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Medical Equipment Problems: Tracheostomies and Gastrostomies. Nightfloat Curriculum 2010-2011 Lucile Packard Children’s Hospital Residency Program. Teaching Goals. Review the critical components of tracheostomy and gastrostomy tubes

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medical equipment problems tracheostomies and gastrostomies

Medical Equipment Problems:Tracheostomies and Gastrostomies

Nightfloat Curriculum 2010-2011

Lucile Packard Children’s Hospital Residency Program

teaching goals
Teaching Goals
  • Review the critical components of tracheostomy and gastrostomy tubes
  • Begin initial management of tracheostomy emergencies
  • Troubleshoot problems with gastrostomy tubes
gastrostomy problems tube blockage
Gastrostomy Problems: Tube blockage
  • Usually clog as a result of medications
  • Treat with:
    • Water
    • Carbonated beverage
    • Pancreatic enzymes
    • Replace tube (last resort)
    • Change to liquid medications, if possible
tube displacement
Tube Displacement
  • Stoma can close within hours if not held open
  • Management: Keep site open!!!
    • Use a foley catheter
    • After new tube is placed, ensure that it is in the stomach before using
    • A false passage may be formed between the abdominal wall and stomach, leading to peritonitis. This is especially important in new gastrostomy tubes less than 4 weeks old.
drainage around gastrostomy tube
Drainage around Gastrostomy Tube
  • A small amount of drainage is acceptable.
  • Keep area dry using nonadherent gauze or foam; do not use occlusive dressings
  • Ensure no cracks in tubing
  • Ensure no excessive traction on tube which can stretch the stoma
  • If drainage persists, may need to upsize tube
  • In severe cases, may require surgical repair
gastrostomy problems vomiting
Gastrostomy Problems: Vomiting
  • Causes
    • GERD (may worsen after gastrostomy placement)
    • Balloon obstructing gastric outlet
    • Other medical causes
  • Treat underlying cause
case 1
Case # 1
  • 8-year-old girl with tracheostomy suddenly desaturates and becomes cyanotic. The first thing you should do is:
  • Begin chest compressions
  • Administer 100% oxygen by tracheostomy
  • Perform needle decompression
  • Check for tracheostomy tube patency
case 11
Case # 1
  • 8-year-old girl with tracheostomy suddenly desaturates and becomes cyanotic. The first thing you should do is:
  • Begin chest compressions
  • Administer 100% oxygen by tracheostomy
  • Perform needle decompression
  • Check for tracheostomy tube patency
case 2
Case #2
  • 18-month-old boy post-op day 7 after a G-tube and Nissenfundoplication pulls his tube out. All of the following should be performed EXCEPT:
  • Call surgery
  • Place a deflated foley in the stoma
  • Place an NG tube and start pedialyte to maintain hydration
  • Check new tube placement using a dye study
case 21
Case #2
  • 18-month-old boy post-op day 7 after a G-tube and Nissenfundoplication pulls his tube out. All of the following should be performed EXCEPT:
  • Call surgery
  • Place a deflated foley in the stoma
  • Place an NG tube and start pedialyte to maintain hydration
  • Check new tube placement using a dye study