Peds home health: dealing with trach and vent

Specialties Home Health

Published

Hi! New to vent and trach. I'm looking for forums of problems other nurses have encountered in the home with vent and trachs. Trying to learn all I can before an issue happens. Even simple stuff. Thanks for any advice.

You've never worked with a trached patient on a ventilator, and your going to take care of a trached peds patient in their home?

Your going to need waaaay more than just some advice you read here or on the Internet.

4 Votes

Okay, if you have never done the above (worked with trach and or vents) you need to refuse to take the case until you get a decent in service from a knowledgeable nurse.

I am sure (hopeful) the patient is fairly stable, has been on home care for some time. I don't mean to scare you away.

You can read up on vent/trachs, YouTube has wonderful educational videos....but NONE OF THAT can take the place of you and a knowledgeable nurse going to the home and learning at patients bedside.

I am searching for the same topic! I just got hired into a New Grad Pediatric Home Health position. I will have one day inservice in the office and one day with a nurse in the home with me and then expected to care for the child on my own.

I am just refreshing everything I know and hoping to feel prepared after the inservice.

Best of Luck!!

Specializes in Home Health (PDN), Camp Nursing.

You may find some more general info in the Privet Duty forum as that’s what pediatric shift work is usually considered. Home Health more commonly refers to visits.

Anyhow. Here’s the deal. If you’re in a new grad position they should be treating you like a new grad. EXTENSIVE in office education. EXTENDED orientation on a range of cases with different veteran nurses. Then a solo case that is basic and well established for at least a month or so.

If you’re getting dropped on a trach vent case with one shift of training. You re not working, you’re being pimped, someone is putting you in a bad situation with no support and then taking the lions share of the money you earn even though you have ALL the risk. Watch out for other Pimp behaviors like normalization of this bad situation, threatening consequences if you try and leave (bad reference) and making your lack of magical abilities to handle a situation completely outside the realm of your experience somehow your fault.

Repeat after me: ventilators are life support. Tracheostomy’s are advanced Airways. Let’s not be causal about their care or emergency preparations or someone will die.

4 Votes

Alex,

I agree that this is a bad situation. I graduated in December and took my Nclex in February. I have been applying to hospitals in a 100 mile radius to my house and have yet to have a acute care hospital interview.

I have fellow classmates in actual New Grad programs and have cried several times about how I feel like I am being thrown to the wolves.

My dilemma is that I am a mom with a household that needs fed and rent and no savings to get me through while I wait for a dreamy New Grad job.

The hope is that I can work here while continuing to apply to other positions. I came to the forum searching for horror stories of this company.... but didn’t find their name anywhere.

I start on the 15th and have been trying to study everything I can to come to my minimal training with some kind of an upper hand.

I feel like I am trying to do everything I can given my *** situation.

2 hours ago, RobinMSN said:

Alex,

I agree that this is a bad situation. I graduated in December and took my Nclex in February. I have been applying to hospitals in a 100 mile radius to my house and have yet to have a acute care hospital interview.

I have fellow classmates in actual New Grad programs and have cried several times about how I feel like I am being thrown to the wolves.

My dilemma is that I am a mom with a household that needs fed and rent and no savings to get me through while I wait for a dreamy New Grad job.

The hope is that I can work here while continuing to apply to other positions. I came to the forum searching for horror stories of this company.... but didn’t find their name anywhere.

I start on the 15th and have been trying to study everything I can to come to my minimal training with some kind of an upper hand.

I feel like I am trying to do everything I can given my *** situation.

I feel for you. YouTube is a good resource. Best of luck. This may be bad advice, but if somehow you can appear confident, but at the same time ask the parents how they've been doing trach care and maybe that your not familiar with that specific vent????!

Specializes in PICU.

You are putting this child at risk with your inexperience. If you do not respond appropriately to a vent alarm, or know how to change a trach, recognize an emergency with a trach and the appropriate steps to intervene, the child could die at your hands.

