Table 6.
Suggested Educational Objectives for Family and Professional Caregivers of Children Requiring Home Mechanical Ventilation
|
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.) |
| Tracheostomy care |
| Guidelines for tracheostomy education are provided in Reference 61 |
| Emergency response |
| Caregivers should be able to: |
| • Verbalize criteria for calling emergency services (such as 911 in the United States) |
| • Be certified in CPR |
| • Be able to access a list of numbers for emergencies or problems not requiring emergency services (physicians, DME, etc.) and know who to contact on the basis of the type of emergency |
| • Demonstrate use of self-inflating bag and mask in routine and emergency care procedures |
| • List signs of tracheostomy obstruction |
| • Demonstrate appropriate suctioning techniques to remove tracheostomy obstruction |
| • Demonstrate an emergency tracheostomy tube change (change done by one caregiver without assistance) |
| • Demonstrate knowledge of emergency medications (if applicable) |
| • Verbalize plans for loss of electricity, fire, tornado, or other natural disaster |
| Ventilator training |
| Caregivers should be able to: |
| • Identify electrical power sources |
| • Assemble ventilator circuit and humidification system |
| • Describe routine cleaning of equipment |
| • Add oxygen to circuit if indicated |
| • Verbalize that ventilator alarms must be audible throughout the home |
| • Demonstrate how to properly turn the ventilator on, test the ventilator before use, and view and verify settings |
| • Demonstrate an understanding of ventilator alarms and how to troubleshoot the alarms |
| • Demonstrate the appropriate technique for draining tubing in the ventilator circuit, down and away from child |
| • Demonstrate the ability to keep battery-operated back-up equipment charged and ready for use |
| • Demonstrate how to charge batteries for ventilators |
| • Demonstrate how to connect and use the external battery for the ventilator if applicable |
| • Verbalize understanding of the approximate battery life for each piece of equipment |
| Infection control practices |
| Caregivers should be able to: |
| • Demonstrate infection control practices as they relate to the plan of care |
| • Demonstrate proper hand-washing technique |
| • Demonstrate proper disposal of contaminated material |
| • Demonstrate how to clean and disinfect reusable medical supplies |
| Medications |
| Caregivers should be able to: |
| • Identify the dosage and frequency of all medications required by the child |
| • Explain the indications and side effects of medications |
| • Demonstrate the ability to prepare and administer medications correctly |
| Oxygen |
| Caregivers should be able to: |
| • Demonstrate the proper care and use of home oxygen delivery equipment (e.g., cylinders, concentrators) |
| • Verbalize the safety issues related to use of oxygen in the home (risk of fire with smoking, open flames, flammable products near the oxygen, or close proximity to heat sources) |
| Demonstrate understanding of when and how oxygen should be used for the patient |
| Oximetry monitoring |
| Caregivers should be able to: |
| • Demonstrate the proper and secure placement of the oximeter probe |
| • Demonstrate the ability to differentiate true from false oximeter readings |
| • Verbalize steps for responding to an oximeter alarm |
| • Verbalize an understanding of normal oxygen saturations and a plan for responding to saturations that fall below the normal range |
| Suctioning equipment |
| Caregivers should be able to: |
| • Demonstrate the correct catheter size to use for the patient |
| • Demonstrate the correct suction pressure and catheter depth to use to clear tracheostomy |
| • Demonstrate how to test for suction pressure |
| • Demonstrate a clean suction technique |
| Nebulizer/metered dose inhaler (if ordered) |
| Caregivers should be able to: |
| • Verbalize when the prescribed inhaled medications are required |
| • Demonstrate how to deliver inhaled medications in ventilator circuit if applicable |
Definition of abbreviations: CPR = cardiopulmonary resuscitation; DME = durable medical equipment.
Further instruction and competency assessment will be required if patient requires equipment/therapy beyond those listed above (e.g., pulmonary clearance therapies, cardiorespiratory monitors, end-tidal CO2 monitors, etc.). The goal should be to ensure that all caregivers are fully versed in all aspects of the child’s care.