The Tracheostomy Decision with Dr. Parisa Kaviany and Dr. Maria Arroyo--Part 1
Nov 28, 2022
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Dr. Parisa Kaviany and Dr. Maria Arroyo discuss the tracheostomy decision, including introducing the concept to families, home nursing challenges during the pandemic, options for post-tracheostomy transfer, and reflections on alarm sensitivity and discharging children with artificial airways.
Open communication and supporting families in decision-making are crucial aspects of the tracheostomy process.
Preparing families for life after tracheostomy involves setting realistic expectations and informing them about the necessary steps and potential transitions.
Deep dives
Introduction of Tracheostomy Care
In this podcast episode, two pulmonologists, Dr. Parisa Caviani and Dr. Maria Arroyo, discuss post-tracheostomy care and the process of transitioning pediatric patients home. They emphasize the importance of having providers initially explain the necessity of a tracheostomy to families, allowing them to voice their concerns and join the conversation. The physicians also suggest starting conversations about tracheostomy before patients even require ICU admission to ensure thorough understanding and preparation. They highlight the significance of open communication, honesty, and supporting families in decision-making throughout the tracheostomy process.
Preparing Families for Life After Tracheostomy
The podcast delves into the steps involved in preparing families for life after tracheostomy. The physicians highlight the importance of gradually introducing the concept and setting realistic expectations. They stress the need to inform families about the long-term commitment and how the road ahead after tracheostomy will not be easy. By laying out the steps involved, including the post-op recovery, trache change, and potential subacute care facility transition, the pulmonologists aim to mentally prepare families for what to expect during the weeks following the surgery.
Home Setup and Nursing Requirements
The discussion shifts focus to the specific requirements and considerations for ensuring a safe home environment for patients with tracheostomy. The pulmonologists emphasize the need for two caregivers available 24/7 for pediatric patients with tracheostomy. They mention that the house needs to be equipped with space for the ventilator, suction equipment, oxygen tanks, and other necessary medical supplies. The physicians also highlight the importance of adequate training for caregivers to perform tracheostomy cares. While insurance typically covers the costs of the required equipment, the physicians acknowledge the challenges parents face in adjusting their lives to provide constant care for their medically fragile children.
Dr. Parisa Kaviany is a former Children’s National Resident, she completed her pediatric pulmonology fellowship at Johns Hopkins and we were lucky enough to get her back as a pulmonologist. Dr. Kaviany’s research interest is health disparities among children with asthma.
Dr. Maria Arroyo did her pulmonology fellowship at Children’s National in DC and stayed as an attending, she also works at The HSC Pediatric Center, a subacute care facility in Washington, DC. Dr. Arroyo is THE person you want your patients’ parents to meet when they’re making the tracheostomy decision.
Objectives: By the end of listening to this episode, learners should be able to:
Describe the typical stakeholders involved in a tracheostomy decision.
Understand the caregiver, spatial, and technical requirements of living at home with a tracheostomy.
Describe the requirements that must be met prior to discharge to an acute care facility.
Differentiate the ventilator weans that must take place prior to discharge home vs prior to discharge to an acute care facility.
Mentioned in this episode: Family Reflections: a website about deciding about home ventilation ATS Trach Education PDF: A pediatric tracheostomy education PDF from the American Thoracic Society Lilly's little lungs: one family's story of going home with a preemie who needs a trach and vent, the account follows her through a successful LTR.
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Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.comfor detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.
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