HINT: How to administer medications to a child with a tracheostomy tube using a metered-dose inhaler or nebulizer?
Connected Care Quick Hits are up to date and evidence based recommendations for the care of children with medical complexity & technology dependence, from hospital to home.
HINT: How to administer medications to a child with a tracheostomy tube using a metered-dose inhaler or nebulizer?
SITUATION:
This Quick Hit was informed by a Connected Care Live consult from a home and community care provider regarding how to administer inhaled medications when a child has a tracheostomy.
BACKGROUND:
Children with tracheostomy tubes may require inhaled medications. These medications are given through a metered-dose inhaler (MDI) via a spacer device or by nebulization of a liquid medication.
Prior to administering medications to a child with a tracheostomy tube, it is important to understand how to appropriately use and maintain MDIs and nebulizers in home and community care settings
ASSESSMENT:
Prior to administering a medication using an MDI or nebulizer, consider the following:
Confirm the child has a clear order for administration of the medication.
Assess the child’s respiratory status before and after each dose to evaluate effectiveness of the medication, as well as the need for additional intervention.
Remove the child’s heat and moisture exchanger (HME), cap or speaking valve before medication administration and ensure that it is replaced afterwards.
Evaluate the need for tracheostomy tube suctioning before and/or after treatment.
Ensure comfort of the child by using appropriate positioning and distraction techniques
RECOMMENDATION:
Connected Care recommends the following for the administration of medications using an MDI or nebulizer to a child with a tracheostomy tube:
Giving Medications Through a Metered-Dose Inhaler
MDIs can be administered through the child's tracheostomy tube using a spacer device (also known as an AeroChamber) or placed in-line with a ventilator circuit.
To administer the medication via the ventilator circuit, the MDI is connected to an adaptor placed along the ventilator tubing close to the child. The adaptor looks like a little cap that can be lifted up and down.
Clean the spacer before the first use and then once a week, or more if visibly soiled or the child has been sick.
Review the AboutKidsHealth article that outlines how to use an MDI to give medications to a child with a tracheostomy tube, as well as cleaning the spacer
Giving Medications Through a Nebulizer
Nebulized medication can be administered directly through the child's tracheostomy tube using a tracheostomy mask attached to a nebulizer or placed in-line with the child's ventilator circuit.
The dose of medication is placed into the nebulizer cup (see image below).The nebulizer cup is connected to a compressor (nebulizer machine) using oxygen tubing.
To administer the medication via the tracheostomy tube, a tracheostomy mask is attached to the top of the nebulizer cap and placed over the child’s tracheostomy tube (see image below).
To administer the medication via the ventilator circuit, the nebulizer cup is attached to the ventilator circuit using a connector to place it in-line with the ventilator tubing closest to the child's tracheostomy tube.
Review the AboutKidsHealth article how to use a nebulizer to give medications to a child with a tracheostomy tube, as well as cleaning the equipment.
Connected Care Live is not to be used in the event of an emergency.
Have a Question? Initiate a Consult!
