

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I posted this previously and it looked like I was asking for research participants. I am not. I am just wondering how it is done at various hospitals.

I'm actually just curious who trains parents to take their newly vent-dependent child home in your facility. And this: When a home vent kid is admitted, do they necessarily go to PICU, or can they go to the floor in your hospital?

In our facility, RT and the vendor do most of the actual trach/ suctioning/ vent training. Nurses do the meds and feedings. And no matter how stable they are, ALL home vent kids come to the PICU, no matter what. So we have a kid for heel cord lengthening, or a circ, for example, admitted to a critical care bed.

I'm JUST curious- that's all- to see how it's done elsewhere.

Thanks!

umcRN, BSN, RN

867 Posts

Has 4 years experience.

This is a huge issue in my unit.

First home vent kids ALWAYS go to ICU, either NICU/PICU/CICU depending on the age/history

For new trachs parents get one 2 hour teaching session with our trach specialist. All other trach teaching is left to the nurse, which if you are having a slow day, great, if the kid is nearing discharge and you have another crashing or busy patient, too bad.

Parents get one (maybe 2? I don't know) session with the vent vendor. They do that teaching. Here's the problem. Nursing is not trained on home vents so we can't answer parents questions on them. Respiratory obviously can but they have up to 10-12 patients and don't always have the time to spend a lot of time with parents.

It used to be that most of our kids went to a rehab facility before going home so nursing didn't have to be that involved in it. Now though more and more parents want to take their kids straight home, which I support but it's very difficult for teaching and many bounce back pretty quick.

Learning in an ICU is also not realistic. Ok so the parents can suction, change the trach and ambu bag the kid. But can they get their child, ventilator, oxygen and feeding pump to another room? Not likely because it's not something we do in the ICU and not something people think of to teach parents. We are currently in process of working on a better system. But what we really need is a step down/rehab unit for this kind of thing. There is a huge difference between an ICU-oriented nurse and a rehab-oriented nurse

NotReady4PrimeTime, RN

16 Articles; 7,358 Posts

Specializes in NICU, PICU, PCVICU and peds oncology. Has 25 years experience.

We're pretty lucky in that we have a trach-vent stepdown unit; kids have to have been successfully transitioned to a home vent such and the LTV before they can go upstairs. Virtually all the teaching related to the trach and vent is provided by our RRTs and the long-term ventilation NP, usually after the kid leaves the PICU. Med admin and feeding is taught by the RNs or LPNs on the ward. Not to say our system is all that perfect... the kids tend to sit on the ward for months to years before appropriate community supports are in place so that the kid can go home. Which means they're blocking a non-PICU trach bed. Typically the only time a trached patient is readmitted to the PICU is if they need more support than their home vent can provide, if they need isolation and there are no isolation beds open on the ward (basically any kid who is "symptomatic" - coughing with or without snot - [therefore just about ALL of them] needs isolation according to our infection control gang)... or if the anaesthetist decannulates them in the OR and intubates them instead. For some reason they really don't like ventilating patients in the OR via trach.

anon456, BSN, RN

7 Articles; 1,144 Posts

I am a peds trach/vent nurse. Trach/vent kids do NOT go to PICU in my facility because we have our own dedicated airway unit for stable trach/vent patients. We are considered critical care step-down, but our kids are often very sick. Others are, as you mentioned, there for some random surgery or something and because they have a home vent we take them.

I am very proud of our unit. We have won national awards for our program and we have had *zero* cases of hospital acquired VAP for more than 2 years!

New trachs and T/V patients are trained by the RN's. We have a detailed checklist, as well as basic and trach CPR classes the caregivers have to take. They have to demonstrate by teach-back proper techniques in all aspects of trach/vent care including loading and unloading them into the family car. Two caregivers must be trained. This can be mom and dad, mom and grandma, etc. We give them a nice trach supply backpack with all their supplies in it. The caregivers have to go through 24 hours of nesting before they can go home, too.

RT's and nurses work as a team. RT's do all the treatments, and RN's respond to alarms, suction, do trach care, trach changes, and pretty much all the other cares our patients need, too. We have a max of two T/V patients at a time, or three airway patients. Or four generic, non-airway patients (which we also get in slower seasons).

We get very sick trach patients with respiratory infections, we get NICU graduates waiting for training to go home, and we get other kinds of airway kids, too: chest tubes, throat surgeries, mouth surgeries, post-bronchs, bronchiolitis babies, RSV, pertussis, and all kinds of other random stuff. It's a very interesting unit to work on.