Whoa - The Trach Vacuum is set at 500mm/Hg for Peds

[SunnyPupRN]

I am private duty and upon arriving check the child's equipment. When I turned on the suction machine the meter went up to 500mm/Hg. I called my supervisor to let them know, because that seemed like an awfully strong suction for an 11 year old. I later saw the parent and asked about the suction level but she brushed it off and assured me it was fine. The child has not needed deep suctioning on my watch, only shallow off the bib and around the trach itself, but I am concerned that if he does need deep suctioning, the vacuum level could injure his trachea/pulmonary branches.

So far, the agency has not been concerned. I am also worried that a tissue injury with this strong vacuum could cause a cough reflex or bronchospasm the chest, and the child has a defect of the aorta that puts him at risk for aortic dissection.

This is literally keeping me up at night. Am I overly worried or should I document that I have addressed it and that the parent is aware and ok with the suction level?

[Julius Seizure]

Can you adjust the suction level on the machine? Does the suction seem crazy high when you actually test it, or could the calibration possibly be off?

[SunnyPupRN]

Really good question. The dial looks like it has been screwed all the way off and is missing, so there is only a screw-stump where the suction dial should be. [i believe the client is receiving medicare and has trouble obtaining supplies, the parent mentioned to me that medicare or maybe medicaid only pays for a few of the heat moisture exchange devices for the trach] As far as calibration...the child sometimes turns on the machine and suctions himself and tolerates it well. I just can't tell how strong it is, I mean it certainly sucks up the secretions like a mini dustbuster but maybe that's ok for external suction?

[LeChien, BSN, RN]

I would call the manufacturer/DME provider of the pump and ask them to come out and calibrate/replace it.