Soins complexes à domicile pour enfants
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Administration of medication via tracheostomy

Indications

Some considerations:

Small volume nebulizer:  

Maintenance of the equipment

Below are suggested weekly maintenance methods that can serve as a guide.

Tracheal collar:

Compressor and tubing:

Nebulizer:

Equipment replacement

Metered dose inhaler (puffer) with a spacer: 

529.aerosol dose vapor in lungs

 

 

Maintenance of the equipment

Below are general suggestions that can serve as a guide. The frequencies suggested may be different; follow the recommendations of your child’s health care team.

Metered dose inhaler (once a week):

Spacer (every 2 weeks):

 

Equipment replacement

Instillation

 

Medication storage

Frequency

As prescribed by your child’s health care team.

Required materials

For a small volume nebulizer treatment:

For a metered dose inhaler treatment:

If needed:

Always have equipment close at hand in case of an emergency.

Refer to your child’s health care team if the material or the sequence of steps you have been shown is different than those described.

By a small volume nebulizer


Step 1: Anticipation

See the full description here

Summary:

Collaborate and form a team with your child. When you invest the time to form a strong team, children feel more comfortable and less anxious – this will help you complete the care with less stress – for you and your child.

Use these tips, from the start, to set the stage for a positive care procedure:

  • Create the right moment: integrate the care in a routine.
  • Alert your child to the needed care and communicate together.
  • Form a team with your child: Encourage autonomy by offering realistic choices such as the method of distraction. Stay tuned to your child. Manage pain and anxiety, using distraction and positioning for comfort.

Step 2: Preparation

See the full description here

Summary:

  • Prepare the environment: Identify a routine place for care. Close windows, doors and fans. Wash and dry the work surface and gather the needed materials for the care and to distract your child.
  • Prepare your child: Get help if needed. Position your child for comfort to receive the care and start to use the selected distraction method.
  • Prepare yourself: Find the right time when you are ready to provide the care safely. Review the list of care steps. Wash your hands.

Now that you are ready to start the care procedure, take the opportunity to encourage and praise your child.

Step 3: Procedure

See the full description here

Summary 3 key concepts:

  • Safety: Carefully follow the care practice steps as you have been taught.
  • Flexibility: Be ready to adjust according to your child’s reactions during the procedure. As needed, reposition or select an alternative distraction strategy. Follow your child’s pace and rhythm.
  • Collaboration: Reassure your child, verbally and non-verbally. Acknowledge your child’s emotions and reactions. Help your child differentiate between the different sensations during a procedure.

Step 4: Prepare the medication

  • Make sure that your child’s name appears on the box of nebules.
  • Verify that:
    • the medication is not expired,
    • it is the correct medication and dose prescribed for your child.
Why ?

This step allows for safe administration of medication to your child.

Step 5: Add the medication to the nebulizer

If the medication is pre mixed:

  • Open the nebule by twisting off the tip.

584.twist off nebule tip.FINAL

 

 

 

 

 

  • Point the opening of the nebule towards the top of the nebulizer and gently squeeze the medication out into the nebulizer chamber through the cap.

 

 

 

 

 

  • Always keep the nebulizer in an upright position.
  • Always empty the nebule completely.
  • Discard empty nebule into garbage bin.

If the medication must be mixed: follow your child’s healthcare team’s instructions.

Why ?

This step allows you to properly transfer the medication from the nebule to the nebuliser.

Always keep the nebulizer in an upright position so that the medication does not spill.

Step 6: Prepare the delivery system

  • Place the compressor on a clean table or counter in a well aerated, dust free room.
  • Plug the unit into an electrical wall outlet. Avoid using an extension cord.
  • Connect the tracheal collar to the nebulizer connector.
  • Connect one end of the tubing to the nebulizer and the other to the compressor outlet.
  • Make sure to that the tubing is not twisted or kinked.
  • Make sure that all the connections are tight.
Why ?

This step must be performed before delivery of the medication.

Step 7: Position your child

  • Place your child in the sitting position.
  • If the sitting position is not possible, place your child:
    • in the position recommended by your child’s health care team,
    • in a position that allows you to access his tracheostomy,
    • in a position that allows the nebulizer to remain in an upright position,
    • according to his comfort, age and ability to cooperate.
Why ?

This position optimizes delivery of medication to the lungs.

