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John’s Troubleshooting Tip of the Month: Food Pump Series- Part 5 Gravity Bag Feeding

Monday, March 5th, 2012

PHS understands how stressful it can be when a piece of equipment isn’t working properly, and we want to help resolve any issues as soon as possible for you. So, once a month, PHS Respiratory Therapist, John Sheahan posts a tip on how to troubleshoot a common error with a piece of equipment.

This month we will finish up our food pump series by troubleshooting gravity bags.

A gravity bag does not need a pump to deliver formula or breast milk. It is used short term if, after troubleshooting with a PHS clinician, it has been determined that the food pump needs to come in for service. This allows you to feed your child/patient while your replacement pump is being delivered. To make sure you give the right amount of formula or breast milk you must use a simple calculation.

Enter the rate on your food pump into the ___(blank line)___
Multiply that number by 20
Divide that number by 60 to give you the number of drips per minute to set using the gravity bag.

For example if you have a set rate on the food pump of 35 mL**/hr it would look like this:
30 x 20 = 600
600 divided by 60 = 10 drips per minute.
**NOTE: If the number is not a whole number round either up or down to the closest whole number.

Once you have figured out the Calculation for Gravity Drip follow these instructions to deliver the right amount of formula or breast milk:

Clean workspace and gather supplies.
Wash hands well.
If formula is in concentrate or ready to feed form, shake can well.
Wipe off top of can with clean cloth.
Close roller clamp on feeding bag.
Pour formula or breast milk into bag. Close top firmly.
Hang feeding bag high enough to allow tube feeding to flow by gravity.
Open roller clamp to fill tubing.
Close roller clamp. The drip chamber must be half full.
Flush feeding tube with warm water.
Have your child sit comfortably in upright position during the feeding.
Open the roller clamp on the tubing. Use the clamp to adjust the flow rate. Speed up the flow by opening the clamp, or slow down the flow by closing it. If your child has diarrhea or abdominal discomfort, slow down the flow rate.
After feeding is complete, close all the clamps.
Disconnect tubing from the feeding tube and flush with warm water.

John Sheahan, RRT-NPS, LRT is a Licensed Respiratory Therapist at PHS and would love to hear from you if you have a tip that you’ve found helps when working with your equipment, or have an idea for a Troubleshooting Tip post. Share your tip or idea through a comment here or an email to John at jcsheahan@pediatrichomese rvice.com.

Tags: calculation for gravity drips, caring for kids with serious illnesses, food pump, formula, gravity bag, help for families with sick kids, medically fragile kids, nutrtition support, respiratory therapty, roller clamp, special needs equipment, troubleshooting, tube feeding
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John’s Troubleshooting Tip of the Month: Food Pump Series- Part 4 Common Alarms

Monday, February 13th, 2012

This month we will finish up on the most common alarms you may receive when using the Infinity Teal and Infinity Orange food pump.

Alarm Message: Push Run to Feed
- Problem: Food Pump paused for more than 2 minutes.
- What to do:
  - 1. To start feeding: press RUN/PAUSE keypad button two times or
  - 2. To turn Food Pump OFF, hold ON/OFF keypad button
Alarm Message: Shut Door
- Problem: Door is open
- What to do:
  - 1. Push in latch and close Food Pump door completely.
  - 2. Call PHS at 651-642-1825 if latch is broken see earlier Troubleshooting Tip here.
Alarm Message: ER01-ER99 or ERRA-ERRZ
- Problem: Many factors can cause this alarm message.
- What to do:
  - 1. Hold ON/OFF keypad button until Food Pump turns OFF.
  - 2. Hold ON/OFF keypad button until Food Pump turns ON.
  - 3. Call PHS if same message reappears in display window.
If the volume delivered by the Food Pump in NOT the same as the dose set
- Reasons: Formula or Breast Milk was NOT correctly measured before placed in feeding bag, or a small amount (12.5 mL) of Formula or Breast Milk in Feeding Bag Tubing is not delivered to child.
- What to do:
  - 1. Make sure Formula or Breast Milk is correctly measured before placing in Feeding Bag.
  - 2. Be sure to add an extra 30 mL of Formula or Breast Milk into Feeding Bag at the beginning of each feeding.
  - 3. Call PHS in problem continues.

