Learn PICU

PICU Survival Guide

Ventilators

Tracheostomy

• Tube types

  • Bivona (silicone) vs Shiley (plastic)
    • typically using Bivona in pediatrics
  • Cuff vs no cuff
    • cuff for risk of aspiration; no cuff if patient is getting better and doesnt need PPV
    • advantage: gives better PIP, PEEP
    • disadvantage: can’t talk, taste, smell
  • Air vs TTS
    • TTS is water sealed
  • FlexTend option
    • one of the favorites in peds on babies with no necks for example (flexible and can move around)
  • Custom
    • can get custom length/diameter to fit patient

• HME - heated moisture exchanger (allows patient to maintain their own humidification of air)

• Obturator - like a stylet, allows rigidity so you can push trach in

• Trach speaking valve

  • one-way valve opens only during inspiration so you can exhale through oronasopharynx
  • may need to remove if pt is hypotonic, in seizure, anything that can cause respiratory problems
  • not something you can just leave on, don’t forget to deflate the cuff!
  • can’t use if pt is feeding by mouth (weird sensation on esophagus)

• Tracheostomy caddy in pt room

  • tells you if upper airway is continuous or discontinuous (for ex craniofacial anomalies)
  • tells you what size tube to use
  • tells you what to do if they need backup or intubation

• Complications

  

• Trach caregiver training checklist

  • Two (ideally three) caregivers
  • CPR
  • Emergency scenario teaching and review
  • 3 trach changes per caregiver
    • wait until stoma has matured

Enteral Tubes

See ET section of Nutrition/GI

Nutrition/GI

Central Lines

• PICC Lines
  • USAGE: Temporary
  • LOCATION: Arm (typically), groin
  • FOR WHOM? Short-term or temporary needs
  • LUMENS: Single, double, triple
  • PROS: Usually no anesthesia, easily removed
  • CONS: Hard to secure, easily dislodged, higher risk of infection, unsightly
• Venous Ports
  • TYPES: Unaccessed or Accessed
  • USAGE: Long-term intermittent
  • LOCATION: Typically placed in the chest
  • FOR WHOM? Intermittent Access, Poor Vascular Access, Active Children
  • LUMENS: Single and double
  • PROS: Lower risk of infection, can bathe/swim, no dressing, low maintenance
  • CONS: Placed/removed surgically, requires needle puncture for access
• Central Venous Lines or Catheters (CVL/CVC)
  • TYPES: Single Lumen Broviac, Double Lumen Hickman
  • USAGE: Long-term, daily
  • LOCATION: Usually tunneled to chest; May be tunneled to back, thigh, or abdomen; some untunneled
  • FOR WHOM? Parenteral nutrition/hydration, daily IV medications
  • LUMENS: Single, double, or triple
  • PROS: Lower risk of infection, easy to access
  • CONS: Surgical placement/removal, daily maintenance, requires dressing, external catheter