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G-Tubes, G-J Tubes, PICCS, Trachs …OMG. Katharine Pearson, RN, MSN, CPN Best Way to Start Every Lecture. No Disclosures. I wish I had disclosures but I do not. Objectives. Demonstrate increased knowledge of common pediatric implanted external devices.
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G-Tubes, G-J Tubes, PICCS, Trachs…OMG Katharine Pearson, RN, MSN, CPN Best Way to Start Every Lecture
No Disclosures • I wish I had disclosures but I do not.
Objectives • Demonstrate increased knowledge of common pediatric implanted external devices. • Verbalize what information is needed to care for pediatric patients with implanted external devices. • Implement emergency planning for pediatric patients with implanted external devices.
Gastrostomy Tubes • A gastrostomy tube is a tube inserted through the abdomen that delivers nutrition directly to the stomach. • These are generally inserted for poor weight gain or lack of feeding tolerance.
Worst Case scenario • The tube becomes dislodged: • Think is the tube less than 30 days. • If the answer is yes, then they will need to be seen in the emergency room or the surgeon's office. • Do you have an extra tube? • If yes replace it. And replace the water in the balloon. • Barriers: Insurance usually only covers a replacement every 3 months. • Best case would be if each child had a replacement in their book bag.
Gastrostomy-Jejunostomy (GJ) • A Gastrostomy-Jejunostomy tube is similar a G tube except there are 2 ports on the GJ. • Gastric Port- Opens into the stomach. • Jejunal Port- Goes through the stomach and into the small intestine. • These are places when the stomach does not tolerate feeds. • Feeding are frequently given slower (continuous) through the J tube. Medications are often given through the G port.
Worst Case scenario • One of the parts of the tube itself breaks: • This is a sign it needs to be replaced. Do not use the other port unless it is approved for that patient. • Dislodged: • These need to be placed in intervention radiology. The parents will need to be contacted for this.
Peripherally inserted central catheters (PICC) • PICC is an acronym for a Peripherally Inserted Central Catheter, and it is, in essence, a long IV line. It is usually inserted in a smaller vein in the upper arm and terminates in a larger vein in the chest near the heart. • Indications: • Long term antibiotics: Perforated appendicitis. • Short term intravenous nutrition.
Things you need to know • KEEP THE DRESSING CLEAN DRY INTACT • The largest complications: • Clots: Inability to flush. • Infection: The site would be red and could start streaking. There is often a fever associated with this complication.
Worse Case scenario • The insertion site is red or draining. The patient should be sent home to see a doctor. • If the PICC line is not able to flush. Attempt to flush a few lines in a pulsating fashion but there should not be a large amount of pressure. • The PICC is pulled out. • If it is slightly out: Ensure the insertion site is C/D/I. • If it is completely out: Apply pressure until the bleeding stops and then place and occlusive dressing.
ports • An implanted device with a flexible tube which connect the silicone drum to a large vessel. This is placed in the operating room but can be accessed and not accessed. When accessed the needle is inserted directly into the drum. When it is not accessed there is no maintenance to be done. • Children will receive these for long term treatments. • Cancer • Monthly IV injections • Difficult IV access in the past
Worst case scenario • The port gets accidently hit with a ball or the child falls on the port: • Almost always fine. If the port is clearly damaged or there is severe pain the port will need to be accessed. • The dressing falls off: • Replace the dressing in a sterile way. • The needle becomes dislodged: • The port needs to be heparinized. Someone will need to reassess and place heparin in the line.
Tracheostomy • A tracheostomy is a surgical opening into the trachea below the larynx through which an indwelling tube is placed to overcome upper airway obstruction, facilitate mechanical ventilator support and/or the removal of tracheo-bronchial secretions. • Indicated for patients: • Blockage in the upper airway. • Inability to clear mucus from the lungs and the airways.
What you need to know • A stable airway is the greatest thing a nurse can have. • In many cases, if a trach becomes dislodged they child can maintain for a bit. It still requires fast moving but not panic. • It is VERY important to know why a child has a trach. This way you can determine how critical the airway is.
Lets talk about that jump bag • With every trach child should come: • Extra trach: One the same size and another one size smaller. • Extra set of trach ties. • Ambu Bag • Suction equipment • Card with sizes of equipment used on the patient. (This can be used if you need to discuss with someone else).
Worst case scenario • The trach ties become loose: • Have someone hold the trach in place while retrieving the equipment and replace the ties. • The patient looks like they are struggling to breathe: • Suction, suction, suction and then suction again. • Ensure the trach is in the stoma.
Worst Case scenario • Dislodgement: • Replace the trach using the obturator of the current trach. • If you have time, grab a new trach from the jump bag. • If you are unable to pass the new trach use the smaller one in the jump bag. • If you any time you are not comfortable or the patient appears to be struggling call emergency services.
Questions…. Please!
Elias, E. R., & Murphy, N. A. (2012). Home Care of Children and Youth With Complex Health Care Needs and Technology Dependencies. Pediatrics, 129(5), 996-1005. doi:10.1542/peds.2012-0606 • Hopkins, A. F., & Hughes, M. (2015). Individualized Health Care Plans. Young Exceptional Children, 19(2), 33-44. doi:10.1177/1096250614566538 • Schilling, E. J., & Getch, Y. Q. (2018). School reentry services for students with chronic health conditions: An examination of regional practices. Psychology in the Schools, 55(9), 1027-1040. doi:10.1002/pits.22154