Tags: caring for kids with serious illnesses, er01 er99 erra, errz, food pump, food pump alarms, help for families with sick kids, home medical equipment, home medical equipment and supplies, infinity food pump, orange pump, pediatric home service, PHS, run to feed, shut door, support for families with sick kids, teal pump, thrive, troubleshooting, tube feeding
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John’s Troubleshooting Tip of the Month: Food Pump Series- Part 3 No Flow Alarm

Wednesday, December 7th, 2011

Continuing in our series of food pump troubleshooting tips this month we will discuss ‘No Flow In’ and ‘No Flow Out’ alarm messages on the Infinity Orange and Teal pumps.

The first thing we need to understand is what each of these alarms is really saying.

A No Flow In alarm is telling us that formula or breast milk is not moving easily between the feeding bag and the food pump.
A No Flow Out alarm is telling us that formula or breast milk is not moving easily between the food pump and the child’s stomach.

If you get a No Flow In alarm do the following:

Straighten out twists or bends in the feeding bag tubing.
Empty formula or breast milk from feeding bag into clean container.
- Flush feeding bag and feeding bag tubing with warm water.
- Pour formula or breast milk back into feeding bag.
- Remove air from feeding bag and feeding bag tubing.
Remove plastic unit and clean the three sensors using cotton swab and water.
Replace feeding bag with new one if needed.

If you get a No Flow Out alarm do the following:

Straighten out twists or bends in the feeding bag tubing.
Empty formula or breast milk from feeding bag into clean container.
- Flush feeding bag and feeding bag tubing with warm water.
- Pour formula or breast milk back into feeding bag.
- Remove air from feeding bag and feeding bag tubing.
Remove plastic unit and clean the three sensors using cotton swab and water.
Use syringe to flush child’s feeding tube with warm water to be sure feeding tube is not clogged.
Replace feeding bag with new one if needed.

NOTE: If there is a clamp on the G-tube be sure to open first and try to resume feeding.

Tags: caring for kids with serious illnesses, food pump, help for families with sick kids, home medical equipment, home medical equipment and supplies, pediatric home service, PHS, support for families with sick kids, thrive, troubleshooting, tube feeding
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John’s Troubleshooting Tip of the Month: Food Pump Series- Part 2 Replacing the door

Monday, November 7th, 2011

PHS understands how stressful it can be when a piece of equipment isn’t working properly, and we want to help resolve any issues as soon as possible for you. So, once a month, PHS Respiratory Therapist, John Sheahan will post a tip on how to troubleshoot a common error with a piece of equipment.

Today’s post is the second in a series that focuses on food pumps. We frequently receive calls from families for troubleshooting the food pump. In this second segment we will focus on what to do if the Infinity food pump door breaks.

There are two types of Infinity food pumps, the Infinity Teal and the Infinity Orange, and both have the potential of the door latch that connects to the pumps inside holder breaking. To prevent this from happening always press the latch in with your thumb before opening and closing the food pump door. If the door latch does break however follow these steps:

Close the Infinity food pump door and secure it tightly with either a hair band or a rubber band.
The food pump will run as long as the food pump door is closed tightly.
Call PHS at 651-642-1825 and report the problem. We will send you a replacement door.
When you receive the new door:
- Open the broken food pump door away from the food pumps main body.
- Firmly hold pump and door in BOTH hands.
- Quickly snap the door away from pump.
- Replace with new door by inserting the replacement food pump door latch into the inside holder.
- Gently snap door into place.
- Do NOT force the door closed.

See the graphic below for a visual on how to remove and attach a door. For even more help with your EntraLite® Infinity food pump watch this video from PHS IV nurse Gail as she walks you through common errors with the pump and how to solve them.

Tags: broken door, caring for kids with serious illnesses, entralite, food pump, help for families with sick kids, home medical equipment, infinity, infusion pump, medically-fragile, pediatric home service, PHS, replace door, troubleshooting, tube feeding
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John’s Troubleshooting Tip of the Month: Food Pump Series- Part 1

Tuesday, October 4th, 2011

PHS understands how stressful it can be when a piece of equipment isn’t working properly, and we want to help resolve any issues as soon as possible for you. So, once a month, PHS Respiratory Therapist, John Sheahan will post a tip on how to troubleshoot a common error with a piece of equipment.

