Resp Care
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The placement of nasal or oral gastric tubes is one of the most frequently performed procedures in critically ill children; tube malposition, particularly in the trachea, is an important complication. Neurally adjusted ventilatory assist (NAVA) ventilation (available only on the Servo-i ventilator, Maquet Critical Care, Solna, Sweden) requires a proprietary-design catheter (Maquet Critical Care, Solna, Sweden) with embedded electrodes that detect the electrical activity of the diaphragm (EA(di)). The EA(di) catheter has the potential benefit of confirming proper positioning of a gastric catheter, based on and the EA(di) waveforms. ⋯ EA(di) guidance helps confirm proper gastric catheter position, is equivalent to our standard practice for confirming gastric catheter placement, and may reduce the need for radiographs and improve patient safety by avoiding catheter malpositions.
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Partial or total obstruction of an endotracheal tube (ETT) by mucus can cause severe respiratory distress, hypoxemia, or death. Signs of an obstructed ETT include increased ventilation pressure, changes in the ventilator graphics, S(pO(2)) decrease, and cardiovascular changes. ⋯ In each case we used a new device (Rescue Cath, Omneotech, Tavernier, Florida) designed to remove mucus from the ETT lumen. The 3 cases demonstrate that the device is effective and capable of relieving the adverse effects of ETT mucus obstruction.
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Arterial blood sampling is subject to numerous pre-analytical errors, one of which is inadvertent venous blood sampling. Especially when assessing oxygenation and titrating ventilation, accidental venous blood sampling may lead to inappropriate respiratory care and repeated percutaneous punctures. ⋯ Lower blood pressure increased the sampler filling time. Measuring the filling time may enable therapists to confirm successful arterial puncture in adult patients. Confirming successful arterial puncture prior to blood analysis would expedite appropriate patient care decisions.