Feeding Tubes
This feeding tube is preferred over a G-tube in children with severe gastric dysmotility, recurrent aspiration despite gastric feeds, or intolerance of gastric feeding
What is a GJ tube?
Compared with a PICC line, this type of central access is generally preferred for children needing frequent long-term intermittent access with lower infection risk and fewer activity restrictions.
What is a port? (PORT -A - CATH)
This anticholinergic medication, also known by a common brand name, is used to treat dystonia and abnormal muscle tone in children with cerebral palsy.
What is trihexyphenidyl (Artane)?
This is the most common immediate cause of acute tracheostomy decompensation in children.
What is mucous Plugging/trach obstruction?
A child with a central line develops fever without a clear source. This diagnosis must always be considered and typically requires blood cultures from the line.
What is a CLABSI?
A child with a mature G-tube accidentally removes it at home. This is the approximate timeframe in which the tract can begin to close, making urgent replacement important.
What is 4-6 hrs?
This complication should be suspected when a PICC line suddenly becomes difficult to flush and the arm appears swollen.
what is a catheter associated thrombus?
This medication used for spasticity carries a risk of withdrawal symptoms including seizures, hyperthermia, and rhabdomyolysis if abruptly stopped, especially when delivered intrathecally
What is Baclofen?
During a trach emergency, this bedside information is critical to know before attempting replacement
What is the age of trach track? (will also accept type and size- should have proper size and one less in case of edema)
A medically complex child with multiple subspecialists is frequently hospitalized due to fragmented care. This model of care, often led by a primary provider, improves outcomes by coordinating across specialties and settings.
What is the medical home model?
A child with a GJ tube presents with retching, increased secretions, and formula backing up into the gastric port. This complication should be suspected
What is J portion has migrated to stomach
A child with a tunneled central line develops fever and rigors immediately after line access. Besides blood cultures, this empiric management is often necessary.
What is broad spectrum antibiotics?
(also maybe peripheral access for things other than antibiotics)
This alpha-2 agonist is commonly used for autonomic storming, irritability, and sleep dysregulation in neurologically impaired children.
What is clonidine?
If a trach-dependent child cannot be ventilated through the trach, this emergency maneuver should be attempted next.
What is bag-mask ventilation via the mouth/nose (covering the stoma)?
A child with autism repeatedly harms themselves during transitions and has escalating aggressive behaviors at school. This behavioral therapy is often recommended as part of management.
What is ABA?
This serious complication should be suspected in a child with a recently placed G-tube who develops abdominal distension, fever, pain, and feeding intolerance.
What is peritonitis from intraperitoneal tube dislodgement or leak?
This dangerous electrolyte abnormality can occur after rapid correction of dehydration or initiation of nutrition in severely malnourished children with central access.
What is refeeding syndrome? (specifically hypophosphatemia)
A neurologically impaired child with chronic unexplained irritability, poor sleep, arching, and episodic crying has had negative infectious and GI evaluations. PM&R recommends starting this medication because the symptoms may represent neuroirritability or neuropathic pain.
What is Gabapentin?
During a trach emergency, bedside replacement attempts are much riskier in this type of tracheostomy because the tract is not yet well formed and false passage creation can rapidly lead to loss of airway.
What is a fresh trach? (5-7 days, trach that hasn't had initial change)
This document outlines emergency preferences, resuscitation limitations, and family goals for medically complex children and is especially important during transitions of care.
What is advanced directive or MOLST Form?
A child with a long-standing G-tube presents with increasing pain during feeds, leakage around the tube site, resistance when flushing, and a tube that appears unusually tight against the skin. Examination shows erythema around the stoma and inability to rotate the tube easily. This complication should be suspected
What is buried bumper syndrome?
Antibiotic locks or ethanol locks, saran wraps, linen changes and chlorhexidine baths
What are strategies to reduce chances of CLABSI?
A child with severe spasticity and an implanted device for continuous medication delivery develops increased tone, pruritus, and irritability before progressing to fever and autonomic instability. Immediate evaluation of this device is critical.
What is the intrathecal baclofen pump (with concern for withdrawal or malfunction)
(can progress to hyperthermia, rhabdo, seizures adn Multiorgan failure- give po or IV baclofen)
A child with a recently revised tracheostomy develops acute respiratory distress shortly after a trach change attempt. On exam, the neck and upper chest have palpable “crackling” beneath the skin, and ventilation through the trach is difficult. This complication should be suspected.
What is creation of a false track with subcutaneous emphysema?
A technology-dependent child with recurrent admissions, polypharmacy, and multiple specialists is at highest risk for this type of medical error during hospital discharge and outpatient transitions.
What is medication reconciliation error (or care transition error)?