View Full Version : Bivona trachs...
01-13-2005, 09:02 AM
A few months ago we decided to switch Jacob over to a Bivona trach in hopes of one day using the TTS cuffed Bivona to prevent the huge leak Jacob has on the vent. His pulmo is very conservative about making any changes, so we always take baby steps. The first time I put in a 4.0 ped Bivona (same size as Shiley he had in), within 12 hours, I was suctioning blood. I attributed it to weather, because Jacob tends to be drier this time of year. But it didn't stop, so I put back in the Shiley. Well, I have tried the Bivona 3 times now and each time I suction blood within a day or two. I know the Bivonas are much more pliable vs. the rigid Shileys, but I thought that is what made them more desirable and the "better" trach. What is going on? Has this happened to any others? I don't want to tell his pulmo right now because he will immediately say "no more Bivonas, ever."
01-13-2005, 09:59 AM
we have a shiley, but perhaps the cannula is too long or the cuff could be to much for his airway. i would talk to pulmonary, it might not be the news you want to hear, but it could be something they could help you troubleshoot. i have done a lot research on problems from a trach and they can be dangerous, if you can rule out the weather i would call ent or pulmonary. good luck
mom to anthony 18 month trach gbutton fundo
01-13-2005, 10:32 AM
Our ENT won't do a cuffed trach for kids. I don't know why. We have a Bivona flextend custom ped 3.5. Never had much problem. It could be that there might be some granulation tissue that is irritated by the Bivona. From what our ENT says, all kids get it. It's just the nature of the beast. The Bivona may sit slightly different in the trachea and irritate graulation tissue. It could be something else. I know you hate to talk to the doc, but perhaps you should. If your shiley is not cuffed and the Bivona is - maybe that's an issue too.
We just changed a recently from a neo to a pediatric length. That's helped tons with the leak issue. The vent used to be very positional and low volume a lot. Now, it's much better. Like I said the ENT won't do a cuffed trach, so increasing the length was a good as we could do for now.
Let us know what happens.
Amanda - I can't imagine that the fact it's a Bivona is causing the problem. Â*I know that a 4.0 Bivona is somewhat bigger in diameter than a 4.0 Shiley. Have you held the Shiley and the Bivona next to eachother to compare? Â*My guess is that the little bit of blood is due to the very small difference in the size of the Bivona. An option may be to get a 1/2 size smaller Bivona, especially if you are going to a TTS eventually. Â*
On a side note, we just switched Jack to a Bivona aircuff from a TTS - OMG, it absolutely freaks me out to do his trach change because the aircuff doesn't fully deflate like the TTS and we really have to push to get the trach in and pull to get it out. Â*It's awful! I've thought of going back to the TTS and just moving up a size with the trach, but it's taken an act of God to get the trach we have (a very LONG story regarding my dealings with the ENT here in Phoenix), so I've decided to just stay with it knowing that it will be many, many years before we have to upsize Jack's trach again.
Again, you may just want to ask the ENT to go down a 1/2 size with the Bivona. Â*
Melisande: I'm not sure why an ENT won't do a cuffed trach for a child if the child in on a vent. A child that is vent dependent for *life* is eventually going to need a cuffed trach especially to avoid having to move up to an adult trach - we almost went that route and it was ugly! I would think it would be a decision between the ENT and the pulmonologist. Donovan is still very young, so it's probably not even an issue right now. Jack didn't get a cuffed trach until he was 3 1/2.
01-13-2005, 02:35 PM
I forgot to say that neither Jacob's ENT or pulmo do cuffs for kids. They say, especially in Jacob's case because he will have his trach long term, it will do more damage than good. I really had to fight to take the step to switch to an uncuffed Bivona in hopes of using a cuff one day. That is why I don't want to call them. Also, this last time I put the Bivona in, Jacob pulled at it for a few hours before I switched it out.
The 4.0 Bivona is .1mm wider (OD) than the 4.0 Shiley. Side-by-side you can't tell the difference in diameter, or length, for that matter, but I know that it can still make a dfiference. I don't want to go back down to a 3.5 because the reason we upsized was because Jacob was having some satting problems. And the 4.0 helped tremendously with that.
I think what Melisande said about position might be it. I may just ask for a routine scope to "check things out" before trying it again. And besides, ENT would be much easier to talk to about this.
Amanda - another thing came to mind and you most likely have checked this, but the Bivona has two types of flanges - a "V" and a straight flange. Â*Jack can only use the "V" flange - I remember when they once sent out a trach with the wrong flange - he hated it. Â*If that's not the problem, I've run out of ideas. Â*It's definitely worth a scope in the office to see what you can find out. Â*
Keep us posted.
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