View Full Version : Switched to Bovina, advice needed

01-27-2010, 05:08 PM
Emma's doc just changed her from a 5.0 ped shiley no cuff to a 5.5 bovina with a cuff. He didn't give me any instructions for it, just ordered it. I was about to ask when I realized we were going to miss our bus if I did, so I figured I would get any questions answered here.

It got here today and we put it in, it was a tight fit, so I think that will take care of our air leak issues, but if I have to inflate the cuff, is there anything I need to know other than what the package insert says? It says check with 5mls sterile water, then pull water out, put the trach in and use min. amount of water to inflate, how will I know when I have used enough water?

Also cleaning and sanitizing, the insert tells a few ways but I want to know what is the best way and the easiest way so how do you all do it?

Thanks in advance

01-27-2010, 05:18 PM
Lori - Jack has about 3-3.5 cc of water in his cuff. But, obviously, each kid is different. Jack has the cuff because his airleak is huge and the vent autocycles. I put in just enough water to stop the autocycling and I always make sure I can still feel air coming out his mouth when the vent gives a breath. I want some airleak. I also put a little more water in the cuff at night and then take it out in the morning when Jack wakes up.

As far as cleaning, you clean the same way as you do a cuffless trach. (we soak in water that has been heated to boiling for 20 minutes, per Bivona).

Did you get a TTS (tight-to-shaft) trach?

01-27-2010, 05:22 PM
Yes its is a TTS. I played with the cuff a bit to see what it would do. Her pressures without it are 20-25 range which is ok right now, but I want to check when she is sleeping too, it will be lower. When I tried to add the water I met a lot of resistance after about .5 to 1 ml, what does that mean? I did check before I put it in, the ballon flated with a full 5mls no leak or anything. I know I have the syringe in correctly and everything.

I can tell just the size diffrence has helped, her pressures before were 15ish or so, give or take a few either direction, and her vent just sounds different if that makes any sense! LOL

Alex's mom
01-27-2010, 05:24 PM
We use a Bivona cuffed trach only when Alex is sick. I have 3 cuffed trachs that I rotate, and they all take different amounts of water. Test the cuff out (like you said above) to make sure the cuff is working. Sometimes it gets sticky and you have to inflate and deflate a few times to unstick it.

Our instructions once the trach is in were to use a stethescope to listen to the leak while slowly inflating the cuff. Once you can no longer hear a leak, take back a small amount so that you can hear a tiny bit of noise. They advised us to not have the cuff inflated too much to avoid causing any issues with the airway. Whenever I am changing the amount in the cuff I do it slowly. She seems to be a little weirded out over the change so I try to make it as comfortable as possible.

I find that I have to adjust the amount that is in the cuff depending on her position (sitting, laying down) and if she is sleeping. I deflate the cuff each morning and reinflate to check it. I also keep a syringe with the spare trach in case I have to do an emergency trach change and have to deflate the cuff quickly.

I clean the cuffed trach the same way I clean the uncuffed Bivonas. Wash in hot soapy water, antibactierial soap. Rinse thoroughly. Boil water, take water off heat and place trach in until the water is almost cooled. Air dry.

01-27-2010, 05:27 PM
Well if I had a stetescope I would do that! LOL I used to have one and it broke and I need to replace it. Emma is never sick and has healthy lungs so we have never really had a need to have one until now. I will look into getting one though, if anything to just listen to see what she sounds like when I inflate it.

Alex's mom
01-27-2010, 05:41 PM
Well if I had a stetescope I would do that! LOL I used to have one and it broke and I need to replace it. Emma is never sick and has healthy lungs so we have never really had a need to have one until now. I will look into getting one though, if anything to just listen to see what she sounds like when I inflate it.

Honestly you don't need one. You can even just use your hand on her neck and feel the vibration from the leak with and without the cuff inflated. I'm sure you'll be doing it all with your eyes closed in no time. :D

01-27-2010, 05:46 PM
Unlike the Shiley, there is an extra part to remove on the Bivona when you clean it. (the gray/blue swivel part). We had a post on that with pictures. Lemme see if I can link it rather than telling you something you probably already know. (LOL)

01-27-2010, 06:07 PM
Lori - it sounds like just having the bigger trach may be enough right now without inflating the cuff. If you meet resistance when you add water, then you are likely touching the tracheal walls with the cuff, which you don't want to do if you can help it. The Bivona TTS is a "pressure cuff" because it uses water and not air, therefore, you want to be careful not to over inflate.

I've never used a stethescope when I inflate Jack's cuff - I use my hand and feel for air coming out of his mouth (very technical, I know :D ). I also look at Jack, he lets me know when I put too much water in because he doesn't like it one bit.

Also, I've also never taken the Bivona apart to clean it - for what it's worth.

Good luck.

01-27-2010, 07:42 PM
I figured it wasn't needed when I couldn't really get any water in, and won't try it anymore until our pressures drop lower, probably as she grows or if she is in a wacky position or something.

She was in a 4.5 ped shiley until Dec then they upped her to a 5.0 shiley, and finally yesterday to this 5.5 bovina. I do like that its more flexy than a shiley, so maybe it will be more comfortable for her too.

01-27-2010, 08:15 PM
the new bivonas no longer have the extra hard plastic swivel part on them.. the part that attaches to the vent now is grey and the whole thing is harder plastic . I do as everyone else, wash in soap/ boil water -take it off heat -place trach in for 20mins or till hand cool- dry completely-place in ziplock.. I also keep an extra syringe taped to wall with emergency trachs for quick deflation when I need to remove it.

When we use cuff trach, I ask joseph to "talk" and as I inflate it, it has enough water when the sound no longer comes out. (yep another highly tech method :p)and then I usually take out another .5 just to make sure it is not too tight.

01-27-2010, 08:40 PM
evan being as big as he is, has a 7.7 bivona cuffed trach we were told to fill it 4ml h20, i never fill it that much, usualy just 3, unless i hear him snoring on the vent then raise it to like 3.2 he cant talk with trach cuffed and gets panicky whe nhe wakes up middle of the night and cant readily deflate cuff to go to thwe bathrrom or whatever. should i steriliz the syringe i use to cuff his trach? it doesn't get into his sytem right?