Cough assist care

PLEASE NOTE: The information in this section is meant as a general guide to help caregivers with common issues and is not intended to replace the care provided by your child’s healthcare team. 

Discuss your child’s unique needs with the healthcare team, including WHO and WHEN to contact when problems arise.

 

Stomach upset during lung volume recruitment technique or insufflation/exsufflation technique

Chest/abdominal discomfort or pain during lung volume recruitment (breath stacking) or insufflation/exsufflation technique

Dizziness or fatigue

Bloating of the abdomen with burping after lung volume recruitment technique or insufflation/exsufflation technique

Inability to expectorate (clear) the secretions

Leak around the mouthpiece during lung volume recruitment technique or insufflation/exsufflation technique

Leak from the nose during lung volume recruitment technique or insufflation/exsufflation technique

Abdomen does not move outwardly during lung volume recruitment technique or insufflation/exsufflation technique

 

For specific advice on your child or any other questions, do not hesitate to contact your child’s healthcare team.

Tracheostomy care

WARNING: The information in this section is meant as a general guide for parents and caregivers with certain problems related to children with tracheostomy using a single non-fenestrated, cuff-less tracheal cannula.
It is not intended to replace the recommendations of your child’s health care team.

Discuss your child’s unique needs with the healthcare team, including WHO and WHEN to contact when problems arise.

One or more of these symptoms: coughing more frequently, yellow, green, pink or blood tinged secretions, secretions are thicker, secretions are more abundant than usual, secretions have a bad odor, labored breathing, breathing more quickly, chest pain, fever (≥ 38⁰C rectal or ≥ 37.5⁰C oral or ≥ 37.5⁰C underarm), irritability, loss of energy, loss of appetite/refusal to eat

One or more of these respiratory distress symptoms: labored breathing, more comfortable in a sitting position or with head elevated than in a lying down position, rapid, noisy or wheezy breathing, shallow breathing, secretions are more abundant than usual, weak cough, indrawing (retraction of the skin over, under and in between the ribs), use of accessory muscles to help with breathing, nasal flaring (enlargement of the nostrils during breathing), extension of the neck backwards to try to breathe in air, continuously crying, agitation, anxiety, irritability, scared look on your child’s face, marked sweating, pale skin, blue color of lips and nail beds

Resistance or impossibility of tracheal cannula reinsertion

Tracheal cannula falls out, partially or completely, accidental decannulation: cuffless tracheal cannula partially or completely out

Blood-tinged secretions

Bleeding from inside the tracheostomy or around the tracheostomy

Introduction of water into the tracheostomy

One or more of these symptoms: coughs and /or choking during meals, saliva more abundant than usual, secretions are more abundant after meals, secretions resemble the liquids or food that was recently ingested, traces of food are found during suctioning of tracheal secretions, vomiting right after a meal

Vomiting

Skin around the tracheostomy site irritated (redness, edema, itchiness, burns, bad odor, oozing, presence of red pimples, small sores or bleeding and/or tracheostomy dressing is wet and soiled)

Skin around the neck irritated (redness, edema, itchiness, burns, bad odor, oozing, presence of red pimples, small sores or bleeding)

Do not hesitate to contact your child’s health care team for any questions or for specific advice related to your child’s condition.

Peritoneal dialysis

Enterostomy care

PLEASE NOTE: The information in this section is meant as a general guide to help parents and caregivers with common issues and is not intended to replace the care provided by your child’s healthcare team. 

Discuss your child’s unique needs with your healthcare team, including WHO and WHEN to contact when problems arise.

 

Skin protector does not stick properly to the skin

Detachment of the bag

Bleeding from the stoma

Movement of the stoma: sinks inward or sticks out by more than 0.5 centimeters from its usual position

Constipation

Irritated skin around the stoma: red, swollen, burning, presence of small red bumps, small wounds or slight bleeding

Watery stool

Unpleasant odors

 

For specific advice on your child or any other questions, do not hesitate to contact the enterostomal therapy nurse or your child’s healthcare team.

Enteral nutrition

Parenteral nutrition

PLEASE NOTE: The information in this section is meant as a general guide to help caregivers with common issues and is not intended to replace the care provided by your child’s healthcare team

Discuss your child’s unique needs with the healthcare team, including WHO and WHEN to contact when problems arise.

 

Redness, heat, swelling or tenderness or pain at the catheter entry site

Extended redness or itching of the skin under dressing

Cord-like sensation of the vein where the catheter is inserted (may be hard, red or tender to touch)

One or more of these symptoms: burning or pain at the entrance site of the catheter, cold skin around the entrance site of the catheter, swelling of the arm (PICC line), swelling around the catheter site, leakage at catheter entry site, change in skin color (whiteness or redness) around the catheter entry site

For those with an implantable chamber catheter (eg, Port-a-Cath®): pain or swelling at the site of insertion of the reservoir during the administration of the solution or irrigation

Blood leaking at catheter insertion site

Protective dressing is wet or damp due to leakage of blood, pus or other discharge

