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Discharge Requirements For Ventilator Dependent Child
Medical stability on home equipment (e.g. ventilator, humidifier, circuit, etc.) with relatively constant ventilator settings for at least 5-7 days (after proving stability on standard hospital ventilator).
- Approval for homecare from insurance/ESDPT.
- Family has:
- Commitment to care for the ventilator-assisted child at home
- Realistic assessment of the medical needs of the child at home
- Pre-arranged ability to meet the needs of the child (e.g. home nursing, back-up care givers)
- All primary caregivers have mastered these areas in the child's care:
- CPR
- Tracheostomy tube changes
- Suctioning techniques
- Recognizing respiratory emergencies
- Managing acute illnesses and emergencies at home.
- Basic use and understanding of home equipment
- Local pediatrician committed to providing well-child care and urgent care.
- Local community emergency medical services (paramedics) informed of child's special needs.
- Notification of telephone and power companies to provide priority service in the event of an interruption of service.
- Arrangement of medical, psychosocial, and developmental support (e.g.. OT, PT, respite care, school, etc.).
- Respiratory equipment vendor and nursing (RN/LVN) with 24 hour availability.
- Orientation of home health nurses (with parents at bedside) to learn the child's care (including tracheostomy tube changes).
- Parents successfully complete 24-48 hours of care. This should happen 5-7 days before anticipated discharge so that problems can be addressed.
- Home Equipment:
- Vendor has taught all caretakers how to use home equipment.
- All home supplies must be delivered at least 3 days prior to discharge.
- Discharge medications, syringes, needles, etc. have already been delivered to home.
- Equipment must be tested at least 2 days before discharge: home circuit (heater, humidifier, etc), double check external batteries, etc.
- Arrangement of routine and emergency transport from home to medical center.
- Transportation Home:
- Parents should transport the child home in a fashion that the child will be transported in the future so that transport to the hospital will be established.
- Parents will bring home nurse, resuscitation bag, portable oxygen (if patient uses oxygen), car seat (as needed), and other items needed for transport to hospital prior to discharge date in preparation of transport home.
- Ventilator vendor: Respiratory therapist must be notified of discharge date and arrive at hospital in morning to assist in discharge. Respiratory therapist should drive follow family home and assist in stabilizing equipment at home.
- Home health agency and home equipment vendor needs to be informed of discharge date. The home health nurse should arrange to ride with the child in the car to home.
- Written discharge plan established at least one day before discharge.
- Follow-up appointments arranged.
Home Vent F.A.Q.
No FAQ available at this time.
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Home Ventilation for Children With Chronic Respiratory Failure
 Children who require long-term assisted ventilation are by definition very complicated. Meticulous discharge planning is needed to support these children and their families at home in order to:
- Ensure the medical safety of the child
- Optimize the child's quality of life (by normalizing the life style as much as possible and by reintegrating the child back into the family)
- Prevent or minimize medical complications to avoid premature rehospitalization.
With this goal, the transition from the hospital to the home requires patience, diligence, and compulsive attention to details. Because of the inherent complexity of the process, we must expect that there will be inevitable delays prior to discharge, however, we need to remember that the work we do is to reach the goals listed above.
The following lists are not complete but do address some basic home care discharge plans for children requiring assisted-ventilation. This hand-out is a work in progress and the list may change. Furthermore, the specific needs of each child will depend on their individual health problems and social situation.
Home Equipment
- Portable ventilator with disconnection or low pressure alarm
- Emergency back-up electrical system (e.g. battery, car battery with case & cables)
- Electrical wiring and circuits in house adequate to support electrical equiptment
- Respiratory circuit for ventilator
- Back-up respiratory circuit for ventilator
- Tracheostomy tubes with back-up tubes
- Cleaning supplies for tracheotomy tubes (peroxide, sterile water, gauze, etc.)
- Primary oxygen delivery system
- Back-up oxygen tank with regulator
- Aerosolized medication delivery system
- Aerochamber spacer for tracheostomy tubes
- Portable suction machine with battery pack
- Resuscitation bag with appropriate mask and tracheostomy adaptor
- Infant apnea-bradycardia monitor with portable battery pack
- Pulse-oximeter
Living with Home Vent
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