Pediatric Trachs/Vents

Editorial Team / Admin · Aug 28, 2007

and welcome to allnurses.com

so good to have you with us. i moved your single post to its own thread in the picu forum for a better response.

hope you enjoy the site.

sticknurse · Aug 28, 2007

Hi and welcome. What sort of information do you need? i can share a couple things I learned working with little ones. They are not to be trusted!! Little ones must be monitored at all times. They are notorious trach yankers, and you must be sure to have a replacement trache available at the bedside (or wherever u and baby are) and make sure the family is trained and comfortable with responding in the event it comes out. If the little one is on a vent you'll need to be trained to understand that particular vent, all the settings, trouble shooting when problems occur (back up battery is charged? available?) is oxygen being used? Be careful that vent tubing hangs lower than the baby, so accumulted fluid never flows back toward the stoma. The local hospital website usually has information which they give the family when they discharge to home. Check it and print it for yourself. You can benefit from requesting the supply company which provides medical equipment come in and in service you on the job too. Are you already familiar with vents? If so you are ahead of the game. I would love to help but not sure what you need to know. Good luck in your new adventure!

Pediatric Critical Care Columnist · Aug 28, 2007

Sticknurse's response was pretty detailed. If there's anything you want added, let us know. I worked with chronic trach/vent kids for five years, and have pretty much seen it all. Oh, and welcome to our little family here at PICU.

txteri222 · Aug 29, 2007

and welcome to allnurses.com
so good to have you with us. i moved your single post to its own thread in the picu forum for a better response.
hope you enjoy the site.

love the response. don't know how to thank sticknurse and janfrn for info on trachs/vents. thanks all and i will be back with more questions after i learn about this "threads" thing. friday is first day at new job. worried about how to transfer 2 year old and keep him hooked to vent at same time. guess i'll figure it out. thanks sooo much for info.

i'll be back. love this site!

Pediatric Critical Care Columnist · Aug 29, 2007

If transferring a 2 year old and keeping him hooked up is your biggest worry, you'll be fine! The circuit will be attached to the trach with a swivel. The tubing will swivel around and still stay connected. And if it pops off, it's probably not the end of the world... you have to take the circuit off to suction unless you have an inline. Kids have no necks, so their chins will often get in the way and if conditions are right (like rolling over in bed), they'll push the swivel off the trach with their chins. And you'll disconnect to put his T-shirt on and take it off again. And he'll disconnect for attention. And sometimes he might even cough it off! It'll be all good. The ventilator will tell you when it doesn't get the expected pressure and if you're close enough, you'll hear the vent delivering the breath quite well.

Where I used to work, we secured our circuits with a trach collar made of gauze and twill tape. It went around the child's neck and the twill ties crossed under the tubing then tied in a bow on top. They could still pop off, but the circuit didn't go very far. I put one on a patient in my current place of employment and you'd have thought I'd committed murder or something. "We don't DO that here." But they do something else that causes a lot of pop-offs... they put a folded receiving blanket on the child's chest under the tubing and secure the whole arrangement to the child with either burn net or Montgomery ties. Every time the child moves their legs, or arches their backs the swivel pops off. But when in Rome...

suzanne4, RN · Aug 29, 2007

Hi from Denton Tx. Just sailing looking for info for pediatric trachs/ vents as I'm beginning new job. Thanks:)

Bigger question that needs to be answered first is do you actually have experience in caring for this type of patient in the hospital setting? Are you going to be doing pediatric home care? What type of previous experience do you have with vents?

txteri222 · Aug 29, 2007

Bigger question that needs to be answered first is do you actually have experience in caring for this type of patient in the hospital setting? Are you going to be doing pediatric home care? What type of previous experience do you have with vents?

