I am a GN student who has a 10 year old child with spastic quadriplegia CP, is 100% fed through MIC-KEY, has a nissen fundiplication, is non-communicative and is 100% dependent on all ADLS.
She is having increasing difficulty handling her secretions. She is pooling them at the base of her throat. She sounds like (pardon the comparison) Darth Vader wheezing/whistling on inspiration. Her pulse O2 sats are in the low 90's and her RR is 30-35 breaths per minute. She is on Robinol, Trilepta (for szr's), diazapem, Trazadone (for zzzz), Zyrtec; is neb'd with Albuterol and has a Flo-vent. None of the above meds are alleviating the problem.
I suction her extremely frequently, yet everytime I think I "got it this time", it starts over again.
I read somewhere that replacing a G-tube/button with a J-tube helps decrease the secretions in the throat. (I use the term throat because I am unaware of where she is pooling her saliva. )
HAs anyone heard of this? Does anyone out there have any suggestions on how to help her, other than using the standard aspiration precautions?
I urge you to rule out temporary causes of this problem, but you need to take into account the possibility that this is not a temorary change -- that there has been a neurological deterioration. It's incredibly sad when someone loses their swallow reflex, and I know the feelings of utter helplessness that you feel. You just want to do SOMETHING to help her, but unfortunately there aren't a lot of options other than positioning and anticholinergic medications. In my line of work where aim our care at providing symptom control and comfort care, this is usually a sign that there is a significant deterioration and the body is "asking to be let go", and it's time to stop heroic measures. As for scopolamine patches, They are usually a very effective short term treatment, but eventually lose their effectiveness. I can't imagine the discomfort of feeling as if I was drowning all the time. YOu could try using a route other than transdermal. Atropine always helps.
Thank you for your posts. I've thought about seeing a speech pathologist with her but haven't as of yet. I will get a referral from her pediatrician. I'll also look into seeing a radiologist(again) as well.
I did notice something later this evening when suctioning her - she is cutting a back molar which could explain this over abundance of secretions she has. I was looking at everything from a medical standpoint while totally overlooking the teething. Since she can not break skin by chewing (she's tube fed) , her teeth have to recede slowly on their own.
I am sure it is a whole host of situations why she is pooling saliva so bad. (change of weather, colds and flus going around, teeth, neurological changes, puberty kicking in, etc, etc.) It is very frustrating trying to keep her healthy when she can't tell me what's wrong. She tried telling me something today, but I don't understand her vocalizations. She's like an infant, but she does laugh and smile and squeal with joy! She loves her Disney and Sesame street videos and music. We just bought her "Finding Nemo!" She's still adjusting to it (she has to get used to seeing a movie 2-3 times before she likes it.)
I'll take all input into consideration! Thanks for all of your help! You guys are great!
Robinul is another cholinergic blocker that is used for decreasing secretions. I'm not sure if it is used for peds or if it comes in liquid form, but might be worth a look. Best wishes.
I currently work in LTC, we use scopalomine patches for excess secretions. One small patch is placed behind an ear and replaced every 3 days. Possibly decreasing her secretions will help with the problem.
Good suggestion...I was thinking the same thing! :)
adrienurse, LPN
1,275 Posts
I urge you to rule out temporary causes of this problem, but you need to take into account the possibility that this is not a temorary change -- that there has been a neurological deterioration. It's incredibly sad when someone loses their swallow reflex, and I know the feelings of utter helplessness that you feel. You just want to do SOMETHING to help her, but unfortunately there aren't a lot of options other than positioning and anticholinergic medications. In my line of work where aim our care at providing symptom control and comfort care, this is usually a sign that there is a significant deterioration and the body is "asking to be let go", and it's time to stop heroic measures. As for scopolamine patches, They are usually a very effective short term treatment, but eventually lose their effectiveness. I can't imagine the discomfort of feeling as if I was drowning all the time. YOu could try using a route other than transdermal. Atropine always helps.