Recycling HMVs?

[middleagednurse]

My biggest challenge currently is keeping HMVs on my patient. She should wear them 24/7. But she is allotted 3 a day per Medicaid. Mom says suction more often and suction the HMV. I do, but eventually the filters get soaked and fall out . She HAS to wear functioning HMVS at school. I want to know if there is any way to "recycle" them. She has worn just the plastic part which is better than nothing, but not really a good idea. Can we wash the filter, roll it up, and reinsert? Is there anything can we can use as a substitute filter? Gauze? Maybe some kind of sponge that we can cut up?

[SDALPN]

Do you mean HME?

[middleagednurse]

Yes I mean HMEs. Can I change the spelling?

[SDALPN]

Can't wash filter inside of them. They are based on tidal volume for the pt. So while I have never seen a study on it, I would guess that maybe the tidal volume the HME is made for would be different if the device was altered. Also, the devices are supposed to be used the way the manufacturer tells us to. If we don't follow their instructions, the pt could be harmed. I personally wouldn't want that held against me for altering HMEs.

Maybe you can get an order to use them as needed. I have some kids that are so "juicy" that we use the HME when they just begin to sound dry and we take it off when they start to sound wet. The HME lasts much longer. But the pt must be watched since the airway is left completely open. Some parents have put bandannas or washcloths loosely over the trach when its open to protect from the accidental bug flying in or dust.

Could you talk with the Dr about an order for scopolomine, robinul, etc?

The more you suction, the more you irritate the airway and create more secretions. Is it possible the patient has been suctioned too much unnecessarily?

[middleagednurse]

She takes robinol. She doesnt get suctioned too much. I have tried scarves etc but she won't tolerate them.oh ny. Guess I'll put the burden on the doctor.thanks

[SDALPN]

That sounds like a challenge! Maybe the Dr or an RT would have more ideas.

Here's another thing you could try. If you can get the Dr prescribing the HMEs to write a letter of medical necessity to insurance asking for more HMEs, most insurances will give more HMEs if medically necessary. The Dr will need to explain why its medically necessary, not an answer like just because they fall apart too soon. A case manager can assist with this since sometimes the physicians don't know what to write unless they have written one before.

[brillohead, ADN, RN]

You could suction the loogies out of the HME as soon as she hacks one up, then switch it out and let that one air dry before putting it back on her.

That might keep the filter from disintegrating and falling out.... just keep them in a rotation of drying out and being used as the day goes on.

[ventmommy]

Reusable HMEs are a real thing. The plastic parts get washed and reused and the filter gets replaced. Let me see if I can find you a part number.

If that is not an option, the sponge ones are easier to use than the paper ones since the sponge ones can be washed and dried while the paper ones fall apart.