1. Managing Devices In PediatricsBy
Samer Al-Ashqar
HEAD NURSE
EMERGENCY Department
Kfsh&RC

2. 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.

3. Access

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

5. Complication
Infection
Occlusion
Thrombosis
Extravasations

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

7. Types

8. 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

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

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

11. 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

12. 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

13. 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

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

15. 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

16. 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

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

18. Displacement
Right or left mainstem
Esophagus

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

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

21. 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)

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

23. G-Tube

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

25. 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

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

27. 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.

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

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

30. 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

31. 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.

32. 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.

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

34. 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).

35. 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

36. 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

37. Recommendations