Trach ?'s

[Whitney]

Ok

1. For those with Pulsox monitors...where to you like to keep your child O2 sats?? Our pediatrician and pulmonologist have conflicting opinions and our home nurses also have their own ideas too. I like to keep Alex around 94-97%...that is also where they tried to keep him in the NICU.

2. Since Alex was trached, he no longer likes to sit upright. He arches his neck back and he throws his arms back too. I am of course working on improving this, but it has been difficult at times. Did you have similar experiences with the trach? Any ideas? He can't sit upright (on my lap) for more than a few minutes. Any ideas on this too?

3. He is not a big fan of tummy-time now. He used to love it prior to his trach. I use my leg, boppy, pillows, etc, but it still builds up his secretions quickly and I have to suction him. Any ideas??

4. How do you go about safely reusing a trach suction catheter? I use half strength vinegar and I rinse with distilled water. I soak the catheters in two different rotations (vinegar/rinse with distilled water) prior to suctioning. Any other ideas?

THANKS A LOT FOR YOUR HELP!!

Whitney

[Olga]

Hi Whitney

I hope these thoughts will help:

1. The hospital Grace went to always said that sats of 95% and higher were fine.
2. It sounds like the trachy is uncomfortable for Alex. Perhaps he needs a different length. Grace never went above a Shiley 3.5 neo and never had any problems. Grace didn't sit up on her own until she was 10 months old and I will never know whether that was due to the trachy or that she was just not ready.
3. Grace also needed more suction when she played on her tummy. In fact she always needed more suction after strenuous activity, right until she was decannulated.
4. We NEVER reused catheters. I didn't have to pay for them directly so I only ever used one per suction and threw them away. The hospital was insistent that catheters were never to be reused because of the risk of infection. Also the ones I got specified that they were for single use only.

[Jacks Mum]

Hi there,

Jacks doctors say to keep him 94% an above, he is usually in air, and barely requires oxygen, for us, if he needs 02 and has a temp he is go to picu, in case of infection.
If Alex is in oxygen, I think 94-97% is good to sit.
I *try* to not look at the numbers, however if he is clearly upset whilst sitting at 94% i will give him Chest physio and suction, this usually works.

2: Do you know why he does not enjoy sitting up? does he need lots of suction when sat up?

3. Maybe alex gets up due to the increase to secretions, I know days when Jack is sitting up, or on tummy, when the secretions build up he got distressed.

4. We have never had to resuse catheters, nor are we allowed, we get allocated 900 single use caths per month by our hospital. I think it is 30 p/d.
I do however, reuse a catheter 2-3 times when i am doing chest physio in the mornings, otherwise I would be using 8-10 catheters in a 30 minute period.
I can you sterilise them in a solution like what you sterile newborn babies feeding equipment?

Jessica

[Brandon & Angel]

Welcome...First I saw you posted some where you live in Colorado..Angels Parents Live in that State as Well....

1*...Angels Doctors Like to See Stats at 97% and Above...We never see them that High,,,,No Matter what....

2*....Angel is unable to sit unassited and is unable to Hold her Head...My only Gues is he finds the Trach uncomfrtable so he tilts a certain way....

3* Angel luves Tummy time..until she gets Bored with it....We use a Boppy pillow...Or when we lay her on her side I made Foam wedges....Both kep her Comfy....Angel alwyas has alot of Secretons I would not say she has More....

4* If I do not reuse a Suction Cath within 30 Min...It is Garbage....It is Garbage after the Second use no matter what....

B and Angel

[cariaad]

We were always told to keep Alli's sats at 93 or above. At 93 we would give O2. Now we dont even have a moniter or anything . If she's in need of O2 she is sick enough to be seen at the hospital (unfortunately). We reuse catheters. At home, on a good day we will only use 2 or 3 in a 24 hour period. She goes thru more at school, but I don't mind because it's a different environment there. I just run some water thru it after use and store it in the paper sleeve it came in. If she is sick however, 2 uses is the most I will do. We have never had any problems with sickness or infection from this. I think it is just what you are comfortable with and how many you are supplied. As to not wanting to sit or do tummy time, I agree that I would ask the ENT if the trach is too long, it may be causing discomfort. Alli is 3 1/2 and still in the same size she began with (Shiley 3.0 Neo). The Peds are longer than Neos. Good luck, Deb

[Karen S.]

