Changing Trach Size from Neo To Ped

[Baby1107]

Austin was trached at 3 months with a 3.5 Neo Shiley. Two months ago we moved from TX to CA. We last saw our TX ENT in late July and he set up a DLB for Sept. He never spoke of resizing at all. Unfortunately, we moved and now we are in the process of getting new Drs etc. So our first specialist appt @ CHLA was with Pulmo Care Center last week. The NP said she thought that Austin's trach was too short and that he needed to move up to a 3.5 Ped length. I told her we had not been able to confirm an ENT appt yet but I would ask about it. I remember reading a post here not too long ago about this very topic Neo vs Ped & age, size, etc...

Meanwhile, the Pulmo requested a baseline chest xray and 2 days later the NP called me back. She said that just as she suspected the Trach was too short and he could decann. She sent a script to our HHC to send out 3.5 Ped Shiley. She said I should have no trouble switching him out on my own during the next Trach change which is next Sat. I asked about the 3.0 downsized back-up, she said no you don't need it. WHAT?!?!

What do you think? Should I wait until we meet with the ENT? He has never had an accidental decann. How much longer is the Ped length? Something about this does not sit well with me...:confused:

[mamabear]

We made the same change a few weeks ago but it was because of granuloma and we had to trim 3mm off the ped. The trach change went smoothly but he did gag a little more with the ped length (ENT said he would hate it for a while but it wasn't that bad).

However, our advice came from the ENT so I wouldn't blame you if you felt more comfortable waiting.

[Mom2TwinsPlus1]

We hae never gotten downsized back ups. I steal them from hospitals and from people online.

[twintotwin]

You can use the 3.0 Neo as a back-up because it's just shorter. It would only be a temporary fix in case of emergency.
But I might have a 3.0 PED in storage for you...if you don't hear from me today please PM me.

I also thought that a doc had to place the first trach of a new size, but perhaps that doesn't count for just length.

mamabear We made the same change a few weeks ago but it was because of granuloma and we had to trim 3mm off the ped.
Mamabear, did you go down to a NEo from a Ped? That would make more sense than physically trimming the canula...or was that not what you meant?

Kerry

[twintotwin]

Janis, I don't have any 3.0 Peds...just a zillion other sizes.

One day I'll list them in "Pass It On"! :rolleyes:

[Livi's_mama]

I also thought that a doc had to place the first trach of a new size, but perhaps that doesn't count for just length.




Maybe that varies by location?

We were told that if we wanted to go down to a 3.0 (from 3.5) that we could, it was our choice. They just didn't want us going down to a 2.5 because of her size.



OP, our back up trach is a 3.0 neo shiley. We've always been a 3.5 ped flextend bivona. A backup is just basically to keep the stoma open and close to size, rather than internal length.

I've never heard the decan theory on NEOs though. I know most here are NEOs, we've been one of the few who's always had a ped.

I was told Peds are harder to breathe thru and really make the lungs work harder. (think the straw concept) Oh and our ENT has never dictated anything trach related, other than placing it. Our pulm handles everything trach related.

[twintotwin]

We were told that if we wanted to go down to a 3.0 (from 3.5) that we could, it was our choice. They just didn't want us going down to a 2.5 because of her size.


I've never heard the decan theory on NEOs though. I know most here are NEOs, we've been one of the few who's always had a ped.

I was told Peds are harder to breathe thru and really make the lungs work harder. (think the straw concept) Oh and our ENT has never dictated anything trach related, other than placing it. Our pulm handles everything trach related.

Do they make 2.5's?
Trish, it's easier to accidentally decann with the shorter canula because it tends to pop out faster. My boys never decanned on their Ped, but they do often now on the Neo. The Neo certainly has it's pros & cons.

Crap, I just brought up our chest O'trachs and we only have a 3.5 Neo Bivona (FlexTend) I thought I had a 3.0 for you.

[Mom_to_an_angel]

I have a few 3.0 shiley's ped left they need cleaned. Let me know if you want them. For Jordan's back up's she had a 2.5 binova ped. For jordan the 2.5 was like sucking thro a straw and the 3.0 was great for her. She was capped off most of the time anyway. So just pm me if you want the 3.0 shiley ped. and yes we switched from the neo to ped on our own. there was no problem w/ that either.