Kids with trachs and trachs with a vent are medically fragile and need a high sense of vigilence. You cannot just call 911 and hope for the best, these children need interventions and the home health nurse must know the appropriate interventions. There is no Youtube video or words of advice that can help you know how to change a trach and suction a trach and know CPR with a trach change. These skills are the most basic skills that can save the life of the child. Practicing these skills in a simulation event on a mannequin does not make you competent to do it on a child.

1 Votes

I am sorry that you are in the position you are in and feeling pressured to take this job, but don’t forget that you could potentially put your license on the line and then not get that dream job. This sounds like a bad situation unless the company is going to do extensive training and not have you do any shifts on your own for a while, and that doesn’t sound to be the case.

When I was a new grad and having trouble finding good work, I initially found a private duty position in a home with a child with severe cerebral palsy, and this patient was not even on a trach or vent, just had a G-tube and needed postural drainage and had some other moderate issues.

After just my first training shift I walked away, realizing that I was not going to get the training or support that I needed and that I could put the child and myself at risk.

The mom had her own way of doing things and gave medications differently than the written physicians orders, and she had nurses who had worked with her for a long time and just did things her way rather than by the book. The nurse who I was going to have to depend on for what little training I was going to get walked into that house at 7 AM looking like she had been at the club all night.

The patient’s mom and the nurses were close in a way that definitely surpassed professional boundaries. And of course at the same time, in order to protect her child she had cameras on the room 24/7.

I can understand how all of this can happen in this type of environment, but I knew right away that this was not where I needed to be as a new grad.

2 Votes

I have a much different take on this matter. First, OP said was new to vent and trach, not a new nurse. Isn't everybody new to vent and trach initially, with no experience? How is OP to get experience unless OP is assigned a patient. How did anybody get experience until assigned a patient on a trach and vent. I'm sure OP will be orientated in the office on a mannequin, and in the home with the client - changing trach, suctioning trach, attaching ventilator, going over different scenarios several times. Is that enough preparation? I would argue yes, IF not a new grad.

I am an LPN with 2 years experience working in LTC/Rehab, and 6 months experience in a medical group home with intellectually and developmentally disabled residents. I've done IVs, wound vacs, dressing changes, external fixator care, etc. I remember my first code and using the AED, my first fall with fracture, my first anaphylactic reaction, etc. The more emergencies I handled, the better I got handling emergencies, even those I never specifically experienced before.

I'm soon starting part-time shift care with trach and vent clients. I've had a little trach experience, no vent experience. I've gone through the 2 day office orientation on trachs and vents. I feel confident. I was drilled over and over and over on different scenarios. I know, I know, it's not exactly the same on real people. Again, I ask, didn't everybody have to have their first? Everyday I go over the material they gave me. I'm good in emergency situations. I know how to access for respiratory distress, cardiac distress, diabetic distress. I have experience intervening in respiratory, cardiac, and diabetic distress situations. I've given the nitroglycerin, the glucagon, the nebulizer, increased O2 and monitor O2 saturation with pulse ox. I have inserted Foley catheters, securing them by inflating the balloon (exact same procedure inflating cuff on a trach, and inflating balloon on MIC-key tube).

No, I don't specifically have vent and trach experience, but I have 2 years nursing experience with similar skill sets that are transferable to trach and vent care and maintenance; and, 2 years experience intervening in emergencies.

OP, you did not say if you are a new grad or what nursing experience you have.

If a new grad, then I would agree with other posters, you're not ready. You need the nursing village to help grow you up (and no, it's not a perfect village - some nurses eat their own, etc). You need other nurses around you to learn from, to ask questions, to be mentored; preferably, in a LTC/rehab or hospital, where you will gain a huge skill set.

If OP has 1 or 2 years experience dealing with emergencies, and having the skill set gained from working LTC/rehab or hospital, then you should be qualified and competent.

I have no hesitation accepting responsibility of caring for trach and vent client, knowing that my experience has more than adequately prepared me.

1 Votes
+ Add a Comment