vent/trach help!!

[Akeos]

Hey guys, i need your help. I work in home health and I have a pt. who has a trach and is on a vent. here's the situation and i've never had trouble with this before..she usually has great pressures that are easily fixed if they go up. but..

she keeps high pressuring unless shes in one position on her left side...she has to be propped up to the right place or she high pressures whenever i try to reposition her in any way..on her back, head elevated, on a pillow, flat, ect. she high pressures! her lungs are crystal clear, and i can't get anything out when i suction, which is also unusual. i feel horrible for not being able to reposition her..no pt. should be in the same position this long.. it's to the point where i'm not sure i'll be able to change her without the issue.. o and her trach was just changed and i've tried the back up vent and the smae thing happens, so its not the vent either.

it's making me really anxious, i can't think of anything else to do..please help!!! suggestions, advice, reasons this is happening??

[Akeos]

I finally figured it out..the cuff was over inflated..should have checked that when i first got there and thought it looked fuller than usual. live and learn, at least it was an easy fix and i figured it out eventually...its hard to learn when i have no one trouble shoot with.

[ventmommy]

Have you ever seen this child when she has pneumonia or atelectasis? When my son has had pneumonia or an increased area of atelectasis, high pressuring on the vent is the first sign of trouble along with decreased secretions.

I would be really careful about changing a child's vent settings like I-time or PEEP without speaking to the pulmonologist unless the child already uses a protocol for settings changes.

When you said that the trach was changed, was it a regular trach change or an upsize?

[Up2nogood RN, RN]

It's great that you come on and ask peers but don't be afraid to ask your clients RT with specific questions and keep them in the loop too!

[Akeos]

It' s hard the ask the agency's one Rt when I work night shift... I have not seen her with pneumonia..that was the mom's first thought but she wasn't displaying any of the other symptoms she does when she has it, plus she's on antibiotics specifically to prevent it. and i would never change vent settings, that machine scares me enough without messing with it! her trach was change to the same size it's been for months, its actually a size smaller than she should have because she needs to go in and get her stoma dilated to get the right size back in.