1. We keep Hannah's SATS at 95 and greater at all times. If they do go below 95, we usually wait an hour to see if they improve. If not, we make changes to her vent settings rather than put her on oxygen. This has worked great for the last 3 years.

2. I agree with the others, that his trach may be too long. I would consult with your ENT.

3. We never had a problem with tummy time. Maybe the situation with Alex is connected to the trach. Again, I would consult with your ENT.

4. We also do not reuse suction caths, but then again, by insurance doesn't limit me either. We have tried the inline suction caths and they work great if your child requires alot of suctioning. Hannah is only suctioned 5-6 times a day, and we didn't feel that it was right for us.

Good luck.

[indiemum]

When we first brought Indie home (3.5 months), she would lay in a normal position and cock her head back as far as it would go, as if she were trying to get max air intake. She HATED tummy time and at 5 months could not hold her head up while on her tummy, however within a very short time she realized that the more she did, the more she could do. Indie's gross motor assessments were very grim at first but she is now above average in every way and she exceeded all of her therapists "time frames". Sitting up used to cause Indie to throw up, we think it was the position of sitting that caused irritaiton in her airway and then gagging and puking etc. I have always said that Indie will do what she wants when she wants and she has no more hurdles except for the trach and G-Tube. We keep our oximiter at 92%to 100%,and if Indie is at 92% for more than an hour, we go ahead with O2. Hope this helps.

Kelly

Jacob at first did not like his tummy time either, but as he got older and learn to roll over it did not bother him as much.

His PT said that when worked physically all babies tend to drool a lot more than usually. Which Jacob does a lot now that he is trying to stand and walk. He just skipped the crawling. I especially notice that he drools and has increased secretions when the PT is working him.

I really think he will get used to the tummy time. It's new to him with the trach. You know your child better than anyone, as long as you don't feel he is hurting. I noticed that Jacob had to hold his head up really good to clear the trach (he has a flextend which is longer) I think that is why it bothered him. He had to really work those muscles. I cheered him on and comforted him when he got really bent out of shape about it. Eventually, it was as though he'd been doing it forever.

Amy

[Judy]

Our 7 year old does not like to sit upright at all. She can not sit unassisted and is in no pain she would just prefer to lie in bed or on the bean bag chair all the time. But, we do not let her lie down all the time. Ha! When we sit her in her feeder seat she will lean over with her head falling out of the seat. WE put her back up right. Out she goes again. I will leave her in the "bad" position a couple of minutes then straighten her up again. She finally gives up and naps in a compromise position.

She does not like to be put on her stomach but if we prop her on her side, she will get to her stomach on her own and loves it. He suctioning needs do not usually change with this position.

We do reuse suction catheters at home. We clean them with each use. We don't reuse them a lot and thus far we have had no infections. All of her doctors are really impressed with how well she stays considering all her medical issues.

All of her doctors want her SATS to be between 93 and 100.
They usually do stay in that range unless she has a cold
or the weather is causing her to need more suctioning. She does not like to be suctioned so he gets agitated and that brings on more secretions. It is a vicious circle and of course she does not understand that she is bringing on the suctioning that she hates.

Good Luck to all of you.

Judy, Ken and the 5 special Angels

[Jacob's Mom]

We also like to see Jacob's O2 sat above 93% - I was also told that there is no significant difference between 93 and 100%. Â*At night, we set his low alarm at 90% to keep from getting up every 30 minutes when he is moving around. Â*He isn't on the pulse-ox during the day, except when he is sick, and then we keep it at 93%. Â*

We also reuse suction catheters, but not for more than an hour or two. Â*If we used a new catheter each time Jacob needed suctioning, we would use 100 a day!! Â*We normally use 10-12 a day.