'Gadget' arrangement on circuit tubing?

[Caty]

Nate is just now tolerating his PMV and I have no clue what the set-up should be on his circuit tubing. Right now, when off the heater/humidifier, he has (in order from the trach down): elbow swivel, omniflex, PMV, PMV adapter, Thermovent, tubing. He had problems in the hospital with CO2 retention and I'm wondering if all the "dead space" is setting us up for this? His nurse will tell us yes, this is too much, but what's the real world answer? Advice, please? :D

Thanks,

[Mom2TwinsPlus1]

I am not sure of advice but I do know when Emma was pre-vent they put an ominflex on her to get that trach passed her chubby neck and I was told that extended the ominflex can hold up to 10 mls of dead air. It caused her CO2 levels to rise, and we had never had problems with Co2. They wanted to revent her and I begged them to take the ominflex off the doctor said it was not going to be that big of a diffrence, but within a few hours her Co2 levels went from mod high to well within normal. Now with the vent she is fine with the omniflex. I would think with all that stuff added that it might be an issue if you have had Co issues before.

Is there anyway he can do without the thermovent? I know some kids do ok secrection wise just on the PMV and maybe just drop a few drops of saline down the neck? That might help eliminate some dead air. Not sure what else to advise but I hope you get it figured out

[Alex's mom]

Alex doesn't use the pmv much, but when we do she is attached to the heater/humidifier. The only time she is off is when we're not home or outside - so we don't use the thermovent. We also don't use an elbow. Just the omniflex, pmv and pmv adapter. I haven't started using the pmv while out. She just seems to get too dry and I don't like to deal w/that issue when we're not home.

I don't know if this effects anything, but on the pmv - would retaining co2 in the tubing be an issue since he is exhaling out of his nose and mouth instead of the vent circuit?

[Caty]

I don't know if this effects anything, but on the pmv - would retaining co2 in the tubing be an issue since he is exhaling out of his nose and mouth instead of the vent circuit?

That's a good point and makes sense. But his CO2 levels were high before the trach/while he was intubated and that's one of the reasons the trach was so important at first. hmm? I just have no clue. I broke down and emailed his RT so maybe she'll have some answers. :confused:

[drct1245]

We always used a HME while on the vent, however, when using the PMV off the vent, we never used a HME w/ the PMV. B/c you are on the vent, do you need the HME? (I don't know the answer just posing a Q for others...)

[lil' G's mom]

We have elbow, omni-flex, then vent.... the only time we use thermavent is when were out and then I put it between omni & vent.... We've never used a pmv....

[Melisande]

Yes, dead space isn't good for CO2 retention. Not sure how you configure that differently other than to perhaps get rid of the ominiflex while you use the PMV, if that's possible. We just use the omniflex and not the elbow with Donovan's set up but he only uses it while he sleeps.

[FightingForFaith]

This is all news to me- I had no idea you could use a PMV on a vent! I don't think Faith would tolerate that right now but it's nice to know it could be an option down the road!

[KJKK8437]

This is all news to me- I had no idea you could use a PMV on a vent! I don't think Faith would tolerate that right now but it's nice to know it could be an option down the road!

Actually, our pulmonologist says that vent kids take to the PMV much more easily than non-vented kids. They don't have quite the adjustment issues with feeling the subglottic pressure because of the support the ventilator provides. (I hope I have that right; Alex was only vented for a few days, so I don't know a whole lot about vents and I might not be remembering the right medical terms.)