07/07/2014
How to Deliver CPR to Children with a Tracheostomy: Little Dove Pediatric Home Health is one of the largest pediatric, private duty home health agencies in Texas. While we provide a variety of pediatric home health services, we strongly emphasize tracheostomy care for ventilator-dependent children. Children in this situation need the most attentive, dependable, and knowledgeable care possible. A question that often arises is how to deliver CPR to children with a tracheostomy. Here we provide those instructions for how to do this with different age groups of children without the ventilator. You can read this here on Facebook or read the same article on our blog: http://littledovepediatrichomehealth.nwsltr.info/. Note the “Print Friendly” button at the bottom of the article if you would like to print a copy. If your family and caregiving situation would benefit from experienced professional assistance at home, please call Little Dove Pediatric Home Health at 1-800-994-2218.
Watch for signs that your child may be having difficulty breathing:
fast breathing
hard breathing
pale skin
bluish skin
sweating
squeaky noise from tracheostomy tube
whistling noise from tracheostomy tube
Initial Action Steps:
Suction the tracheostomy tube promptly
Replace the tracheostomy tube if the tube comes out
mucus blocks the tube
breathing does not improve with suctioning
Slow down, be quiet and determine if your child has stopped breathing. If so, perform CPR.
Cardiopulmonary Resuscitation (CPR):
Call 911 for help if there is time. Ideally, instruct someone else to call for help while you begin CPR. If there is not time, try to call 911 after five CPR sets. See below.
Gently move your child to stimulate him or her.
On a firm surface, place your child on his or her back. The floor or a sturdy table works.
Look, listen, and feel for breathing.
Place your mouth or breathing bag over the tracheostomy tube. Give two breaths. Make sure your child’s chest is moving with each breath.
If there are not signs of breathing, begin CPR
For Infants Less than 13 Months of Age:
Place two fingers on the breastbone, one finger width below the ni**le line. Press straight down one-third to one-half the depth of the chest at a rate of at least 100 times per minute – about twice per second. Give thirty compressions. Then give two breaths.
For Children Ages 1 to 8:
Place the heel of your hand on the lower half of the breastbone. Press straight down one-half to one-third the depth of the chest. Give compressions at a rate of at least 100 per minute – about twice per second. Give 30 compressions. Then give two breaths.
If You Are Alone and Did Not Call 911:
After five CPR sets (30 compressions followed by two breaths), move your child to a telephone if you are not on mobile. If it is not possible to move your child safely, do not move your child to the telephone. Call 911 (or your local emergency number where 911 is not available) to get help. Then promptly go back to CPR as long as there is a continued need.
For Children Age 8 and Over:
If you are alone, call 911 before beginning CPR. To begin CPR, place the heel of both hands on the lower half of the breast bone. Press straight down one-half to one-third the depth of the chest. Make compressions at a rate of at least 100 times per minute – about two per second. Give 30 compressions. Then, give two breaths.
All Ages:
Continue CPR sets for two minutes. Check for signs of circulation. If there are no signs of circulation, continue CPR for two more minutes. Repeat as needed.
Safety Notes:
If a child stops breathing, suction and change the tracheostomy tube as needed before starting CPR.
Discuss emergency plans with all caregivers and members of the household.
Even if your child improves quickly with CPR, seek emergency medical assistance immediately.
If your child is taken by ambulance, go with him or her. Take a clean tracheostomy tube of the same size and a smaller tracheostomy tube.
More: http://littledovepediatrichomehealth.nwsltr.info/how-to-deliver-cpr-to-children-with-a-tracheostomy/
07/07/2014
How to Deliver CPR to Children with a Tracheostomy: Little Dove Pediatric Home Health is one of the largest pediatric, private duty home health agencies in Texas. While we provide a variety of pediatric home health services, we strongly emphasize tracheostomy care for ventilator-dependent children. Children in this situation need the most attentive, dependable, and knowledgeable care possible. A question that often arises is how to deliver CPR to children with a tracheostomy. Here we provide those instructions for how to do this with different age groups of children without the ventilator. You can read this here on Facebook or read the same article on our blog: http://littledovepediatrichomehealth.nwsltr.info/. Note the “Print Friendly” button at the bottom of the article if you would like to print a copy. If your family and caregiving situation would benefit from experienced professional assistance at home, please call Little Dove Pediatric Home Health at 1-800-994-2218.
Watch for signs that your child may be having difficulty breathing:
fast breathing
hard breathing
pale skin
bluish skin
sweating
squeaky noise from tracheostomy tube
whistling noise from tracheostomy tube
Initial Action Steps:
Suction the tracheostomy tube promptly
Replace the tracheostomy tube if
the tube comes out
mucus blocks the tube
breathing does not improve with suctioning
Slow down, be quiet and determine if your child has stopped breathing. If so, perform CPR.
Cardiopulmonary Resuscitation (CPR):
Call 911 for help if there is time. Ideally, instruct someone else to call for help while you begin CPR. If there is not time, try to call 911 after five CPR sets. See below.
Gently move your child to stimulate him or her.
On a firm surface, place your child on his or her back. The floor or a sturdy table works.
Look, listen, and feel for breathing.
Place your mouth or breathing bag over the tracheostomy tube. Give two breaths. Make sure your child’s chest is moving with each breath.
If there are not signs of breathing, begin CPR
For Infants Less than 13 Months of Age:
Place two fingers on the breastbone, one finger width below the ni**le line. Press straight down one-third to one-half the depth of the chest at a rate of at least 100 times per minute – about twice per second. Give thirty compressions. Then give two breaths.
