Managing Devices In Pediatrics By Samer Al-Ashqar HEAD NURSE EMERGENCY Department Kfsh&RC

Port-A-Cath VAD A portacath is an implantable port device, which is positioned completely under the skin and inserted into the subclavian vein and avoid the need for repeated venepuncture or cannulation. Used for patient who may require regular drug administration, often as an inpatient.

Access

* Redness * Swelling * Infiltration *Bleeding * Patency OBSERVE Site for : * Redness * Swelling * Infiltration *Bleeding * Patency

Complication Infection Occlusion Thrombosis Extravasations

Intraosseous Is the process of injection directly into the marrow of the bone . Alternative route when peripheral blood vessels are collapsed or inaccessible.

Types

INDICATIONS FOR INTRAOSSEOUS ACCESS Altered Level of Consciousness Respiratory Compromise Need for immediate rapid sequence induction Hemodynamic Instability Mass Casualty Situations Medical or Trauma resuscitations Difficult or impossible IV Placement Bridge to Central Line Allowing for controlled central venous placement Intraosseous Access = Immediate Vascular Access

CONTRAINDICATIONS FOR IO Fracture Infection at the insertion site Prosthesis Recent IO in same extremity (24 hours) Absence of Anatomical Landmarks (Excessive Tissue)

PEDIATRIC IO INSERTION SITES Distal Femur Proximal Tibia Distal Tibia Proximal Humerus

REMOVE DRIVER FROM NEEDLE SET When you feel a decrease in resistance indicating the Needle Set has entered the medullary space, take your finger off the trigger, and remove the driver by stabilizing the hub with one hand and pulling straight back with the driver. This releases the magnetic connection between the driver and the Needle Set. Be careful to avoid excessive movement of the Needle Set. The Needle Set should feel secure and stable in the bone with the driver removed.   Stabilize Needle Set while disconnecting Driver T-430 Rev, E

A stabilizer is available if needed REMOVAL OF THE STYLET Stabilize Needle Set and rotate the stylet counter-clockwise Remove stylet and dispose of in approved bio-hazard sharps container While continuing to hold the needle hub, twist the stylet out of the needle by rotating the stylet counter-clockwise. Once removed, dispose of the stylet in an approved bio-hazard sharps container.   If using an EZ-Stabilizer®, apply the stabilizer prior to attaching the primed EZ-Connect tubing. Once the stabilizer is in place, attach the EZ-Connect tubing to the needle hub. A stabilizer is available if needed T-430 Rev, E

CONFIRM CATHETER PLACEMENT Confirm by noting one or more of the following: Firmly seated catheter Flash of blood in the catheter hub or blood on aspiration * Pressurized fluids flow without difficulty Pharmacologic effects * may or may not be able to aspirate blood Confirmation of catheter placement can be achieved by aspirating marrow prior to the initial saline flush or lidocaine administration. Slowly retract the plunger on the syringe to withdraw marrow. If marrow is present, the needle has been successfully placed in the medullary space. Blood may also be noted in the hub of the needle after removal of the stylet. Absence of blood or inability to withdraw aspirate at the catheter hub does not mean the insertion was unsuccessful.   A firmly seated catheter and the ability to administer pressurized fluids without difficulty are indicators of successful cannulation of the medullary space; as is noting the pharmacologic effects of your medication administration. Once catheter placement has been confirmed, the site should be continually re-evaluated for signs of extravasation, fluid leakage or any other signs that indicate the needle tip is no longer in the medullary space. Monitor the insertion site and posterior extremity for signs of extravasation T-430 Rev, E

Replace once you have a peripheral line Once removed place a sterile dressing and apply firm pressure for 5 minutes.

PUT STYLETS WHERE THEY BELONG . . . 45 mm Needle Set sharps protector Do not use the cartridge as a sharps container. The EZ-IO stylet will fit into most approved bio-hazard sharps containers. Using the cartridge as a sharps container may result in the inadvertent insertion of a contaminated stylet into a subsequent patient.   Portable sharps protector in approved bio-hazard sharps containers T-430 Rev, E

E.T.T A catheter that is inserted into the trachea through the mouth or nose in order to : Maintain an open air passage Deliver oxygen Permit the suctioning of mucus Prevent aspiration of the stomach contents

E.T.T D.O.P.E VAP

Displacement Right or left mainstem Esophagus

Obstruction Secretions in ETT Patient biting the ETT Kinks in ventilator circuit Water in ventilator circuit

Pneumothorax Unilateral chest rise Absence of air entry on one side of the chest Tracheal deviation toward the unaffected lung

Equipment Failure Lack of pressure in the ETT cuff Connections between the ETT / ventilator are secure The ventilator circuit is free of defect The ventilator is functioning normally Incorrect ventilator settings f. Power supply to ventilator (Red Outlet)

Ventilator Acquired Pneumonia VAP VAP bundle: Sedation vacation HOB > 30 degrees OG tube Meticulous oral care Gastrointestinal prophylactic agents Deep vein thrombosis prophylactics

G-Tube

G-Tube Feeding tubes are increasingly used for long term enteral nutrition. It is used where patients cannot maintain adequate nutrition with oral intake

Indication Prematurity Central nervous system problems Burns Head trauma Inherited metabolic disorders Gastrointestinal diseases Failure to thrive Abnormalities of the anatomy of the gastrointestinal tract Severe cleft lip/cleft palate Cancer

Benefits Satisfactory use by home caregivers Low incidence of complications Reduction in aspiration pneumonia associated with swallowing disorders Cost effective

Management & Care Examine skin around site for infection/ irritation Clean stoma site with sterile saline. Dry area with gauze. Rotate gastrostomy tube to prevent adherence to sides of track Wound care advice.

Minor complications Tube blockages Tube dislodgements External leakage Unplanned removal Site infections

Major complications Peritonitis Internal leakage Gastric perforation Subcutaneous abscess Internal leakage Gastric perforation

Tracheostomy Vocal cords Thyroid cartilage Tracheostomy are surgical procedures on the neck to open a direct airway through an incision in the trachea Cricoid cartilage Tracheal cartilages Balloon cuff

Inner cannula—Smaller tube that fits inside the tracheostomy tube, which can be removed quickly if it becomes obstructed. This is often used for patients who have copious secretions.

Tracheostomy tube—An indwelling tube used to maintain patency of the tracheostomy. It can be made of metal (for long term use) or disposable plastic. The tube can be cuffed (a balloon is inflated to keep the tube in place) or uncuffed (air is allowed to flow freely around the tube). It can also be fenestrated, which allows the patient to speak.

Complications of trachs: 1. Bleeding. 2. Infection. 3. Trach plugging. 4. Granulation (scar) tissue. 5. Skin necrosis.

Signs of breathing problems: 1. Restlessness or increased irritability. 2. Increased breathing (respiratory) rate. 3. Heavy, hard breathing. 4. Grunting, noisy breathing. 5. Nasal flaring (sides of nostrils move in and out with breathing).

Signs of breathing problems: 6. Retraction (sinking in of breastbone and skin between the ribs with each breath). 7. Blue or pale color. 8. Whistling from the trach tube. 9. Sweating. 10. Change in pattern of heart rate (less than 80 or more than 210 beats/minute). 11. Bleeding from trach tube

Tracheostomy Care Suctioning the Trach tube CPR with a tracheostomy Sterile Technique: sterile catheters and sterile gloves CPR with a tracheostomy CLEANING THE TRACH. AND TIES O2 therapy USE YOUR RESOURCES

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