Step 8: Suction tracheobronchial secretions, if needed

Why ?

This step removes secretions, allowing for better delivery of medication.

Step 9: Turn the compressor on

Depending on the training provided by your child’s health care team, you can complete step 10 before this one.

  • Press the ON/OFF button.
  • Observe for the production of a fine mist from the tracheal collar.
Why ?

This step allows for administration of medication to your child.

Step 10: Place the tracheal collar

  • Place the tracheal collar over your child’s tracheostomy.
  • Glide the elastic band behind his neck and pull on the elastic band for proper adjustment.
  • Make sure that the tracheal collar is placed in such a way so that the mist enters the tracheostomy.
Why ?

This step allows for the full dose of medication to be aerosolized.

Step 11: Administer the medication

  • Always keep the nebulizer in an upright position.
  • If possible, ask your child to take deep and regular breaths.
  • Gently tap the nebulizer during the treatment until the medication is completely gone and there is no more mist (about 10 to 30 mins).

581.empty nebulizer

 

 

 

 

 

  • Remove the tracheal collar.
  • Turn the air compressor off by pressing on the ON/OFF button.
Why ?

The compressor produces very fine particles of medication.

The nebulizer must be kept in an upright position at all times in order to function properly.

Slow, deep breaths optimizes medication delivery.

Gently tapping the nebulizer allows any medication on the sides of the nebulizer chamber to be aerosolized.

Step 12: Suction tracheobronchial secretions, if needed

  • Suction the tracheobronchial secretions, if needed.
  • If indicated, ask your child to cough after the treatment.
  • Suction secretions after the treatment if recommended by your child’s health care team.
  • Wash your hands after the procedure.
Why ?

This step clears the tracheal cannula and optimizes the child’s comfort.

Step 13: Clean and store the equipment

  • After the treatment, disassemble the equipment.
  • Disassemble the nebulizer.
  • Rinse both parts (cap and chamber) under warm tap water.
  • Shake off excess water.
  • Allow to air dry on a clean hand or paper towel.
  • Wipe the tracheal collar with a damp towel. It is not necessary to clean the tubing. Ensure that there is no water accumulated in the tubing. If there is water, turn ON the compressor to flush it out. Tubing must be dry prior to use. Never immerse the compressor in water; this will cause damage.
  • Store the equipment in the space provided for this purpose in the air compressor or in a container until the next use.
Why ?

This step is required to keep the equipment functioning properly and prevents contamination.

Step 14: Recovery

See the full description here

Summary:

The treatment is finished. Wash your hands again.

Be prepared to recognize the challenges faced and to provide positive feedback. Help your child recognize his/her strengths. Acknowledge the collaborative teamwork.

  • Listen to what your child says about the parts of the procedure that were difficult or painful.
  • Comfort your child and recognize your child’s collaboration with positive feedback.
  • Highlight your child’s  specific strengths that helped make the procedure positive.
  • Discuss with your child what might be done the same or differently the next time the care is needed.
  • Keep your promises if you have promised a reward, follow through.
  • Reward yourself too.

By meter dose inhaler with a spacer


Step 1: Anticipation

See the full description here

Summary:

Collaborate and form a team with your child. When you invest the time to form a strong team, children feel more comfortable and less anxious – this will help you complete the care with less stress – for you and your child.

Use these tips, from the start, to set the stage for a positive care procedure:

  • Create the right moment: integrate the care in a routine.
  • Alert your child to the needed care and communicate together.
  • Form a team with your child: Encourage autonomy by offering realistic choices such as the method of distraction. Stay tuned to your child. Manage pain and anxiety, using distraction and positioning for comfort.

Step 2: Preparation

See the full description here

Summary:

  • Prepare the environment: Identify a routine place for care. Close windows, doors and fans. Wash and dry the work surface and gather the needed materials for the care and to distract your child.
  • Prepare your child: Get help if needed. Position your child for comfort to receive the care and start to use the selected distraction method.
  • Prepare yourself: Find the right time when you are ready to provide the care safely. Review the list of care steps. Wash your hands.

Now that you are ready to start the care procedure, take the opportunity to encourage and praise your child.

