Suctioning 2 yo

I need advise. My 2 yo pt has asthma and seasonal allergies. Lately he's had increased secretions, he has order for prn sx, neb tx and Zyrtec. Before, I would sx orally and nasally without any problems but being he's had increased secretions he's been getting more suctioning by mom and also nurses, he has 2 PDN. I've encourage coughing, done manual cpt and give prn neb tx. I've tried swaddling which is what our case manager suggested, but that didn't work. He kicks and pushes himself up, turns his head and bites on yaunker. I'm not sure what else to do. I'm afraid of hurting him if he pushes up or turns his head while suctioning. Does anyone have any suggestions on what I could try?

Its yankauer, btw.

Sounds like someone has been too rough and now he's uncomfortable with the procedure. Are people just obsessing over suctioning to the point that they have created this issue. Suctioning too much will increase secretions. Has there been a sputum culture done? Maybe he has an infection. Has this been discussed with the Dr? Maybe something like robinul could be prescribed. Really, the only time suction is needed is when sats drop, when there is difficulty breathing, or every few hours to keep the trach patent. Other than that its not really necessary. Some parents obsess over secretions not getting on clothes...that's just part of having a trach. So they suction for cleanliness instead of medical necessity. All of the extra suctioning increases risk for infection.

For behavior, find things he likes or distract him. Eventually he will do better if everyone is suctioning gentle. If he has sensory issues, a therapist can help with that. A doctor would have to order PT/OT. When I do trach changes on little ones, I tell them I'm turning them into a burrito. They feel secure and if started young enough, it will become routine and they won't be nervous. Maybe you could try that for suctioning? Make sure you have the parents permission for it.

He doesn't have a trach and MD is aware. MD stated do PRN Zyrtec and neb if pt continues with increased secretions she will then increase the Zyrtec. I try not to suction and encourage a lot of coughing. But I do think mom has been suctioning a lot more. He already sees OT/ST right now they are working with getting him to eat PO since he had a gtube. He is terrified of even seeing the suction machine and this started just recently even with brushing his teeth he fights, and before he was okay with it.

Maybe OT can give you ideas if they come in on a day you work. They are great with that stuff. If its sensory, they can help you with that. I know it can be frustrating to try to suction when the kid are resisting. Also, make sure to document it. I normally say its a bad idea to let kids play with medical equipment. But maybe he could play with an old yankauer? Maybe even dipped in a flavor he likes? See if you can order a little sucker. They are more flexible and softer. Plus if he hasn't seen it before, he may not relate it to the current one used. There are a few types of little suckers...the tips are different. But maybe that would help??

Thank you. I'll ask OT see what they suggest. :)

This is the 800 number for Neotech Products, Inc., makers of the Little Sucker line of products. One of my clients called them and spoke to a very nice lady. The client asked if they could send her a sample (at my suggestion), and they were gracious enough to send her a box of several samples! 1-800-966-0500 The site: www dot neotechproducts dot com The home health specialist provided her card with these local numbers (661) 775-7466; Fax (661) 775-7464. Can't give her name here.

I think the Little Sucker will go a long way to help solve your problems.

Make sure you have an order. Each supply item has an order from a Dr. The equipment company can obtain the order if you don't. But I'm not sure if the direct supplier would ask for one. CYA!