Caregiving Hacks
Its impossible to provide good care to PALS without innovation and hacks. This page is dedicated to share some hacks and tricks we have developed during our journey.
- Innovative nebulizer solution for keeping nebulizer cup straight upright
During nebulization, its always been a challenge to keep the nebulizer cup perfectly vertical for effective drug delivery to the lungs. We have come up with a solution to this problem with 3 "T Pieces" arranged in a specific way as shown in the photographs. Unnecessary holes can be blocked using stoppers. For blocking, we use the cap of "Fast & Up Reload" instant electrolytes, marked with a yellow arrow in the last photograph.
Another variation of the same setup can be seen in the following photograph where the catheter mount is placed sideways making the nebulizer cup in line with the ventilator airflow. So this should be preferred over the 'top' placement of the catheter mount.
2. Using an Ambu bag as a manual ventilator for lung volume recruitment or handling emergency situations
Ambu bag can be used as a manual ventilator for lung volume recruitment or even in the emergency of ventilator failure. Ambu bag has an optional port for supplementing with oxygen. Under normal circumstances, Ambu strokes should follow the natural rhythm of the patient's breathing and per minute typically 12 to 16 breaths can be given. In case of emergency (low saturation, tracheostomy tube blockage, unconsiousness), Ambu ventilation should be supplemented with oxygen, and Ambu strokes can be faster than normal until a good saturation is achieved.
3. Simultaneous nebulization and Ambu bagging for lung volume recruitment and clearing lung secretions
Doing nebulization and Ambu ventilation simultaneously not only delivers medication deep into the lungs but also Ambu's forced expiration effect brings cough into the trachea which is easy to suction out.
4. Make your enema solution at home
We have found the "Neotomic" enema (intended for kids) to be working the best for our PALS. It has shown no side effects so far and we have been using it since Feb 2021. However, commercially available Neotomic enemas in the Indian market are very expensive, approx 70 Rs for 20 ml as of Feb 2024. Hence we synthesize it at home. A close inspection of the composition of Neotomic enema is as follows:
Sodium Chloride aka NaCl: 15% w/v or 15 gms in 100 ml enema
Glycerine [Density = 1.26 gm/ml ]: 15% w/v or 15 gms in 100 ml enema
Rest is Water aka H2O [Density = 1.00 gm/ml ],
All basic components of the enema ie Salt, Glycerine, and Water are easily available. However, these should be acquired and processed in the most sterile manner. We mix glycerine, salt, and normal saline in appropriate amounts to follow the desired composition.
As per our calculations: take a sterile bottle, and pour around 587 ml of normal saline, 95 gm of salt (sterile, non iodized), and 100 gm of glycerine. Shake well. It will lead to around 680 ml enema which can be used for around 17 times, assuming that for each enema, 40 ml solution is required. From our experience, if applied appropriately, 30 ml is sufficient volume for each time. The remaining enema should be kept at room temperature in a sterile airtight container.