Oxygenand Pediatric Patient Tammy Marie Baker RN P E D I AT R I C S E R I E S 2 0 1 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.
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
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
Methods of Administration Nasal cannula Mask Ambu bag Ventilator
Humidiﬁcation Humidity must be provided to moisten internal airways and loosen secretionsTypes of humidiﬁcation for Pediatric Oxygendelivery Trach collar with Bubble nebulizer HME ( Humidity Exchange Device) Humidiﬁer for in line ventilator use
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.
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
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
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.
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
Potential Complications of Ambu Bag usage: Hyper inﬂation Gastric distention Vomitus and aspiration
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
G-Tubes in Children Nutritional support for Nutritionally Challenged, Dysphasic or Gastric malfunctioning children Types of Gastric Feeding Tubes for children:Nasogastic tubeGastric tubes Mickey Button MCI Mini button Peg tube Mick G NutriportJejunostomy tubes G/J tube jejunostomy
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 childs 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