RT Book, Section
A1 Malcolm, William F.
SR Print(0)
ID 1105544770
T1 Home Equipment
T2 Beyond the NICU: Comprehensive Care of the High-Risk Infant
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 978-0-07-174858-2
LK accesspediatrics.mhmedical.com/content.aspx?aid=1105544770
RD 2024/04/19
AB TracheostomyIndications:  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.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.CPAP  and  BIPAPIndications:  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.Oxygen  TherapyIndications:  Generally,  for  infants  with  chronic  lung  disease  and  pulmonary  hypertension.Description:  Provided  by  nasal  cannula  in  the  infant  without  artificial  airway.  Infants  with  tracheostomy  tubes  who  require  oxygen  use  tracheostomy  collars  or  oxygen  is  entrained  into  a  home  ventilator.  Oxygen  can  be  delivered  from  several  liters/minute  to  as  little  as  1/32  L/min.  Patients  have  small  portable  oxygen  tank  ...