position for tube change

saywhatyouwill · #1 06-25-2008, 03:09 AM

Emily is 16 months so we lie her down and swaddle her when we change her tube - she doesn't like it much. I used to also clean her neck this way every evening, but a couple of days ago i sat her up in front of the mirror to do it and she LOVED it! she had a satisfied little smile on her face and kept asking me to get more saline and clean some more! same again the next 2 times i did this.

so...i'm sure she is too young to sit up for a tube change, but was wondering when other people progressed to this?
or any other suggestions to make tube changes less annoying for her?

JWorthington · #2 06-25-2008, 03:44 AM

We still change Sam's tube with him laying down (he's 5). He is still quite a wriggler and thinks it's funny to wave his arms and feet around and laugh at us when we are doing the change. We use a rolled up blanket under his neck for easier access, then once the new tube is in we sit him up to finish off.
I really think it depends on the child, Sam is autistic so can be pretty uncooperative at times, I think children with learning difficulties cannot always understand that they need to keep still and that you need to get the new tube in quickly. JMO

Juliex

cariaad · #3 06-25-2008, 05:35 AM

I think we started doinf Allison's sitting up areound age 3 or so. She was much better with it. It may have actually been earlier--it was when she started trying to roll over and crawl aaway during the tube change. I think if she will sit up and cooperate, then I'd try it. Deb

KJKK8437 · #4 06-25-2008, 08:11 AM

Quote:

Originally Posted by cariaad

it was when she started trying to roll over and crawl aaway during the tube change. I think if she will sit up and cooperate, then I'd try it. Deb

Oh, we are so there. Alex wants to roll away for anything. We change ties sitting up, but not the tube. As soon as we started changing ties sitting up, he stopped crying when he saw the ties coming. He just doesn't meet the second criteria -- "cooperate"! Waiting for the day....

faywrayy · #5 06-25-2008, 09:03 AM

We still do it lying down. Kate is too stubborn and wants things her way. I'm afraid if her mood changed mid way through the tube change, we'd be in trouble. It's not easy lying down, but it's not bad either.

LKN · #6 06-25-2008, 09:24 AM

I agree--it definitely depends on the child. We started doing Nathan's tube changes sitting up right after he turned 2. He likes it much better--no swaddling, no holding his arms and legs, and he can tilt his head back when the tube is pulled out. I think he feels more in control, and he really likes that!

We started doing trach care/trach ties sitting up as soon as he could sit up--probably around 6 months old.

saywhatyouwill · #7 06-25-2008, 10:09 AM

Quote:

Originally Posted by LKN

We started doing trach care/trach ties sitting up as soon as he could sit up--probably around 6 months old.

i'd just never thought of cleaning her neck whilst she was sitting up!!...we don't change the ties at all because her tube comes out every other day.

this all makes sense though - i'm sure emily would prefer to sit up for the change because she'd be in control (and my god, she hates not to be - she is like looking at a mini version of myself sometimes) but equally, she's too unpredictable to be able to trust that she won't suddenly decide not to cooperate.

TommysDad · #8 06-25-2008, 04:26 PM

We too have wondered when would be a good time to try changing the tube while Tommy is sitting up. He already hates to lay down for tie changes so we sit him up while he watches Signing Time while we do his ties. Now he knows when we lay him down he's getting a trach change, and he does not like it! So, we have told him we are going to pull it out on "3", and let him help. He seems a little more at ease, but still doesn't like it! However, I'm waiting for this to back fire on us

I'm afraid this is teaching him to pull out his trach

We opt not to do the trach change sitting up because Tommy has such a chubby face, you can barely see his neck. Plus he has such a critical airway, we want quick and immediate access to his stoma. We can't get that while he's sitting up. I do think he would "cooperate", and he's not even 2 yet, but if we can't get it in...

Alethia · #9 06-25-2008, 05:22 PM

We've been changing Angus' trach tube sitting up since somewhere between the ages of 18 months and 2 years. He was starting to get fidgety and panicky when we changed it lying down - mostly because he doesn't breathe as easily lying down. If you are worried abotu the transition, position her somewhere so you can lie her down quickly over a neck roll if you start to have trouble.

saywhatyouwill · #10 06-30-2008, 07:02 AM

we've tried it twice now sitting up - i put a mirror in front of emily so that she could see what was happened, and also as a distraction.
both times went well and she didn't cry at all until this morning when i couldn't quite get the new tube in quick enough

we were all sitting on the floor so i think if she was higher and we could stand it would be easier.