Positioning an older, chronic lung baby

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Hi Everyone!

I wanted to get some feedback on what you all think about positioning your older, heavier long term chronic lung kids who are still intubated, or maybe have a tracheostomy with lots of heavy vent tubing. Do you feel like it's a constant challenge to keep them from sliding down or maybe from drifting sideways in their crib? (Making them either 'hang' from their ETT eventually, or create unwanted tension on their tracheostomy and tubing.) And if it is a challenge you often see, how do you prefer to position these babies?

Thanks in advance for your thoughts!

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I used a big blanket (adults sized) rolled into a long tube and made a "horseshoe" under the fitted sheet. Their butts rested in the curve at the bottom and the sides kept them upright and also helped in taking the weight off their trachs or ETTs. Never really had issues with them sliding when I did this and could still turn side to side.

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17 minutes ago, Wuzzie said:

I used a big blanket (adults sized) rolled into a long tube and made a "horseshoe" under the fitted sheet. Their butts rested in the curve at the bottom and the sides kept them upright and also helped in taking the weight off their trachs or ETTs. Never really had issues with them sliding when I did this and could still turn side to side.

Thanks for the reply!! We currently use 'bendy bumpers'-a Philips product. We also will put the 'froggy', a u-shaped bean bag (another Philips product) at the base of the bendy bumper, but these big kids still tend to slide!!

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The bumpers are too small. You can try a towel if the baby is still little.

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1 hour ago, Wuzzie said:

The bumpers are too small. You can try a towel if the baby is still little.

I agree, they are too small!

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On 9/13/2019 at 11:42 AM, Wuzzie said:

I used a big blanket (adults sized) rolled into a long tube and made a "horseshoe" under the fitted sheet. Their butts rested in the curve at the bottom and the sides kept them upright and also helped in taking the weight off their trachs or ETTs. Never really had issues with them sliding when I did this and could still turn side to side.

We use a variation of this a lot on my peds unit, too. Instead of using an entire adult blanket, we'd either use some cloth bed pads (like they use for adults, if you stock them) or a stack of 4-5 baby blankets, fold them in half, and roll them up into a log that's about 4-5 inches in diameter. You can put a piece of tape around them to keep their shape. Instead of having an adult blanket horseshoe, you'd have 2 or 3 'blanket logs,' with one under the bum and one or two on the sides. We just shove them up underneath the flat swaddle blanket that the baby is laying on top of. If you really want to, you can reinforce them with beanie frogs, although it usually isn't necessary. I find that having a couple of blanket logs is a bit less unwieldy than a full blanket horseshoe (since you have control over each of the separate pieces), but to each his own.

If you really want to use a bendy bumper, you can take the largest size and fold it in half, then shove the entire thing up under the baby's bum like a shelf. For big kids, this is far more effective than using the bendy in a horseshoe shape. However, I personally feel that the 'blanket log' method works better. The bendies are just too darned slippery for big kids who wiggle a lot.

Another major point about vent tubing (with trachs or ETTs): when kids are big enough to be in cribs, it is really important to secure the tubing to the bed so it doesn't tug. In warmers/isolettes, the tubing is held in place by the little rubbery grommet where the tubing exits the bed. In cribs, there's nothing to hold the tubing in place, and gravity will cause it to slide off the bed back towards the vent, causing it to tug. Our RTs will often set a beanie frog on the vent tubing at the edge of the crib so that the baby has a ton of slack on the tubing. Another option would be to put a piece of tape or loosely tied tourniquet around the tubing, then use a hemostat or pin to secure the tape/tourniquet to the bed (however, I'd check with your RT before doing these things).

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Specializes in NICU.

Won't help in a crib, but try putting them in a swing. It sounds a little crazy if you've never seen it before, but it worked great for our 6 month olds that were still intubated or had a trach. They loved the swinging motion and then went right to sleep after their "session" in their cribs.

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Specializes in NICU, Infection Control.

These work well. And they have a variety of styles to fit different cribs/incubators, etc.

https://tucker-sling.myshopify.com/

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I use every positioning side possible I’ll use a bendy bumper underneath of their bottom, I’ll use froggys behind their head if their archy, and support it with a towel. A nice swaddle ( I know it’s developmentally inappropriate) but it keeps them intubated and I never had an extubation yet ? position of the ETT is critical

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Specializes in NICU.

We use poseys to secure vent tubing to the crib.

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