Technology-Dependent Children

1

What is the definition of a “technologically-dependent child?”

Technology-dependent children are those who are reliant on a medical device to augment (or completely replace) a vital bodily function to sustain life.

2

What are the most common classes of technologies used by technology-dependent children?

Respiratory support, nutritional support, indwelling venous catheters, cerebrospinal fluid shunts.

Case: You respond to a call at a chronic care facility where a 5-year-old male with a tracheostomy is having difficulty breathing and intermittent oxygen desaturations.

3

What are common indications for a tracheostomy?

• a.

  Acquired respiratory dysfunction (e.g., prolonged mechanical ventilation)

• b.

  Congenital respiratory dysfunction (e.g., bronchopulmonary dysplasia)

• c.

  Acquired neurological problems (e.g., hypoxic-ischemic encephalopathy)

• d.

  Chronic neurological problems (e.g., central hypoventilation)

• e.

  Anatomic airway obstruction (e.g., subglottic stenosis)

4

What are the parts of a tracheostomy tube?

Tracheostomy tubes contain several parts ( Fig. 39.1 ). All tracheostomy tubes contain an outer cannula , which serves to hold the tracheostomy open, and a neck plate (flange) that sits on the child’s neck and contains two holes for a tie that wraps around the neck to secure the tracheostomy in place. The outer cannula may or may not have a cuff that can be filled with water or air. There may be an inner cannula that fits snuggly inside the outer cannula and can be removed to facilitate the cleaning of the tracheostomy tube. An obturator is a small rigid stylet that fits inside the tracheostomy tube to help guide the tube into place during insertion. The obturator must be removed after insertion so that the child can breathe through the tracheostomy tube.

5

What information is necessary when identifying a tracheostomy tube?

There are several variables relating to pediatric tracheostomy tubes, and it is crucial to be specific when requesting a tube. Variables include the A ge range (PEDiatric or NEOnatal), B rand (e.g., Shiley), C uffed vs. uncuffed, and S ize (the diameter of the outer cannula)—otherwise known as the ABCs . This information is typically printed on the neck plate of the tracheostomy tube ( Fig. 39.2 ).

6

What supplies are necessary for an emergent tracheostomy tube change?

• a.

  Oxygen and appropriate delivery system (stoma mask and face mask)

• b.

  Bag-valve mask

• c.

  Suction

• d.

  Tracheostomy tubes (anticipated size and one size smaller)

• e.

  Sterile lubricant

• f.

  Syringe (for a cuffed tracheostomy tube)

7

What is the first step in evaluating an obstructed tracheostomy tube?

The first step is to attempt to suction the tracheostomy tube. If there is an inner cannula, this can be removed to facilitate suctioning. If symptoms resolve after suctioning of the tube, there is no need for tracheostomy tube replacement.