Step 3: Procedure

See the full description here

Summary 3 key concepts:

  • Safety: Carefully follow the care practice steps as you have been taught.
  • Flexibility: Be ready to adjust according to your child’s reactions during the procedure. As needed, reposition or select an alternative distraction strategy. Follow your child’s pace and rhythm.
  • Collaboration: Reassure your child, verbally and non-verbally. Acknowledge your child’s emotions and reactions. Help your child differentiate between the different sensations during a procedure.

Step 4: Prepare the medication

  • Verify mediation label for:
    • your child’s name
    • medication expiry date,
    • it is the correct medication and dose prescribed for your child.
  • Make sure that the medication cartridge is not empty and that it is properly placed in the plastic casing.
  • Make sure that the spacer is clean and dry.
  • Remove the plastic casing cap covering the mouthpiece.
Why ?

This step allows for safe administration of medication to your child.

Step 5: Position your child

  • Place your child in the sitting position.
  • If the sitting position is not possible, place your child:
    • in the position recommended by your child’s health care team,
    • in a position that allows you to access his tracheostomy,
    • according to his comfort, age and ability to cooperate.
Why ?

This position favors delivery of medication to the lungs.

Step 6: Prepare the medication delivery system

  • Vigorously shake the metered dose inhaler for 10 seconds.
  • When using the metered dose inhaler for the first time, activate 2 to 4 puffs into the air to prime the inhaler, according to your child’s health care team.
  • Place the metered dose inhaler vertically into the spacer adapter. The metered dose inhaler should fit properly into this opening.
Why ?

This step is done before delivery of the medication.

Shaking the metered dose inhaler must be done before each treatment.

Step 7: Connect the spacer to the tracheal cannula connector

  • Remove the cap from the spacer if present.
  • Holding the tracheal cannula by the flanges, connect the spacer to the tracheal cannula connector.
  • Make sure your child stays still by comforting him and by gently holding his head.
  • Avoid any movement of the tracheal cannula as much as possible during the procedure.
Why ?

This step allows for safe administration of medication to your child.

Step 8: Administer the medication

Activate the metered dose inhaler by firmly pressing down once on the cartridge.

Why ?

This step delivers medication into the spacer.

Step 9: Optimize entry of medication to the lungs

  • If your child can collaborate, ask him to take slow, deep breaths.
  • Count on average, 5 to 6 breaths (inspiration/expiration) through the tracheostomy.
  • If the spacer used has an integrated respiratory flow indicator, make sure that it doesn’t emit a whistling sound. If so, ask your child to breathe a bit slower.
Why ?

This step optimizes delivery of the medication to the lungs.

The spacer with integrated respiratory flow indicator will emit a whistling sound if your child breathes too quickly; in this situation, he will not inhale the medication optimally.

Step 10: Repeat according to the prescribed dosage

  • Wait one minute between each dose.
  • Shake the metered dose inhaler vigorously for 10 seconds before administering each dose.
  • If several doses must be administered, remove the spacer from the tracheal cannula in-between the doses, always remembering to stabilize the tracheal cannula by the flanges.
  • Reconnect the spacer to the tracheal cannula connector to continue the treatment.
Why ?

This step allows your child to receive the correct amount of medication.

Step 11: Remove and store the equipment

  • Remove the spacer from the tracheal cannula connector once the treatment is complete; always hold the tracheal cannula in place by the flanges.
  • Avoid movement of the tracheal cannula as much as possible during removal of the spacer.
  • Remove the metered dose inhaler from the spacer.
  • Put the cap back on the metered dose inhaler plastic casing and on the spacer, if present.
  • Store the metered dose inhaler, including the cartridge in a clean, dry container until further use.
Why ?

This step is required to keep the equipment functioning properly and prevents contamination.

Step 12: Recovery

See the full description here

Summary:

The treatment is finished. Wash your hands again.

Be prepared to recognize the challenges faced and to provide positive feedback. Help your child recognize his/her strengths. Acknowledge the collaborative teamwork.

  • Listen to what your child says about the parts of the procedure that were difficult or painful.
  • Comfort your child and recognize your child’s collaboration with positive feedback.
  • Highlight your child’s  specific strengths that helped make the procedure positive.
  • Discuss with your child what might be done the same or differently the next time the care is needed.
  • Keep your promises if you have promised a reward, follow through.
  • Reward yourself too.

https://complexcareathomeforchildren.com/respiratory-support/tracheostomy-care/administration-of-medication-via-tracheostomy/

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