For Children Ages 1 to 8:
Place the heel of your hand on the lower half of the breastbone. Press straight down one-half to one-third the depth of the chest. Give compressions at a rate of at least 100 per minute – about twice per second. Give 30 compressions. Then give two breaths.
If You Are Alone and Did Not Call 911:
After five CPR sets (30 compressions followed by two breaths), move your child to a telephone if you are not on mobile. If it is not possible to move your child safely, do not move your child to the telephone. Call 911 (or your local emergency number where 911 is not available) to get help. Then promptly go back to CPR as long as there is a continued need.
For Children Age 8 and Over:
If you are alone, call 911 before beginning CPR. To begin CPR, place the heel of both hands on the lower half of the breast bone. Press straight down one-half to one-third the depth of the chest. Make compressions at a rate of at least 100 times per minute – about two per second. Give 30 compressions. Then, give two breaths.
All Ages:
Continue CPR sets for two minutes. Check for signs of circulation. If there are no signs of circulation, continue CPR for two more minutes. Repeat as needed.
Safety Notes:
If a child stops breathing, suction and change the tracheostomy tube as needed before starting CPR.
Discuss emergency plans with all caregivers and members of the household.
Even if your child improves quickly with CPR, seek emergency medical assistance immediately.
If your child is taken by ambulance, go with him or her. Take a clean tracheostomy tube of the same size and a smaller tracheostomy tube.
More: http://littledovepediatrichomehealth.nwsltr.info/how-to-deliver-cpr-to-children-with-a-tracheostomy/
06/12/2014
Reducing Preventable Mortality among Ventilator-Dependent Children: On any given day, there are an estimated 350 children in East Texas who are dependent on mechanical ventilation and at home.1 Technological advances in portable equipment and home monitoring have made treatment at home more prevalent. Ventilator-dependent children are in a high-risk state. Despite the improving technology, the preventable death rate among ventilator-dependent children – approximately 28% – has remained fairly constant over the past two decades.2 Record reviews suggest that the primary causes of preventable mortality among these high-risk cases are inadequate training of the family caregivers, inadequate training for home health nurses, improper responses to emergencies, and lack of vigilance.3
To prevent inadequate training of family caregivers and promote adequate vigilance, families with ventilator-dependent children with tracheostomies should receive home health nursing support in 100% of cases. This is part of the guidelines of American Thoracic Society.4 These families tend to receive 12 to 24 hours of care per day, with 16 hours of nursing being an average.
Unfortunately for many doctors and their patients, this solution has problems of its own. Doctors and discharge planners who are not referring to Little Dove Pediatric Home Health often find that coverage for these cases is a challenge. However, Little Dove Pediatric Home Health specializes in pediatric therapies – especially the care of ventilator-dependent children. As such, we are currently prepared to staff your referrals. The other problem with home health nursing is that research suggests that the majority of nurses providing this type of care lack adequate preparation. In a study published in Home Healthcare Nurse, when researchers tested 600 nurses who claimed to be qualified for tracheostomy care and ventilator management, despite an average of 14 years’ experience, the average test score was 60% on a test requiring 100% correct answers.3 Agency testing and training programs were riddled with self-guided, self-reporting methods. Other research has found that seasoned nurses often rely on outdated practices proven to be ineffective or harmful.5 Over the past decade, there have been important changes to the guidelines for suctioning, saline installation, and CPR of patients with a tracheostomy. Stuck in documented practices of regurgitating consensus opinions printed 20 years ago, home health agencies often fail in their responsibility to teach nurses the current, evidence-based practices.
Your solution to the home health nursing problem is Little Dove Pediatric Home Health. Recognizing that standard nurse training usually does not provide in-depth experience with tracheostomy care for ventilator-dependent children, Little Dove has developed its own training and competency verification program. The program is constantly updated based on the latest recommendations from authoritative bodies. All nurses complete the program annually. Nurses individually demonstrate 100% competency to an evaluator. Areas of competency include respiratory assessment, tracheostomy care, tracheostomy string change, suctioning of the tracheostomy, tracheostomy tube change, tracheostomy emergencies, CPR with a tracheostomy, ventilator care and management, and troubleshooting ventilator alarms. If you have families at home without adequate nursing coverage, families waiting to go home, or families complaining about the experience or availability of their home health nurses, please tell them about Little Dove Pediatric Home Health.
References
Boroughs D, Dougherty J. Care of the ventilator-dependent child in the home: A 30-year experience. American Thoracic Society Project Committee: Pediatric Chronic Home Ventilation Guidelines Workshop. 2011; Denver Colorado.
Edwards J, Kun S, Keens T. Outcomes and causes of dath in children on home mechanical ventilation via tracheostomy: An institutional and literature review. Journal of Pediatrics. 2010; 157 (6): 955.e2-959.e2.
Boroughs D, Dougherty J. Decreasing accidental mortality of ventilator-dependent children at home – A Call to Action. Home Healthcare Nurse. 2012; 30 (2): 103-111.
Sherman J, Davis S, Albomonte-Petrick S, et al. Care of the child with a chronic tracheostomy. American Journal of Respiratory and Critical Care Medicine. 2000; 161 (1): 297.
Halm M. Krisko-Hagel K. Instilling normal saline with suctioning: Beneficial technique or potentially harmful sacred cow? American Journal of Critical Care. 2008; 17 (5): 469-472.
More: http://littledovepediatrichomehealth.nwsltr.info/reducing-preventable-mortality-among-ventilator-dependent-children/
07/03/2014
06/03/2014
05/01/2014
