This document provides information on oxygen use and pediatric respiratory treatments in the home setting. It discusses oxygen orders and monitoring, nebulizer treatments, oxygen safety, administration methods including nasal cannula and mask, and types of humidification. It also covers opening oxygen tanks, attaching regulators, types of oxygen, using Ambu bags properly, tracheotomy care in children, and feeding tubes in children including common types like G-tubes and their replacement and care.

1. Oxygen
and Pediatric Patient
Tammy Marie Baker RN
P E D I AT R I C S E R I E S 2 0 1 2

2. Oxygen use in the Home:
 Oxygen is considered a medication
 MD orders are required with parameters for usage
 If child is not compensating on prescribed dose
call MD and notify MD if distress persists.
 Oxygen should be on the MAR and Med profile and
signed off by the SN.

3. Nebulizer Treatments
 Nebulizer treatments are used to open airway and break
up secretions
 Method of Delivery :Mask or mouth piece
 Types of Medications include Bronchodilators, Mucolytics,
Steroids and Antibiotics
 PSS bullets may also be used to humidify or break up secreations
Note: Equipment must be sanitized
after each use and stored clean and dry

4. Oxygen Safety in the Home
 No smoking in the home
 Oxygen sign placed on the door of home and
available through DME
 Local fire dept. notified of oxygen at address of
home
 Storage in secured area away from furnace or heat
 No Vaseline or petroleum products used on face or
neck of patient
 Pediatric regulator will limit O2 to 1-3 l/min

5. Methods of Administration
 Nasal cannula
 Mask
 Ambu bag
 Ventilator

6. Humidification
Humidity must be provided to moisten internal airways and loosen secretions
Types of humidification for Pediatric Oxygen
delivery
 Trach collar with Bubble nebulizer
 HME ( Humidity Exchange Device)
 Humidifier for in line ventilator use

7. How to open Oxygen tank:
cracking the tank and attaching the regulator
 Wash your hands. Remove the white or blue plastic tape from the top of the tank. Remove and discard the disposable crush
gasket. Caution: never use the crush gasket for setting up the tank.
 Crack the tank Point the oxygen outlet away from yourself and others.
 Place the wrench (included with the oxygen tank) on the valve on top of the tank Turn the valve to the left (counterclockwise). A
hissing sound means gas is coming out.
 Stop once you hear the hissing sound, and turn the valve off by turning it to the right (clockwise). Don’t over tighten.
 Always be sure the valve, regulator, and sealing washer are free of oil or grease. Oil or grease can cause a fire.
 Next place the sealing washer on the tank. Attach the regulator on the tank by lining up the three regulator pins to the three
holes on the tank. Tighten the regulator onto the tank with the T-bar handle. Open the tank by turning the valve with the
wrench one complete turn counterclockwise. Turn the wrench slowly.
 A hissing sound designates a leaking tank. If this occurs there is a leak. Immediately Close the tank by turning the wrench
clockwise. Call your oxygen supply company right away.
 Check the pressure gauge. Place the oxygen tubing on the regulator’s outlet or nipple. Turn the flow meter knob to the LPM
setting prescribed by your child’s doctor .
 wait until the valve is fully open, to get an accurate reading of how much oxygen is in the tank.


8. Types of Oxygen
 Compressed
 stored as a gas under pressure in a cylinder equipped with a
flow meter and regulator to control the flow rate.
 Liquid
 At extremely cold temperatures, oxygen changes from gas to
a liquid. The liquid oxygen is stored in a vessel similar to a
thermos. When the oxygen is warmed, it becomes a gas
 Concentrator
 electrically operated medical device that extracts air from the
room, separates the oxygen from other gases present, and
delivers oxygen to the patient

9. Ambu Bag
 A bag valve mask, ( BVM )also Known as an
Ambu bag
 A hand hand-held device used to provide positive
pressure ventilation manually when a patient is not
breathing or breathing inadequately
 Used to manually air rate the patient for transport,
between circuit changes on a vent, after suctioning
 Ambu bags Emergancy management Equipement
for

10. Types of Ambu Bags
 Flow-inflating bags : Termed "anesthesia bags" or
"flow-inflating bags" these bags require an
external flow source to inflate.
 *Self-inflating bags: The bag portion of the BVM is
rigid and self-inflates when released; this does not
require an external flow source.
 The self inflating bag would be more likely to be
used in the home and home care setting.

11. Methods of Application
 *Mask placed over mouth and or nose
 Endotracheal tube – direct attachment
 *Trach – direct attachment
 Used over nasal airway
 Oral pharengeal airway
 Laryngeal mask airway
 * more commonly found in HC setting

12. Potential Complications of
Ambu Bag usage:
 Hyper inflation
 Gastric distention
 Vomitus and aspiration

13. Proper Usage
 Gently compress ambu bag to inflate chest
 3 seconds for an infant or child provides an
adequate respiratory rate ( 12 RPM Adult and 20
RPM in child or infant)
 Administer 3-5 breaths after suctioning the child

14. Tracheotomy in Children

15. Tracheotomy in Children

16. Tracheotomy in Children

17. Tracheotomy in Children

18. Feeding Tubes in Children

19. G-Tubes in Children
Nutritional support for Nutritionally Challenged, Dysphasic or
Gastric malfunctioning children
 Types of Gastric Feeding Tubes for children:
Nasogastic tube
Gastric tubes
 Mickey Button
 MCI Mini button
 Peg tube
 Mick G
 Nutriport
Jejunostomy tubes
 G/J tube
 jejunostomy

20.  Gastric tubes are placed in OR or Radiology
 Most gastric tubes can be replaced by PCG/SN once stoma is matured if not sutured in place.
 G-Tubes are changed per MD orders every 1-3 months unless dislodged, or damage of balloon occurs.
 G-tubes are cleansed every shift or daily and prn. Warm soapy water or ½ strength peroxide , PSS may also be
used. MD orders are followed for care. Check POC.
 If redness or irritation occurs notify MD. Assess for excoriation and S/S of infection and report to MD.
 MD may order antibacterial cream, antifungals or stoma powder. MD orders needed for these treatments.
 Children whom experience gastric tube dislodgement should have their Gastric tubes replaced and placement
checked immediately after dislodgement unless resistance met or stoma unable to be threaded.
 A nutritionally dependent child must have GT tube replaced ASAP. Delay may impede child's Fluids/
Electrolytes/Nutritional status ASAP.
 If stoma is unable to be re cannulated child should be taken to EMD for evaluation and replacement of tube. Notify
MD if G-tube out and unable to be replaced. Reassure parent and offer support.
 EMD can Dilate of stoma via via red rubber catheter with surgi-lube will allow re-access of stoma


21. G-Tube “Go Bag” SUPPLIES
 Gloves
 Replacement g-tube same size
 Surgi- lube
 Syringe
 Guaze or drain sponge
 Bottled water
 Nutritional supplements