Pulse Ox & Trach Swivel Questions

[JandD]

I have two questions. Our nursing agency's policy is that the pulse ox sensor is moved to a new site every two hours to prevent burns. Do you all do this as well?

My second is about the swivel. At the nursing home, they didn't use a swivel with Lil D. But he also was in bed 99% of the time. We started using a swivel that was in the supplies that were sent but it seems "slippery" and it's really easy to come off the trach. What order do you use it in? I have it trach then swivel then omniflex then vent. It's pretty cool and keeps things less tangled but I worry about it coming off accidentally.

Oh, wait, I have more questions. Lil D has an LTV950. Everything was working just fine then all the sudden the PEEP went to 2 (it was at 10) and stayed there for several cycles. I screwed the PEEP thing down further, almost to 20, but the vent said it was only on 5. So I put him on the other vent and changed the circuit and threw it away. Is this something that happens or is this some freak occurrence? Is there anyway to troubleshoot this?

So far we have had two nurses that made me nervous. Both new grads. One was very, very, very shy but actually is quite good on the vent. The other was a little freaked out by the desats in the 20s today. Today was her first day and I hope she comes back tomorrow. Do you ask your nurses about their emergency plans? Like just a bit ago, the nurse and I were giving him a bed bath and he desatted into the 30s but wouldn't come back up and needed to be bagged for several minutes. The nurse tonight is like 20+ years experience but now I am worried for the new grads.

Sorry for all the questions but thanks for all the support!!!

[grtchnk]

We never used the swivel - we had the inline catheter and then the omniflex right to the vent tubing.
Can't help with the peep - our vent built in the peep and we didn't need to manually adjust.
As for being nervous with the nurses- in the beginning you need to give them time to adjust. We had many episodes with very low desats as well and it totally freaked out a lot of nurses. And some simply didn't know how to respond appropriately. So stay close in the beginning - make sure they know how you expect them to respond (leading by example works well), give them a chance to get used to D, and if your gut tells you they aren't cut out for it, they probably aren't. You will no doubt, have to get rid of a few.

[glowingpurpleaura]

hospital change pulse ox probe every four hours but we dont have a home pulse ox

[RylanDakota]

We also use the LTV950 and don't go by the numbers on the PEEP it self, but by what the vent tells us.

We don't use the swivel either. Just the omniflex. We pop it off each time we need to suction.

Pulse ox- we change every night or every few nights, but we aren't monitoring all day, just at sleep times. I don't think I would switch it every 2 hours. I think @ the hospital it was done every 12hrs.

As far as nurses...I slept with Rylan for a while even with the nurse there, because I didn't trust them 100%. Do what makes you most comfortable!

[jamie]

i can say that yes Evan has complained about feeling burned from the pulse ox, he only wears it at night, but i change fingers about 3 hours after he falls asleep. or at least once during the night.
peep drives me crazy too, he has the same type of set up. i set the peep only when i change the tubing, for evan that is once a week as long as he is not ill. i do not go by the numbers on the vent, but by the sound of the peep. if it is full of water you can hear it and it will not be right. i just turn it over and tap the water out of it.
good luck i have been doing this for over a year now, but still feel new to it too.

[Trix]

Not on pulse ox unless Isabelle is sick. Hospital change every 4 hours but we dont. Put on toe and leave it but use different toe on another night. We have Nellcor and use to tape sensors. I think her toes just toughened up and got use to it. Never had an issue with it being on for 12 hours at a time.

[Kate]

We don't switch sites. I try to switch toes every night...but never in the middle of the night-he seems to do fine.

nurses-go with your gut. Sometimes older and more experience isn't always best. But, you need to go with your gut feeling on them. I would make sure they know how YOU want them to handle a situation like desatting. I do always get a bit nervous with brand new nurses out of school because they are in an environment where it is JUST them-they can't rely on help from another nurse or dr. like you would a hospital floor.

[Alex's mom]

Sometimes if your kiddo is upset, moving around etc. the peep can fluctuate. Also - the peep valve can become dislodged and sometimes tapping it can knock it back into place. Tapping it will also knock any water out that may have accumulated. You can also check the vents connections, make sure all the sensor lines are connected properly and nothing has come loose. If all else fails, I do what you did, change out the entire circuit.

I've never used the swivel adaptor. I tried it but didn't like it either. I always just connect the omniflex directly to the trach.

[bryantem]

I did not move the pulseox every 2 hours. I also did not have nursing to do it for me. After a while, we only used the pulseox when sleeping.

[kadiera]

in the NICU, we moved pulse ox probes every 4 hours, and still occasionally had burns.

At home, we have a permanent probe, and frequently leave it all night. we don't monitor at all during the day, though, and only monitor during naps because we're working up to capping his whole nap. It seems to me that the permanent probes are less likely to burn, but it's hard to say.

We used swivels, but Alexander was on the move all the time. I've been told the tightness of fit depends on the the trach - stuff is usually loose on Shileys, tight on Bivonas.

We had the 1150, which does peep internally. We had an exhaleation valve, though, and frequently it'd get water in it and the vent would freak out. You should be able to call the RT from your DME and ask for troubleshooting advice, but I'd start by looking for water in the tubing, and try tapping it out.

As to nurses.....I think it takes time to get used to each kid. Alexander had cyanotic episodes daily when we first came home, and it took a couple weeks for everyone to get used to them. We specifically told nurses, "if this happens, do X, Y, and Z" and repeated it over and over until everyone was comfortable.