Dressing is falling off, loose, punctured or torn

Presence of blood in catheter tubing

More residual solution than usual in the bag at the end of administration

More air bubbles than usual or presence of particles in the bag, whether the additives have already been added or not

Re-separation of the solution (before or during administration) after mixing the contents of the two chambers

Ambulatory infusion pump alarms

Resistance or inability to irrigate (flush) the catheter

Inadvertent disconnection of connector without needle or pump tubing

Broken (leaking) catheter or malfunctioning equipment

External displacement of the catheter (part of the catheter outside the vein shorter or longer than usual or catheter completely removed from the vein) with or without: pain in the ear, neck or shoulder on the side of the catheter, swelling in the neck, unusual sound heard by your child on the catheter side during flushing of the catheter or administration of the medication

Unusual sound heard by your child on the catheter side during irrigation with or without: pain in the ear, throat pain

Particular odor or a strange taste reported by your child during catheter irrigation

One or more of these symptoms: nausea, vomiting, headache, blurred vision, cold sweats, pallor, tiredness or irritability, seizures

One or more of these symptoms: headache, nausea, increased thirst, weakness, agitation, irritability, increased urination

One or both of these symptoms: dry skin, dry mouth, significant thirst, weakness, dizziness, decreased urination

One or more of these symptoms: faster breathing, difficulty breathing, swelling especially in the legs/feet or around the eyes, decreased urination, unexpected rapid weight gain

Fever with or without general malaise: ≥ 38⁰C rectal or ≥ 37.5⁰C buccal or ≥ 37.5⁰C armpit

One or more of these symptoms: swelling of the arm or side where the catheter is located, underarm pain in the arm where the catheter is located, swelling of the neck and face

 

For specific advice on your child or any other questions, do not hesitate to contact your child’s healthcare team.

Intravenous antibiotic therapy

PLEASE NOTE: The information in this section is meant as a general guide to help caregivers with common issues and is not intended to replace the care provided by your child’s healthcare team

Discuss your child’s unique needs with your healthcare team, including WHO and WHEN to contact when problems arise.

 

Redness, heat, swelling, tenderness or pain at the catheter entry site

Extended redness or itching of the skin under dressing

Cord-like sensation of the vein where the catheter is inserted (may be hard, red or tender to touch)

One or more of these symptoms: burning or pain at the entrance site of the catheter, cold skin around the entrance site of the catheter, swelling of the arm (PICC line), swelling around the catheter catheter site, leakage at catheter entry site, change in skin color (whiteness or redness) around the catheter entry site

Child with an implantable chamber catheter (eg, Port-a-Cath®): pain or swelling at the site of insertion of the reservoir during the administration of the solution or irrigation

Blood leaking at catheter insertion site

Protective dressing is wet or damp due to leakage of blood, pus or other discharge

Dressing is falling off, loose, punctured or torn

Presence of blood in catheter tubing

Medication administration time longer than usual

Leakage of the elastomeric infusion pump or bursting of the balloon

Presence of air bubbles or particles in the bag, cassette reservoir or elastomeric infusion pump

Ambulatory infusion pump alarms

Resistance or inability to irrigate (flush) the catheter

Inadvertent disconnection of the needleless connector or the pump tubing

Broken (leaking) catheter or malfunctioning equipment

External displacement of the catheter (part of the catheter outside the vein shorter or longer than usual or catheter completely removed from the vein) with or without: pain in the ear, neck or shoulder on the side of the catheter, swelling in the neck, unusual sound heard by your child on the catheter side during flushing of the catheter or administration of the medication

Unusual sound heard by your child on the catheter side during irrigation with or without: pain in the ear, throat pain

Particular odor or a strange taste reported by your child during irrigation

One or more of these symptoms: swelling of the hand, arm or side where the catheter is located, underarm pain in the arm where the catheter is located, swelling of the neck and face

Fever with or without other symptoms: ≥ 38⁰C rectal or ≥ 37.5⁰C buccal or ≥ 37.5⁰C armpit

 

For specific advice on your child or any other questions, do not hesitate to contact your child’s healthcare team.

Intermittent bladder catheterization

PLEASE NOTE: The information in this section is meant as a general guide to help parents and caregivers with common issues and is not intended to replace the care provided by your child’s healthcare team.

Discuss your child’s unique needs with your healthcare team, including WHO and WHEN to contact when problems arise.

 

Urinary incontinence (leakage) between catheterizations

The urine does not flow or flows more slowly than usual through the catheter

The catheter is difficult to insert

Urine has an unusual odor or is milky, not clear

Bleeding after catheterization

Difficult catheter removal

Skin around the stoma of Mitrofanoff is: red swollen itchy, burns, or there are small bumps, abrasions or bleeding

Movement of the stoma of Mitrofanoff more than 0.5 cm from its usual position, whether sinking in or protruding out

Abdominal discomfort; pain and/or burning at the meatus or urethra

Fever with or without malaise: ≥ 38⁰C rectal or ≥ 37.5⁰C oral/armpit

 

For specific advice on your child or any other questions, do not hesitate to contact your child’s healthcare team.