Uncooperative child with trach/on vent

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Specializes in Peds, developmental disability.

If your trach patient (child) or patient on a vent is not cooperative, for whatever reason, I am sure there are challenges. What are some of the tricks or techniques you have used to avoid a mishap, such as trach being pulled out, or other hazards?

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

You can make a holder out of trach ties to hold the trach in place and keep the vent connected. We had to do this with a pt who had no purposeful movements, but he had a repetitive movement that was just right for disconnecting the vent and/or pulling out the trach. The holder decreased the number of times we had to insert the trach or reconnect the vent. But it still happened frequently.

We cut a hole in the tie for the flexible adapter to fit through. Then used the Velcro to secure it to the trach tie in place already. The length of the holder was maybe 2.5 inches not including Velcro.

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

Oh yeah, one nurse made bibs out of washcloths and we would place that over the trach and vent. Because it was made out of washcloths it could be cut easily in an emergency.

We got an order to place socks over a kids hands on one case. We were to try everything we could before doing that. And they were large socks so the pt could move his hands freely inside the sock.

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Specializes in Peds, developmental disability.
Oh yeah, one nurse made bibs out of washcloths and we would place that over the trach and vent. Because it was made out of washcloths it could be cut easily in an emergency.

We got an order to place socks over a kids hands on one case. We were to try everything we could before doing that. And they were large socks so the pt could move his hands freely inside the sock.

What were some of the things you tried before resorting to the socks?

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Specializes in Peds, developmental disability.

Very creative!

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Specializes in Peds, developmental disability.
Very creative!

I was referring to the trach tie used as a holder to keep things together.

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

That kid had Ativan ordered PRN. We could reposition him in bed or move him to a therapy chair or w/c. We could hold him when we were able to (he had lots of meds, tx's, etc) and "put toys in his hands" which was really us holding the toy in his hands and away from the trach. The kid was a handful.

The short and sweet of his history. He died in his parents arms and the parents thought he went to sleep. When they realized what happened, EMS got a pulse back. After a long hospital stay, he came home severely brain damaged. Other than the movement with his hands, we could observe sleep/wake behavior. No response to pain or anything!

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Specializes in NICU, ICU, PICU, Academia.

I have a VERY active 17 month old who is a challenge to keep connected. We started using the padded belt that came with the apnea monitor to place around his chest and pin the vent tubing to it. It helps a lot. He can purposefully decannulate himself- but his stoma is over a year old, so it's no problem putting it back in- IF you can get him to hold still!!

Also had a girl who we would put rubber bands in the openings of the trach phlanges (sp?) and loop them over the connector- it helped in that she didn't have the dexterity to pull them off.

I had a three year old once who would play in her room while I would wash equipment and such in the kitchen. She would come to me all innocent-like, trach in hand, and say "I found this!" Yeah, found it in your NECK!! :) Before they finally decannulated her for good, she got to where she could almost change out her own trach, at age four! :)

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