Capping

erikall · #1 06-18-2005, 03:06 PM

Everyone...tell me about capping. If we have a 3.5 Pedi Shiley, what can we go down to? The Pedi id the same OD as Neo, and the Pedi fills her airway (saw it in pics from last weeks bronch)

We are 3 1/2 weeks out from 2 stage LTP, posterior and anterior rib grafts, stent placed for 2 weeks. Last LMB we saw an inflamation in the front graft, Dr Cotton says he has seen this before and still had the graft work, on antib's in case. We will scope again this friday.

I am just trying to figure out,
1. Has anyone had a 2 stage work with an infected stent (they say we are not acutely infected, just in danger of it.)

2. Anyone decann without capping after a 2 stage.

3. What in the world is smaller than a 3.5 neo/pedi, 3.0 can't be enough of a difference to matter, right?!

TIA
Erika

#2 06-18-2005, 03:40 PM

I have not experienced capping, but what I wanted to ask you is if you are stayig¨ng at Ronald Mcdonals, I think I have seen you around, and here at the hospital, Next time we see I will stop and say hello because I think it is you.
It is great.

erikall · #3 06-18-2005, 03:49 PM

Yeah, I'm the one with the two babies. I am in room 23.

Erika

cariaad · #4 06-18-2005, 06:36 PM

http://www.tracheostomy.com/resources/table.htm

There's a link to the standard sizing charts. i believe there is quite a difference in the outer diameter of a 3.0 and a 3.5 ped. The Neo is going to have the same OD/ID but will be shorter in length. In Neo a 2.5 is available.

Deb

erikall · #5 06-18-2005, 08:31 PM

Thanks Deb.

I have Neo and Pedi 3.5's and 3.0's here with me. The length is the only difference in size, looking at 3.5 vs. 3.5 and 3.0 vs. 3.0. But you are right, OD jump from 4.5mm in 3.0's to 5.2mm in 3.5's. If there is a 2.5, then that could, I guess make the difference she would need. Now I wonder why she started in a 3.0 when she was only 2 lbs, and a 2.5 would have been more appropriate...just checked the chart...now I know why, my ENT sticks with Shiley's.

I just hate the thought of capping...why make them work so hard to breath!

Erika

Jessica's Mom · #6 06-19-2005, 04:49 PM

Hello Erika,

"1. Has anyone had a 2 stage work with an infected stent (they say we are not acutely infected, just in danger of it.)" --- We had the stage 2, on 5-4-05 and we had to give her antibotics after it, and after the stent was removed two weeks later, we had to give her antibotics and some steroids. I never asked why, I just figured they gave them to everyone that has this surgery. We were never told if anything was infected...

2. Anyone decann without capping after a 2 stage. --- We wanted too! But they told us we had to cap for 48 hours so I sent my husband to spend the 48 hours. She did fine during the day, but at night her sats dropped into the upper 80's a few times and they said she couldn't handle being decannulated - by they I mean Dr. Cotton's fellows, interns, and nurse practioners... I don't believe that. I believe if you remove the trach completely her sats will be fine, but it was probably for the best since exactly 4 hours after being discharged from the hospital she started throwing up...

3. What in the world is smaller than a 3.5 neo/pedi, 3.0 can't be enough of a difference to matter, right?! --- Jessica used to have a 3.5 neo, then after her surgery they upped her to a 4.0 ped for 2 weeks, then they removed the stent, we went home and I put a 3.5 ped back in. Then during the 48 hour capping trial, they downsized her to a 3.0 ped, then when her sats dropped I wanted a smaller trach, so they got the 2.5 ped and put it in, but when she failed the next night according to them, they put the 3.0 ped back in. When she got home, I put the 2.5 ped in (I would prefer the 2.5 neo) and capped her and she did fine and now her stoma is too small to fit anything but a 2.5 trach. This trach is REALLY small. I just want to be rid of the thing all together! I am all for pulling the trach out and seeing how she does, I mean Dr. Cotton himself said her airway looked great, so why does she still have the trach???

Jessica is capped all day and is fine. She is not working any harder to breathe. She has been capped for almost three weeks and was even sick and never worked harder to breathe when awake. When she lays down she does cough alot, her sats are a little lower than normal and sometimes her heartrate is alittle higher than normal, so I remove the cap and within a few minutes, everything seems to go back to the baseline. I don't understand it except to say that the ped. trach is too long for her and she would do beter with a 2.5 neo trach or NO trach at all, but Dr. Cotton's team won't listen to me...

I hope everything is going well... One more thing about the 48 hour capping trial, make sure the cap is on! My husband got so wrapped up in watching her sats, that he didn't check to see if the cap was on, so when the intern, fellow and nurse pracitioner rounded in the morning, he didn't know the cap was off, or when it came off, so this was another reason she failed the capping trial!
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erikall · #7 06-19-2005, 09:07 PM

Thanks Denise. I am going to talk to dr cotton about this on Friday, or maybe email him earlier. I have had, as you know, alot of the same experiences as you at CHMC. I am also of the thought that the Neo is what she was doing fine with, why change to Ped? Dr Cotton knows I can't stand talkig to the residents, but am happy with one of the Fellows...I will dedinately put these thoughts to them and see what they do with them.

After all, who knows our kids better than us, right?

Erika

Jessica's Mom · #8 06-20-2005, 10:27 AM

Great Erika! I hope you get the answers you want! Let me know what they say. What size and make of trach did your daughter have before the stage 2 LTP? I am assuming after the LTP they put in a 3.5 ped, shiley. How is she doing with it? I couldn't stand the residents either. Who is the fellow you liked? When is your daughters next bronch?

Good Luck with everything!
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