Hi! Thanks for response. No experience in hospital setting. I'm a pediatric home health nurse (for 2 years). I figure now is perfect opportunity to learn and get experience. I've observed trachs/vents in home of teen boys with Muscular Dystrophy. I know how to chart numbers on vent. How to reset alarm and change circuit. Parents met me and showed me around home. Bedroom is mini hosp room with all close by. Boy is bundle of spontaneous movement and energy. He also has a mickeybutton for meds. NOw I'm getting nervous. How do I hold him and move the vent at the same time when I move him and the machine to the high chair in the kitchen? I'm sure I'll have a lot more questions after Fri. I love you guys. Thanks for sharing! I wish I would have known about you years ago when I had so many questions in school! Thanks soo much!!!!

suzanne4, RN · Aug 30, 2007

Please be very careful with this. The issue that I am seeing is that you do not have experience with trached kids at this age, and insurance companies are paying for your experience, and expect you to have it.

Do you know how to change out a trach if it slips out? Are you adept at suctioning trachs? Replacing a button if that comes out? Actually trouble shoot a vent, and know how to fix things with it, usually there is more to it than just resetting a vent alarm, but understanding what triggered it in the first place. What type of training is your agency actually providing for you? Is there going to be another nurse with you for a couple of shifts?

Hate to be the one asking these questions, but you are to be there to provide education to the parents, not the other way around. And what will you do if you run into a problem and the parents are not there? They are not required to be there all of the time when you are there.

This same thing occurs with nurses that take home health patients but have never cared for adults with trachs either in the adult medical field. So please, do not think that I am singling you out. I did peds home health care for years and very aware of what can happen and you need to feel comfortable with all that can go wrong and know how to deal with it.

txteri222 · Aug 30, 2007

Please be very careful with this. The issue that I am seeing is that you do not have experience with trached kids at this age, and insurance companies are paying for your experience, and expect you to have it.
Do you know how to change out a trach if it slips out? Are you adept at suctioning trachs? Replacing a button if that comes out? Actually trouble shoot a vent, and know how to fix things with it, usually there is more to it than just resetting a vent alarm, but understanding what triggered it in the first place. What type of training is your agency actually providing for you? Is there going to be another nurse with you for a couple of shifts?
Hate to be the one asking these questions, but you are to be there to provide education to the parents, not the other way around. And what will you do if you run into a problem and the parents are not there? They are not required to be there all of the time when you are there.
This same thing occurs with nurses that take home health patients but have never cared for adults with trachs either in the adult medical field. So please, do not think that I am singling you out. I did peds home health care for years and very aware of what can happen and you need to feel comfortable with all that can go wrong and know how to deal with it.

Thanks

suzanne4, RN · Sep 2, 2007

How did your first day go? If I remember correctly, you were going to start on Friday.

txteri222 · Sep 3, 2007

How did your first day go? If I remember correctly, you were going to start on Friday.

First day went well. Dad works from home on computer and was there training me all day. I learned so much! This job will teach me so much. Parents are great and so patient! Watched Dad trouble shoot alarms. Most of time the problem was the accumulation of too much fluid on the sensors. Occasionally he would take tubing off and quickly shake moisture out of circuit. Baby is nonverbal, has allergies, and makes sounds that aggravate drainage. Baby eats PO as well as having GB feedings via feeding pump. Meds are via GB. There was a breathing tx as well as an antibiotic breating tx via vent. O2 was 0.5 via vent or via bagging post suctioning. They prefer not to oxygenate pre suction but only post suction as bagging prior pushes secretions deeper into lungs. Pulse ox stays taped to toe for continual monitoring of O2 stats during this time.

Also baby has special vest that percusses him for 14 min. Must remove tubing for moments at a time as when it comes off, for moisture removeal, changing shirts. Pt. is strong and stable and tolerates this well. He cries at sad misic and becomes ecstatically happy with fun child songs. Music calms him. His favorite dvd is Happy Feet. Likes Sesame street also (and Hello Dolly). Pt was premie 24 weeks Was in hosp. 7 or 8 mo. Transfers -you prepare destination before , unplug and wrap wires around machine and then pick up baby facing you while pulling vent with other hand to destination. Machine continues to operate. Always aware of placement of tubing. continually watch affect of pt. for cues of problems. Only problem so far was too much air in feeding tube during flush and had to burp GB. Dad says he will show me how to replace trach just in case. Parents are willing to work with me. Job is a 2 hr. commute and a 12 hr. shift. If I run into other concerns I will contact you. Thank you so much for your input.

The Friday Nurse Teri