ATS GUIDELINES Bundle

8 Management Table 3. Suggested Educational Objectives for Family and Professional Caregivers of Children Requiring Home Mechanical Ventilation a Pulmonary care and assessment Caregivers should be able to: Obtain basic vital signs, including pulse rate, breath rate, and oxygen saturation Recognize and state the child's usual breath rate, pulse rate, oxygen saturation, respiratory effort, and color Identify type of ventilator used in home and ventilator settings Identify type of tracheostomy tube and whether it is cuffed or uncuffed and, if cuffed, instructions for inflation of the cuff (manufacturer recommendation for cuff inflation [air vs. water], amount of air/water used to inflate cuff, hours per day spent with cuff inflated) Identify type of "back-up" tracheostomy tube to be used if primary tube cannot be replaced Know that an additional tracheostomy tube, the back-up tracheostomy tube, and the supplies needed to change the tracheostomy should be with the child at all times (the "Go Bag") Identify signs of respiratory distress and describe proper intervention. (Signs of respiratory distress to review may include: increased tracheal secretions or change in color of secretions, retractions, increased work of breathing, cough, color changes, nasal flaring, increased or decreased heart rate, increased or decreased respiratory rate, desaturation, anxiety, abnormal breath sounds.) e home must have a functional fire extinguisher that home occupants are able to operate. A home fire escape plan that includes the patient and minimal equipment needed for life support should be in place. e ambient temperature in the home should remain within the range recommended by the ventilator's manufacturer. Irritants (e.g., cigarette smoke, incense burning, molds) should not be present. Local EMS should be made aware of the patient and the patient's condition. On the basis of distance from emergency services, consideration should be given to additional back-up equipment in home. Letters requesting that services be restored quickly in an outage should be sent to the telephone and utility companies. Table 2. Proposed Standardized Criteria for Discharge of an Invasively Ventilated Child to Home (cont'd)

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