Presentation on theme: "Managing Devices In Pediatrics"— Presentation transcript:
1Managing Devices In Pediatrics BySamer Al-AshqarHEAD NURSEEMERGENCY DepartmentKfsh&RC
2Port-A-CathVADA 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.
8INDICATIONS FOR INTRAOSSEOUS ACCESS Altered Level of ConsciousnessRespiratory CompromiseNeed for immediate rapid sequence inductionHemodynamic InstabilityMass Casualty SituationsMedical or Trauma resuscitationsDifficult or impossible IV PlacementBridge to Central LineAllowing for controlled central venous placementIntraosseous Access = Immediate Vascular Access
9CONTRAINDICATIONS FOR IO FractureInfection at the insertion siteProsthesisRecent IO in same extremity (24 hours)Absence of Anatomical Landmarks (Excessive Tissue)
11REMOVE 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 DriverT-430 Rev, E
12A stabilizer is available if needed REMOVAL OF THE STYLETStabilize Needle Set and rotate the stylet counter-clockwiseRemove stylet and dispose of in approved bio-hazard sharps containerWhile 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 neededT-430 Rev, E
13CONFIRM CATHETER PLACEMENT Confirm by noting one or more of the following:Firmly seated catheterFlash of blood in the catheter hub or blood on aspiration *Pressurized fluids flow without difficultyPharmacologic effects* may or may not be able to aspirate bloodConfirmation 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 extravasationT-430 Rev, E
14Replace once you have a peripheral line Once removed place a sterile dressing and apply firm pressure for 5 minutes.
15PUT STYLETS WHERE THEY BELONG . . . 45 mm Needle Set sharps protectorDo 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 protectorin approved bio-hazard sharps containersT-430 Rev, E
16E.T.TA catheter that is inserted into the trachea through the mouth or nose in order to :Maintain an open air passageDeliver oxygenPermit the suctioning of mucusPrevent aspiration of the stomach contents
19Obstruction Secretions in ETT Patient biting the ETT Kinks in ventilator circuitWater in ventilator circuit
20Pneumothorax Unilateral chest rise Absence of air entry on one side of the chestTracheal deviation toward the unaffected lung
21Equipment Failure Lack of pressure in the ETT cuff Connections between the ETT / ventilator are secureThe ventilator circuit is free of defectThe ventilator is functioning normallyIncorrect ventilator settingsf. Power supply to ventilator (Red Outlet)
24G-TubeFeeding tubes are increasingly used for long term enteral nutrition. It is used where patients cannot maintain adequate nutrition with oral intake
25Indication Prematurity Central nervous system problems Burns Head traumaInherited metabolic disordersGastrointestinal diseasesFailure to thriveAbnormalities of the anatomy of the gastrointestinal tractSevere cleft lip/cleft palateCancer
26Benefits Satisfactory use by home caregivers Low incidence of complicationsReduction in aspiration pneumonia associated with swallowing disordersCost effective
27Management & 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 trackWound care advice.
30TracheostomyVocal cordsThyroid cartilageTracheostomy are surgical procedures on the neck to open a direct airway through an incision in the tracheaCricoid cartilageTracheal cartilagesBalloon cuff
31Inner 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.
32Tracheostomy 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.
34Signs 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).
35Signs 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
36Tracheostomy Care Suctioning the Trach tube CPR with a tracheostomy Sterile Technique: sterile catheters and sterile glovesCPR with a tracheostomyCLEANING THE TRACH. AND TIESO2 therapyUSE YOUR RESOURCES