Today’s post is the first in a series that will focus on food pumps. We frequently receive calls from families for troubleshooting the food pump. In this first segment we will focus on blending the formula and priming your feeding bag.

Formula

If you have a powdered formula it is best to mix it well in a blender. This is to make sure all of the powdered formula granules, that can cause alarms, are well dissolved. Watch a video from PHS Dietitian Gwen, on how to properly mix your formula to avoid granules here.

At PHS we recommend mixing powdered formula with cold water unless the formula manufacturer instructions recommend using a different temperature.

After blending, formula may be frothy, so let it sit for 15 minutes.

Pour breast milk or formula into feeding bag and remove air from filled feeding bag by gently pushing down until fluid rises into neck of bag, as pictured above. Replace cap before lifting bag. Note: some feeding bags may different than the one pictured.

Priming feeding bag and tubing

If you are using an EnteraLite Infinity food pump (orange or teal) you will have to prime the feeding bag tubing by completing the following steps.

Push in latch and open Food Pump door.

Hook U-shaped tubing around pump wheel. Gently stretch plastic unit away from pump wheel and press down into place.

Push in latch and close Food Pump door completely

Hold down ON/OFF keypad button until Food Pump beeps and turns ON. Food Pump then does a self-check.

The word RATE and a number will show in display window when Food Pump finishes self-check.

Remove cover from Feeding Bag Adapter at end of Feeding Bag Tubing. Place Feeding Bag Adapter into clean container.

Hold Feeding Bag upside down. At the same time, hold down PRIME keypad button until Formula or Breast Milk comes out of Feeding Bag Adapter. NOTE! PRIME button MUST be held down during the entire priming process.

Replace cover on end of Feeding Bag Adapter.

Tags: breast milk, caring for kids with serious illnesses, caring for kids with serious illnesses at home, entralite, feeding bad, food pump, formula, help for families with sick kids, infinity, medically-fragile, pediatric hopme service, PHS, prime food pump, priming, taking care of the child, thrive, troubleshooting, tube feeding
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John’s Troubleshooting Tip of the Month: Capnography Monitors (ETCO2) for nasal cannula

Wednesday, September 14th, 2011

Novametrix Capnogard ETCO2 Monitor

PHS understands how stressful it can be when a piece of equipment isn’t working properly, and we want to help resolve any issues as soon as possible for you. So, once a month, PHS Respiratory Therapist, John Sheahan will post a tip on how to troubleshoot a common error with a piece of equipment.

Last month I discussed using a capnograph or ETCO2 monitor, as they are sometimes called, to patients with tracheostomy tubes. This month I would like to talk about using a capnograph to patients without a tracheostomy tube, using a nasal cannula.

The Novametrix Capnogard ETCO2 Monitor is the only capnograph PHS carries that will measure exhaled carbon dioxide (ETCO2) levels using a nasal cannula. Be sure to use the step-by-step instructions at the end of this post to setup and calibrate the monitor before use.

Troubleshooting

If the exhaled carbon dioxide, or ETCO2, results seem inaccurate:

Make sure the pump is on (there will be a small pump icon displayed in the lower part of the LED screen and the monitor will make a pumping noise).

Make sure the patient cable is tight and not damaged.

If you need to disconnect and reconnect the patient cable be sure to recalibrate the monitor.

Check the Sample Airway Adapter for cracks or water spots.

Check tubing and cannula for kinks.

Check for excessive humidity in the Dehumidifier Tube – and change if necessary.

Check nasal cannula prongs to make sure they are not clogged – clean or change if necessary.

If these steps do not correct the problem call PHS.

Using ETCO2 monitor with a Nasal Cannula

Make sure Sampling Airway Adapter windows are clean, dry and not cracked.

Snap Sampling Airway Adapter to child’s cable.

Connect sampling tubing from adapter to inlet port on the front of monitor.

If instructed by your PHS Clinician, connect Dehumidifier Tube to Sampling Airway Adapter.

Connect appropriate CO2 Nasal Cannula to Sampling Airway Adapter.

Press POWER key to turn monitor ON.

Make sure HIGH/LOW ETCO2 and HIGH/LOW RESPIRATORY RATE alarm parameters are correct.

