Sleeping with HMEs (Trach noses) safe?

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I'm new to caring for tracheostomy patients and just started caring for a 4 year old with a trach in her home. We were trained that the patients should never sleep with an HME (heat moisture exchanger), but per mom she sleeps that way every night... What have you all seen with regards to that, whether in a home or hospital setting? The mom looked at me like I was crazy when I told her it wasn't safe for the patient to sleep with it.

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Specializes in NICU.

I certainly am no expert, but we only let our NICU babies wear their HMEs for a few hours at a time during the day. Obviously this kid is probably less sensitive, but I would be afraid that she could plug off during the night (very common amongst our NICU grads). We always had our trach pts hooked up to at least a humidifying collar during the nighttime. Now I'm curious...

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Specializes in Trauma Surgical ICU.

Is this pt on the vent?? Every vented pt I have ever had via ETT or trach had a HME attached. I don't work HH or peds so maybe someone has some more information.

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Specializes in NICU, ICU, PICU, Academia.

Is she on a pulse oximeter? If so, I don't see where this would be a problem.

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Specializes in acute rehab, psych, home health, agencey.

If patient a straight trach, no ventilator, the hme is generally used during wake periods as the replacement for a moist, humidification system. Remember no two patients r the same, thus what may work for one might not for another. Also, in homecare parents often call the shots, sometimes the best u can do is educate with whatever resources r available.

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I know of several trach/no-vent children and adults that are HME or PMV 24/7. I think in all of those cases, the mist collar is just too moist.

My son was trach/vent. We used the HME when he was on the "portable" vent (ie. the one not on the stand with the humidifier) during the day and the one with the humidifier when he was in bed.

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Specializes in Home Health (PDN), Camp Nursing.

Yea I have known several trach kids who just drown on the humidifiers. Or they don't keep them on and dry out. So they use HMEs around the clock. I have also seen kids who's spO2 is better on HMEs I'm assuming because of the increased peep. I would have your clinical manager contact ENT or pulm and just get an order that it's ok, or if it's not let them slogg it out with the parents. In the mean time I don't think it's so far off the wall as to cause a great stir. The child has done well with the HMEs overnight for some time I assume. It should be low risk especially since your their to monitor overnight.

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Specializes in NICU, ICU, PICU, Academia.

I think the big objections to trach collars are the chance of 'drowning' from the condensation in the tubing and the obnoxious amount of heat in the tubing that lays- at some point -across their chest.

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Specializes in School LVN, Peds HH.

I've had 2 peds trach patients. 1 wore the HME 24/7 with no issue. The other wears it while off the most collar. I will let him sleep with it on for a couple hours if necessary. I supervise of course. He never has an issue.

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Specializes in Pediatric Private Duty; Camp Nursing.

I work w a now-2-year-old who stopped w the humidity collar at about age one, purely due to client intolerance. The second you'd try to pop it on as she slept, she'd wake up cranky. She also flipped a lot, so if we'd get it on during deep sleep, it would be tugged at soon enough and that would also wake her. So she uses an HME and also they run a room humidifier full blast. Not ideal but she does have the POX on continuously and she's not overly moist or dry anyway, so in her case it's not much of a problem.

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Specializes in Peds(PICU, NICU float), PDN, ICU.

The humidifier is the best option as long as it is tolerated by the patient. Next best is the HME. The reason for both is to warm and humidify the air inhaled. The HME also filters the air (somewhat). If the HME works for the patient while sleeping, its ok. What you were taught may just be agency policy...probably because a nurse left a kid off humidity too long and the kid plugged.

My other concern is that if you don't know the answer, you shouldn't be giving info to the parent that could be wrong information. Its unsafe practice. Plus the parent will find out answers and will hold it against you. Many parents ask multiple people the same question to see if they get the same answer.

Its best not to tell a parent not to do something unless the child is in immediate danger. Parents don't like that! Its better to document and notify your supervisor of your concerns and possibly the Dr. Take the time to educate yourself on "why" with trachs. Its important to understand why we use a humidifier or HME as well as why we titrate settings on the humidifier based on the secretions/patient. That will help you tremendously in caring for the patients and being able to educate parents.

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Specializes in LTC, Memory loss, PDN.

im really curious

what is the rationale for pts not to sleep with hmes

what makes the hme unsafe during a nap

please post your source's rationale

as far as im concerned, you have gotten all the right answers here

to hme or not to hme is decided on an individual, not a global basis

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