ALERT: How to approach ventilator alarms for children receiving invasive ventilation?
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.
ALERT: How to approach ventilator alarms for children receiving invasive ventilation?
SITUATION:
This Quick Hit was informed by Connected Care Live consults from home and community care providers that required support with troubleshooting common ventilator alarms when caring for children receiving invasive ventilation via tracheostomy.
BACKGROUND:
Children with tracheostomy tubes may require invasive ventilation at home. Ventilators have alarm settings that are prescribed by the child’s medical team. Audiovisual alarms on the ventilator may alert when there are potential issues with the child, circuit or ventilator. Examples of patient-related issues may include a blocked or dislodged tracheostomy tube, a significant leak around the tube, or a sudden change in the child’s condition.
To ensure safety at home, it is important for home and community care providers to understand how to approach ventilator alarms when caring for a child receiving invasive ventilation. When responding to ventilator alarms, focus is given to the child, their airway and ventilation needs. Understanding the meaning of each prescribed alarm is crucial for effectively tailoring the approach to responding and troubleshooting as needed. While some alarms may activate due to scheduled interventions, such as disconnecting the child from the ventilator for suctioning or cough assist therapy, unplanned alarms should be addressed promptly and systematically.
ASSESSMENT:
Home and community care providers caring for children receiving invasive ventilation should routinely assess the child’s environment, equipment and supplies at the start of each shift and as needed. Comprehensive safety checks will help ensure that all necessary equipment and supplies are easily accessible and functioning appropriately, and that settings and alarms are programmed according to the child’s medical orders. Safety checks can also involve the child's family caregivers, offering an opportunity to review the child's status and emergency plans together.
Consider using Connected Care’s Invasive Ventilation Safety Checklist to guide you in performing your safety checks at the beginning of each shift and as needed. Ensure you are checking both the primary and back up ventilators.
RECOMMENDATION:
Connected Care recommends the following when approaching ventilator alarms for children receiving invasive ventilation in home and community settings:
Immediately look at the child and assess their airway. Ensure the tracheostomy tube is in situ and the ventilator is connected appropriately.
Verify the type of alarm that has been triggered on the ventilator (e.g., low minute ventilation, high leak, high pressure, high respiratory rate, etc.). If you experience a ventilator inoperative alarm, remove the child from the ventilator immediately and place them on their back-up ventilator or manually ventilate, if needed, until the back-up ventilator is secured
Perform tracheostomy tube suctioning to confirm patency of the tube.
If the tracheostomy tube is patent, place the child back on the ventilator after suctioning and re-assess the child
If the tracheostomy tube is obstructed,
perform an emergency tracheostomy tube change
Reposition the child to promote effective chest rise and patient comfort.
Find a position for the child that minimizes any leaking around the tracheostomy tube or ventilator circuit
Re-assess the child after repositioning
If the child has a cuffed tracheostomy tube, ensure the cuff is inflated with the prescribed amount of air or sterile water. Re-assess the child after intervention.
If the ventilator alarm persists, switch the child to their back-up ventilator or manually ventilate if needed, until the back-up ventilator is secured.
Check tubing for unintentional leaks, drain excess condensation, replace soiled filters, and ensure device is plugged in.
Consider performing a Learn Circuit check on the ventilator (Astral ventilator only)
Re-assess child after intervention and inform family caregiver if they are not already aware
If there are issues with the functioning of the child’s ventilator, contact the Ventilator Equipment Pool for additional troubleshooting and/or replacement of the device.
If the child is stable and you require additional support with troubleshooting ventilator alarms, consider initiating a consult through Connected Care Live.
Review the AboutKidsHealth Tracheostomy Care for Children Manual: For Family Caregivers and Homecare Providers for additional information.
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