[JWorthington]

When we upsized Sam we did it at the hospital, but I did the change because they wanted it to be familiar for Sam. If you don't feel comfortable I would wait until you see ent.

Julie x

[Baby1107]

OP, our back up trach is a 3.0 neo shiley. We've always been a 3.5 ped flextend bivona. A backup is just basically to keep the stoma open and close to size, rather than internal length.

I've never heard the decan theory on NEOs though. I know most here are NEOs, we've been one of the few who's always had a ped.

I was told Peds are harder to breathe thru and really make the lungs work harder. (think the straw concept) Oh and our ENT has never dictated anything trach related, other than placing it. Our pulm handles everything trach related.

Good thinking! I still have a few NEW 3.0 NEO so I guess those can easily be the back up. If indeed we are moving to the 3.5 PED then I will have a few NEW 3.5 NEO's to offer up soon. I guess I am just not sold on the whole switching concept yet. Plus I just realized that this Saturday is his 1st birthday party and I am not doing a switch on that day...just in case he has any problems! I will wait until next week so I can think it over and hopefully get a 2nd opinion.

[Baby1107]

We hae never gotten downsized back ups. I steal them from hospitals and from people online.


We have always gotten them from the HHC, it is written in the script.

[KJKK8437]

We were told that a downsize neo is sufficient for a backup, even when you move to pedes. As Kerry said, it is just for emergencies.

[Baby1107]

We were told that a downsize neo is sufficient for a backup, even when you move to pedes. As Kerry said, it is just for emergencies.

Karin,

Did Alex move to Ped length too? I have noticed as Livismama pointed out older & bigger kids on here with Neo length so this switch has me worried. Austin is only 23lbs & 29in. I know it is based on where the trach "falls" so it is the internal structures...but still I am a bit worried about it.

[KJKK8437]

Karin,

Did Alex move to Ped length too? I have noticed as Livismama pointed out older & bigger kids on here with Neo length so this switch has me worried. Austin is only 23lbs & 29in. I know it is based on where the trach "falls" so it is the internal structures...but still I am a bit worried about it.

Yep. We switched last November when Alex was 5 months old. We were upsizing to a 3.5 and they did an xray and decided to get a pede instead of neo.

As active as Alex is, I am grateful for the pede length. As you know, we had problems after the upsize, but the length never seemed to be the issue. We have since downsized to a 3.0, but it, too, is a pede, and all the problems went away. Basically, Alex throws his head back a lot and turns his head vigorously, and I am sure he would decann himself if he had a shorter tube.

I was going to give you our suction depths, but we had Bivonas and I doubt that will be useful.

Let me know if there is anything else I can tell you about our experiences.

[Baby1107]

YES! I was wondering about the depths...right now we go to 5cm...when I get the Trach I will call back the NP to verify.

[KJKK8437]

YES! I was wondering about the depths...right now we go to 5cm...when I get the Trach I will call back the NP to verify.

Ok. For our 3.0 neo, we had a suction depth of 6.2. When we went to a 3.5 pede, it was 7.0 (I think). When we went to a 3.0 pede, it was 6.9.

[faywrayy]

Janis,

Kate started out in a 3.5 Neo Bivona. At 14 mos (and probably 20 lbs), she was upsized to a 3.5 Ped Bivona. I requested the upsize because she needed the length, she was decannulating herself by turning her head to fast (like Alex!). The ENT had wanted to upsize, so he put the new size in, in the OR during a bronch. Kate had no issues and he told us to keep a 3.0 Neo Shiley as our smaller sized back up trach.

I can look through our bag o' trachs and see what sizes I have. I'm pretty sure I have a 2.5 Neo Shiley...

[Livi's_mama]

Kerry,

That does make total sense!

I just looked at the neo compared to the ped and it looks so small (and foreign) to me! We've just always been a PED. She was 6 months and 14 lbs when we got her trach.

I'm not sure they go smaller than a 2.5 but they do make those. One was sent to us by mistake and I sent it to someone here who used them.

[mamabear]

Mamabear, did you go down to a NEo from a Ped? That would make more sense than physically trimming the canula...or was that not what you meant?