When Capnogard displays “ERASE STORED TRENDS?”, press YES to erase stored data. NOTE! If doing an overnight study, DO NOT erase the trends once study begins.

Make sure sampling pump is turned ON. NOTE! A pump icon displays on screen. If you do not see this pump icon, do the following:

Press MENU.

Press PUMP.

Press ON.

If needed, calibrate the sensor as instructed. Calibrate if sampling method has changed or “ADAPTER CAL?” appears on display. Read the Calibrating the Sensor section below.

Place appropriate CO2 Nasal Cannula on child.

Watch your child’s respiratory rate and ETCO2 value. Record these values in the child’s chart or on the log sheet provided.

Calibrating the Sensor

Press CAL key. The message “PLACE ON ADAPTER IN ROOM AIR” displays.

Place sensor and adapter away from all CO2 sources.

Press START key. The “TIME REMAINING” number counts down and main menu displays.

At the end of countdown, remove Patient Airway Adapter and place Capnostat on “0” rear cell. Wait for the countdown.

When “PLACE REFERENCE CELL” message displays, move to (front) “REF” cell.

When “CALIBRATION VERIFIED” displays, remove from reference cell and place Patient Airway Adapter on Capnostat.

Press CAL key.

Press START key. Wait for the countdown.

Tags: airway, calibrate, calibration, cannula, capnogard, carbon dioxide levels, caring for kids with serious illnesses at home, cero, etco2, home medical equipment, home medical equipment and supplies, medically fragile kids, monitors, nasal, pediatric home service, pediatric monitor, PHS, respiratory, troubleshooting, zeroing
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John’s Troubleshooting Tip of the Month: Capnography Monitors (ETCO2)

Tuesday, August 2nd, 2011

PHS understands how stressful it can be when a piece of equipment isn’t working properly, and we want to help resolve any issues as soon as possible for you. So, once a month, PHS Respiratory Therapist, John Sheahan will post a tip on how to troubleshoot a common error with a piece of equipment.

Capnographs or ETCO2 monitors as they are sometimes called are extremely valuable machines for monitoring your patient or child’s carbon dioxide as they breathe. Of course with any machine there can be problems. This month I will focus on a few troubleshooting steps that will insure you always getting the most accurate readings when using a capnograph to trach.

Novametrix Capnogard ETCO2 Monitor

When using the Novametrix Capnogard monitor be sure to always calibrate before use by following the step-by-step instructions below:

Calibrating the Sensor

Press CAL key. The message “PLACE ON ADAPTER IN ROOM AIR” displays.
Place sensor and adapter away from all CO2 sources.
Press START key. The “TIME REMAINING” number counts down and main menu displays.
At the end of countdown, remove Patient Airway Adapter and place Capnostat on “0” rear cell. Wait for the countdown.
When “PLACE REFERENCE CELL” message displays, move to (front) “REF” cell.
When “CALIBRATION VERIFIED” displays, remove from reference cell and place Patient Airway Adapter on Capnostat.
Press CAL key.
Press START key. Wait for the countdown.

Tidal Wave Novametrix Capnograph

TIDAL WAVE Novametrix Monitor

When using the TIDAL WAVE Novametrix monitor be sure to always zero before use by following the step-by-step instructions below:

Zeroing a new patient airway adapter

Attach a new patient airway adapter to the TIDAL WAVE patient cable.
Press POWER button to turn machine ON.
Make sure light below NEO key is OFF.
Wait for the sensor on the patient cable to warm up. NOTE! The text SENSOR WARMING displays on screen.
Press and hold NEO key until the ZERO menu screen displays.
Press the PAGE button to “zero” the adapter. NOTE! Pressing this button starts a process that allows the machine to read your child’s carbon dioxide levels accurately. This process is occurring when the machine’s screen shows a numerical countdown.
When the zero process is complete, the machine automatically switches to monitoring mode.
You can now use the machine as ordered by your child’s doctor.

Troubleshooting tips for your TIDAL WAVE monitor

If the carbon dioxide, or ETCO2, results seem inaccurate (for either monitor):

Make sure patient cable is tight and not damaged.
Check Patient Airway Adapter for cracks or water spots.
If you need to disconnect and reattach the patient cable (Novametrics Capnograph only) or change the Patient Airway Adapter recalibrate or Zero the machine.
If ETCO2 results are still low check for leak around the trach. This can give a false low reading.
If these steps do not correct the problem call PHS.

