Transcript 6.0 tracheostomy tube sizes

Choosing equipment…….
…and getting it home
Equipment & supplies
 Equipment chosen for home care should be portable, durable,
and simple to use. The aim is not to transfer an ITU to the
child's home.
 An itemised equipment list should be prepared and checked by
the team. The child should be established on the equipment
while still in hospital. A monthly estimate of disposable supplies
and consumables needs to be provided.
 A second ventilator is required for any child who is unable to
cope for six hours off the ventilator. Alternative power sources
in case of mains failure are essential and could be either in
battery form or a generator.
 Characteristics of equipment that need consideration when
making a choice for home use include dimensions, weight, noise
of operation, and battery options for travel.
Thorax, 1998
Considerations
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Child & family circumstances
Underlying diagnosis
Mode & duration of ventilation support
Space, costs and need for portability
Power
Training, maintenance and emergencies
Monitoring
Insurance
A structured approach
A.
B.
C.
D.
E.
F.
G.
Airway (masks, tubes, suction, straps)
Breathing (ventilator, oxygen, monitors)
Carriage (where does it need to go?)
Diagnosis (is survival ventilator-dependent?)
Electricity & emergency planning
Fun (this is a child!!)
Governance (costs, insurance, training)
Airway: interfaces
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Need to be age appropriate
Regular review
Should usually have at least one spare
Spare tracheostomy tube always with
child (plus one smaller)
 Ideally one member of staff will develop
expertise in range of interfaces
6.0mm tracheostomy tubes
Prediction of tracheostomy size
What to think about
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Age of patient
Diagnosis: does patient breathe?
Nocturnal versus daytime ventilation
Humidification of circuit
Interface: mask vs tracheostomy
Preference & familiarity
Ease of use & additional features
Oxygen and humidification
Heated
1-5 l/min O2
Passover
Monitoring and alarms
• Pulse oximetry +/- capnography
• Patient problems
– Disconnect
– Obstructed trache tube
• Ventilator problems
– Failure to cycle
– High/low pressure
– Low minute ventilation
Funding
Respiratory Medicine
Level 5
Bristol Royal Hospital for Children
Paul O’Gorman Building
Upper Maudlin Street
Bristol
BS2 8BJ
Telephone: 0117 9288258
Respiratory Medicine
Level 5
Bristol Royal Hospital for Children
Paul O’Gorman Building
Upper Maudlin Street
BRISTOL
BS2 8EG
Equipment Required for New NIV Patient
Telephone:0117 9288258
Fax:0117 9285751
Equipment Required for New NIPPY Patient
(Attach Patient Label)
GP-Name:
Tel:
GP-Name: …………………………….
GP-Address: ……………………………
……………………………………………
……………………………………………
……………………………………………
……………………………………………
Postcode:
Hospital consultant:
Tel:
To Whom It May Concern:
Contact details:
Re:
To Whom It May Concern:
Re:
Initiation on to invasive ventilation of above patient with a view to home ventilation.
The following equipment will be required, funded by patient’s PCT.
All items (except fluids and trachae tubes) available from B & D Electromedical:
Nippy Junior ventilator ( 2 required)
Trache tubes (several)
4 hour back-up battery
Charger
Carry bag for battery and charger
8 hour Mobility battery
Charger
Carry bag for battery and charger
Circuits ( over 10kgs)
Dry circuit, with HME & anti-b filter
Wet circuit for F & P 850 humidifier
Circuits (under 10Kgs)
Dry (as above)
Wet (as above)
Inlet Filters (square)
Spare anti b filters
Oxygen coupler
Humidifier, temp probe, wire connector
and stability clamp
Humidifier fluids
Servicing (10,000 hrs/ 3 years)
Order No.
0817
(4850.00 each)
(specific to patient)
0787
0797
0852
0837
0837
0866
Initiation on to mask ventilation of above patient
The following equipment will be required from RESMED however the VPAP STA III, H2i humidifier and
mask are already with the patient. Please inform RESMED of this. The mask will need to be forwarded
to Hayley Smith, Clinical Nurse Specialist for the Home Ventilation Service, C/O CIU, Bristol Children’s
Hospital, once funding is agreed by the PCT.
Cost
9700.00
115.00
112.00
63.00
345.00
112.00
45.00
0794
0805
For 10
For 10
168.00
293.00
0806
0810
0584
0635
22mo2F22
Fisher and Paykel MR850
For 10
For 10
For 5
For 5
For 10
175.00
269.00
7.00
10.00
28.00
1500.00
Obtain locally
TOTAL:
14 litres approx 40.00
Approx
12500.00
400.00
Order No.
VPAP III ST-A
Mask
(Reslink)
Humidifier
02 diverter x 2
Green connector x 2
Filters (air filters)
Bacterial Filters (dry, 24 hour life)
ResMed Power Station and DC cable
Cost
24123
30922 (humidaire 2i)
22001
14915
30907
70266
24907 and 24911
3500.00
120.00
pack of 3
pack of 5
Ongoing Costs per Year:
Servicing of machine
Mask/cushion/headgear
Filters
Valve
Grey circuit
Sleep study costs
New x2 a year
30907
16617
14948
120.00/mask
5.00
1.00
18.00
150.00
20.00
16.00
5.00
10.00
500.00