Kerry

We actually did have to cut the "tube" to fit his airway. The Neo was starting to get blocked by the granuloma and the Ped was a little too long for his airway so the ENT told us to trim 3mm from the Ped and file it down. :eek: Creepy, huh?! My husband did it and it turned out really nice.
-Diana

[lil' G's mom]

We just went from a NEO 3.5 to a PED 3.5 just today, G was decanning himself also by throwing his head back or turning to fast, so while we were doing some vent weaning today at doctors they had me switch it to the PED size and then did a X-Ray for placement to make sure it wasn.t to long, so maybe you can get in at least with your pulm, and see if he can have that done when you place it the first time.....

[KJKK8437]

2.5 neo shiley? I had thought only Bivona made 2.5s in any length. Live and learn.

I've seen 2.5s in neo and pede, but pede is usually special order.

[twintotwin]

We actually did have to cut the "tube" to fit his airway. The Neo was starting to get blocked by the granuloma and the Ped was a little too long for his airway so the ENT told us to trim 3mm from the Ped and file it down. :eek: Creepy, huh?! My husband did it and it turned out really nice.
-Diana

Will they be removing the granuloma soon? Milo's granulomas become overwhelming if we don't have them removed right away.
Good thing it worked out. They do make custom Bivonas for these reasons. Not every ENT knows this though. The Bivona is just a nice trach (who thought a trach could be nice?), I like the silicone, it's so soft and pliable. But the Shiley is suffice for my boys right now.

So I think it comes down to: the Ped vs. Neo issue is really just per kid. Children who tend to throw their heads back (as mine used to when we used a Ped), or child on the vent...they should probably benefit best from the longer Ped. Otherwise, kids with general issues such as chronic lung would benefit from the shorter Neo, so they don't have to work as hard to breathe through the "cocktail straw".

Of course if your child can't go one second without becoming dusky, you're better off with the Ped.

Bivona Flex Tends are generally used for vent kids because of the pliability. But they also make a flush trach comparable to the Shiley which can be customized.

[Baby1107]

So I think it comes down to: the Ped vs. Neo issue is really just per kid. Children who tend to throw their heads back (as mine used to when we used a Ped), or child on the vent...they should probably benefit best from the longer Ped. Otherwise, kids with general issues such as chronic lung would benefit from the shorter Neo, so they don't have to work as hard to breathe through the "cocktail straw".

Of course if your child can't go one second without becoming dusky, you're better off with the Ped.

That is just the thing...he is not on a vent, doesn't throw his head back or turn wildly risking decann. Also he has chronic lung disease so I am not sure this switch is such a good idea...esp. solo.

Also, as lilGsmom pointed out I would prefer to be able to check placement as the Neo is 32mm long vs 40mm for the Ped.

[faywrayy]

I can look through our bag o' trachs and see what sizes I have. I'm pretty sure I have a 2.5 Neo Shiley...


Nope, sorry no 2.5 neo...and frankly no clue why I thought I had that! We used a 3.0 new shiley for back up the entire time she was trached.

I so have 2 3.0 neo shileys if you need more. Let me know. I also have a 3.0 neo Bivona.

[cari]

We just went from a 4.0 neo to a 4.0 ped. We were told that they are still of the same dimension and size but one centimetre longer in length. So now when we suction her we go down an extra number. Emerson was popping her trach out and so we knew she needed a longer one. We let an RT student do the change under supervision because we don't mind having Emerson help others to learn. We were given a 3.5 back up for her also but were told we could also still use our 3.5 neo's still too, they would just be shorter. I hope this helps and good luck!

[Livi's_mama]

Bivona Flex Tends are generally used for vent kids because of the pliability.

And chubby cheeked / not much neck babes. :p


I love the bivonas.

In my non-medically degreed opinion....the breathing thru the ped tube, helped strengthened Olivia's lungs, her recent xrays are looking quite good. :cool: :D

[twintotwin]

And chubby cheeked / not much neck babes. :p


I love the bivonas.

In my non-medically degreed opinion....the breathing thru the ped tube, helped strengthened Olivia's lungs, her recent xrays are looking quite good. :cool: :D

Lots of tickling helps too! :p