Tags: airway, calibrate, calibration, capnogard, carbon dioxide levels, caring for kids with serious illnesses at home, cero, etco2, home medical equipment, home medical equipment and supplies, medically fragile kids, monitors, pediatric home service, pediatric monitor, PHS, respiratory, troubleshooting, zeroing
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John’s Troubleshooting Tip of the Month: Oxygen Concentrator

Tuesday, July 5th, 2011

An oxygen concentrator is a machine that allows you to deliver the exact amount of oxygen your doctor has prescribed for your patient or child without the hassle of having to change tanks. The machine does this by filtering out nitrogen and other gasses from the air to create a higher amount of oxygen.

Sequel Eclipse Oxygen Concentrator (left) Puritan Bennet 590 Oxygen Concentrator (right)

Of course, with any machine, there can be problems. So if there is ever a problem with the oxygen concentrator always use a tank to make sure you are giving the proper amount of oxygen before going on to these trouble shooting steps.

If you get an alarm check:

that the power cord is plugged into a working wall outlet.
that the ball on the flow meter is not all the way up or all the way down.
that the intake filter is not clogged with lint. If so, replace with clean filter.
that the machine’s air intake area is not blocked by walls, furniture, or drapes.
that the oxygen tubing is not kinked or blocked.

If the alarm does not stop:

Disconnect tubing and bubbler if you are using one.
Turn machine off if still giving alarm.
Look for one of the above causes of the alarm.
Wait ten minutes for the machine to cool down.
Turn machine back on and adjust as needed.
Call PHS at 651-642-1825 if machine is still not working.

Always make sure you have enough oxygen tanks in case of power outages and equipment failure. Your PHS clinician will help you calculate the right amount.

Tags: caring for kids with serious illnesses, concentrator, help for parents caring for seriously ill kids, home medical equipment, home medical equipment and supplies, home medical supplies, oxygen, puritan bennet, sequel, troubleshooting
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John’s Troubleshooting Tip of the Month: Bi-Annual Battery Charging

Monday, June 6th, 2011

It’s Summer—or so we hope.

The weather has been unpredictable at best. With more storms and power outages sure to come it’s a good time to check the battery life of your equipment. Twice a year you are responsible for making sure all battery units can last the required time needed to run a piece of equipment. As each piece of equipment will vary be sure to check your PHS manual to find out how long each piece of equipment should last.

BEFORE recharging ANY battery make sure:

Always check the weather report before doing any battery rundowns.
Batter case is placed in a well ventilated area and is as far from the battery charger as possible.
Battery charger and case are on a stable surface so it cannot tip over.

As always, if you ever have questions about your equipment or troubleshooting tips don’t hesitate to contact your PHS Respiratory Therapist at 651-642-1825.

Tags: battery, caring for kids with serious illnesses, charging, food pump, interacter, pediatric home service, PHS, troubleshooting, ventilator
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John’s Troubleshooting Tip of the Month: Oximeter Probe Placement

Monday, April 4th, 2011

PHS understands how stressful it can be when a piece of equipment isn’t working properly, and we want to help resolve any issues as soon as possible for you. So, once a month, PHS Respiratory Therapist, John Sheahan will post a tip on how to troubleshoot a common error with a piece of equipment.

An oximeter is a monitor that indicates the level of oxygen in the blood. Oximeters are one of the most important monitors in the home, but they are also one of the most sensitive. To help ensure best results and minimize false readings proper probe placement is essential. Follow these placement tips below and be sure to contact your PHS respiratory therapist if you have further questions.

Probe Placement Tips

Make sure the red light is on top part of nail bed. NOTE: Fingernail polish should be removed from the finger or toe being used. If prove is being placed on a foot, make sure the red light is placed on the pinky side of foot.
Line up the receiving dot so it is opposite to red light.
Wrap the probe securely, but not too tightly, around a finger or foot. NOTE: If wrap is too tight, blood flow may affect oximeter reading. You can use tape to better secure the probe.
If probe is on a toe or foot, cover the foot with a sock to help the foot stay warm and to reduce the chance of the probe becoming loose. Probes that becomes loose may give off inaccurate readings.