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Medical Equipment

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  1. Tracheostomy

    Indications: Prolonged respiratory failure, subglottic stenosis, bilateral vocal cord paralysis, congenital airway malformations, tumors, craniofacial anomalies, and severe neuromuscular disorders.

    Description: Made of either polyvinyl chloride (Shiley) or silicone (Bivona), a tracheostomy tube is inserted into the trachea to provide an artificial airway.

    Tips:

    • Decimal point and the number zero (#4.0) are used to designate a neonatal or pediatric trach. Trachs will be identified as either #3.5 NEO Shiley or #3.5 PED Shiley on the neck plates of the tracheostomy tube.

    • Premeasured suctioning depth not longer than the trach cannula is essential to prevent epithelial tissue damage.

    • Trach care should be performed bid and more frequently PRN to prevent skin breakdown.

    • Clean technique should be used for trach changes in the home environment. Sterile technique does not decrease infections.

    • Parents and/or caregivers should demonstrate proficiency in tracheostomy tube change, suctioning, and troubleshooting prior to discharge home. Caregivers should be taught assessment skills and be aware of/and know how to implement emergency measures.

    • All patients with a tracheostomy tube should have an emergency “Go bag” with supply list consisting of replacement tracheostomy of the same size and one tracheostomy tube one size smaller, flexible suction catheter and suction machine, scissors, spare trach ties, gloves, water-based lubricant, Ambu bag, and oral endotracheal tube.

    • Ventilated patients and those with thick secretions should always use humidification.

    • Use of the motto “When in doubt, change it out” may be applied to most situations where tracheostomy tubes require action due to inability to diagnose the problem during patient deterioration.

  2. Home Ventilator—Laptop Ventilator (LTV)

    Indications: Provide ventilation for children with chronic respiratory failure due to various disease processes such as bronchopulmonary dysplasia, congenital and acquired central hypoventilation syndrome, and neuromuscular disease in the home setting.

    Description: Small, computer laptop size, portable ventilator for home use.

    Tips:

    • Patients with home vents should always have Ambu bag readily available in case of ventilator failure.

    • Condensation in ventilator tubing can cause ventilator to autocycle and trigger additional ventilator breaths. Troubleshoot by emptying ventilator limbs to remove water.

    • Consult LTV Operator's Manual for up-to-date troubleshooting.

  3. CPAP and BIPAP

    Indications: Chronic atelectasis, respiratory compromise, certain neuromuscular conditions such as spinal muscle atrophy.

    Description: Provides pressurized air to the infant by a low-pressure ventilator support system through either a face/nose mask or a tracheostomy tube.

    Tips:

    • BIPAP differs from CPAP in that it has a variety of settings to achieve desired respiratory effects of the infant including an IPAP (inspiration) and EPAP (expiratory) mode. A rate may also be prescribed with BIPAP.

    • CPAP provides a baseline PEEP throughout the time the infant is attached to the device.

    • Skin breakdown, particularly on the bridge of the nose, can be common due to ill-fitting facemasks. Generally, the durable medical equipment company can refit the mask to the infant and/or provide pressure relief dressings.

  4. Oxygen Therapy

    Indications: Generally, for infants with chronic lung disease and pulmonary hypertension.

    Description: Provided by nasal cannula in the infant without ...

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