Trach / Vent Sick Day Management at Home

When your child is sick with a respiratory illness, they may need extra support to be able to breathe better. It is important for you to contact your child’s pulmonary team when your child starts to show signs of respiratory illness.

Here are some common questions we will ask to help determine how sick your child is.

• When did your child’s symptoms start?
• How often are you suctioning?
• What do their secretions look like?
• How would you describe their work of breathing?
• Are there any vent/ monitor alarms going off more frequently than normal?
• Have they had a fever?
• What are their oxygen saturations? Have they needed any extra oxygen?
• Have you given any extra airway treatments (CPT: clapping, cough assist, vest)?
• Have you given any “as needed” (PRN) respiratory medicines?
• Are they tolerating their feeds/keeping food down?

• How hard they are breathing - retractions or nasal flaring, etc.
• Your child’s respiratory rate and the respiratory rate shown on the vent
• Frequent ventilator alarms
• Secretion color, thickness, and amount
• Breath sounds: coarse, wheezing
• Coughing
• Oxygen saturations: desats or lower than normal
• Changes in oxygen needs
• Changes in heart rate and temperature
• If you are giving any extra airway treatments or giving any “as needed” respiratory medicines, are they helping?
• Energy level/ lethargy
• Change in urine output (how much are they peeing?)

The nurses on the pulmonary trach/vent line will assess your child’s symptoms and will always consult with the pulmonary doctor. We may:

• Tell you to just watch your child for a while and not treat immediately.
• Likely always have you increase frequency of airway clearance and increase use of ordered “as needed” respiratory medicines like puffs, nebulizer.
• Add new medicine or change dose or frequency of current respiratory medicines.
• Have you drop off a trach sputum sample at a lab.
• Consider antibiotics. Not all respiratory illnesses will require antibiotics.
• Have you hold vent breaks or use of speaking valve or cap during illness.
• Temporarily increase your child’s vent settings.
• Update home nursing agencies with plan of care.
• Recommend a visit to your child’s PCP or the nearest emergency room. In some cases, we may recommend calling 911.

The direct line to reach your child’s pulmonary nurses is 206-987-4728. Add us as a contact to your smartphone so you have quick access to us and your pulmonologist.

If you are calling after 5 p.m. weekends, or on holidays, please call Seattle Children’s Hospital operator and ask for the on-call pulmonologist.

• Call your Respiratory DME company if your child’s respiratory equipment is not working properly.
• For non-respiratory symptoms, please contact your child’s primary care provider or other specialty clinic.