A blocked tracheostomy tube is a common pediatric emergency which requires practice ideally in a clinical simulation environment. An airway emergency in a pediatric patient with a complex airway can be incredibly daunting for any medical professionals involved in the patient’s care. This article by Erin Carn-Bennett, RN, MSN will explore planning, delivery and adaptations to the healthcare simulation scenario of a blocked tracheostomy tube in a pediatric patient.
Collaboration with the Clinical Pediatric Department
Firstly, when contemplating the creation of a clinical simulation scenario for pediatric blocked tracheostomy, it is imperative to consider the established local knowledge base within the proposed clinical areas. Work alongside local departments to either build this healthcare simulation based education into already established annual educational packages or to meet the educational needs of participants. This can be done with a tailored and bespoke clinical simulation program which scaffolds learning and makes simulation participants feel empowered and increases learner confidence.
A pediatric blocked tracheostomy healthcare simulation package may start with online learning modules, task trainer scenarios and then build from singular team training into multidisciplinary team training. This process is to tactically share information that builds in skill acquisition, increases confidence and mastery can ensure that the learner feels a sense of accomplishment and often moves from a fear of tracheostomy emergency care to empowerment. Empowerment of clinical skills acquired can be utilized to save the life of a child which could potentially perish quickly while awaiting specialist physician responses.
Plan the Scenario Alongside Local Policy and Algorithms
A blocked pediatric tracheostomy tube clinical simulation scenario needs to be aligned with local policy, procedures and common emergency algorithms. As always, a healthcare simulation scenario which is ideally in situ however can be any clinical environment enables the ability to test out any local guidelines and emergency responses to a pediatric blocked tracheostomy tube.
The scenario of a pediatric blocked tracheostomy tube can be a great opportunity for non-medical staff to have the opportunity to take on a hands off leader role in the first five minutes of this critical airway emergency. As a hands off leader in this simulation scenario the opportunity to allocate roles, read out and respond to the emergency algorithm or local guideline and put these actions into motion can be confidence-building and empowering for the clinical simulation participant team.
The Use of Expired Equipment Can Add to Fidelity Greatly
The collection of expired pediatric tracheostomy tube equipment for a healthcare simulation program is a great opportunity to make use of this niche equipment. Contact local clinical areas such as the emergency department, operation rooms, and ICU to ask for this expired equipment for education. There is the opportunity to create an actual blockage in the tracheostomy tube through measures such as a dot of super glue or blue tack at the end of the tracheostomy tube, which gives the clinical simulation participants the fidelity and haptics sensation of a blocked tracheostomy tube when suction is attempted in the scenario.
View the LEARN CE/CME Platform Webinar Using Healthcare Simulation to Train Patient Families in Pediatric Ventilation Care to learn more!
If possible a great investment is to have the same equipment that the patient would have access to in both the home and clinical environment. This increases fidelity for the simulation participants and ensures that there is awareness of what equipment families should have access to in an emergency as well. In some areas, families are sent home with a grab bag full of all required equipment to manage this emergency at home, and clinical staff often forget that this is available in an emergency.
Honor Parents as Experts in the Clinical Simulation
Parental involvement as experts with clinical simulation scenario experience can also be really useful. This may be achieved through simulated persons involvement or healthcare simulation faculty acting in the role of the parent in a pediatric blocked tracheostomy scenario. The parents are a huge resource to clinical teams in a complex pediatric patient’s care and so this resource should be considered and incorporated into the simulation scenario.
Consideration should be given to meet the needs of all clinical staff who may care for a pediatric patient with a tracheostomy tube. This will include nurses and allied health staff who do not rotate on a planned basis. Medical rotations and timing of the healthcare simulation based education should also be considered, alongside staff who don’t rotate. Clinical areas that care for children with tracheostomy tubes should be prioritized for this simulation-based education. Staff who do not rotate areas may require a more comprehensive and in-depth clinical simulation-based education package.
In the healthcare simulation scenario of a pediatric blocked tracheostomy, there will be a requirement of the director of the scenario to give the simulation participants clinical cues which will not be visible on the pediatric manikin. These cues should include notification to the participants that the patient’s eyes are bulging, there is significant cyanosis, and the patient appears to be choking at the point of the scenario in which the tracheostomy tube becomes blocked. This clinical information will assist to guide the simulation participants this is an emergency, and immediate action is required.
Other critical cues should be given to the clinical learners such as low oxygen saturations and comments such as the patient looks very scared and is struggling to breathe. The start of the scenario can commence with one nurse assessing the patient and then this will enable them to practice the skill of escalation of a call for help and the relay of critical clinical information in a succinct handover process. Other adjuncts that would normally be available for this patient, such as displays of tube size and airway information such as bag valve mask capabilities, should be displayed as per local policies in different organizations.
The pediatric blocked tracheostomy tube clinical simulation scenario is an incredibly versatile and useful healthcare simulation experience for those who work in pediatric care. A blocked tracheostomy tube scenario is a case in which healthcare simulation participants will often be happy to complete a number of times in order to reach mastery. A blocked tracheostomy tube can be incredibly frightening for anyone in clinical practice to experience, particularly in pediatric patients. Regular effective healthcare simulation scenarios can have a huge impact on providers’ confidence and competence in the management of this common airway emergency in the pediatric population.
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