Tracheostomy and Ventilator Education Program Module 7...

Tracheostomy and Ventilator Education ProgramModule 7: Humidity

DisclaimerThis material is intended for use by trained family members and caregivers of children with tracheostomies who are patients at the Alberta Children’s Hospital. Although reasonable efforts were made to confirm the accuracy of the information, Alberta Health Services does not make any representation or warranty, express, implied or statutory, as to the accuracy, reliability, completeness, applicability or fitness for a particular purpose of such information. This material is not a substitute for the advice of a qualified health professional, so please seek medical advice from an appropriate health professional for questions regarding the care and treatment of any patient. Alberta Health Services expressly disclaims all liability for the use of these materials, and for any claims, actions, demands or suits arising from such use.

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• A basic introduction about the principles of humidity

• Humidity is the amount of moisture in the air we breathe in – this is important when a trach tube is present

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Photo Used with Permission, JD 2017

• Humidity is the amount of moisture in the air• We can measure humidity by using a hygrometer – a device that can read

relative humidity (the percentage of how much water vapor is in the air compared to how much water the air could carry)

• Optimal humidity range is 30 to 50% for the Calgary area

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• We need humidity in the air we breathe in so our lungs stay moist and our mucus doesn’t get too thick

• Even when there is moisture in the air we breathe in, more moisture is added as the air passes through the different regions of the pharynx

• When a trach tube is in place, we need to add humidity because this natural ability to humidify the air is bypassed by the trach tube

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How do we humidify the air we breathe in?With a trach tube in place, the air we breathe in is cool, unfiltered, and dry because our nose and mouth are bypassed

With a normal airway, the air we breathe in is warmed, filtered, and humidified mostly by our nose

When a humidity device is in place with a trach tube, the air we breathe in is humidified and may be warmed and filtered as well depending on the humidity device used

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Children’s Home Care Edmonton Zone 2016, Used with PermissionChildren’s Home Care Edmonton Zone 2016, Used with PermissionChildren’s Home Care Edmonton Zone 2016, Used with Permission

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A lack of humidity may result in:• Thicker secretions• A dry cough that does not clear mucus well• Secretions that stay in the lungs and do not clear• A harder time breathing• An increased risk of infection in the lungs

A child with a trach is at a higher risk for these concerns because their ability to warm, filter, and humidify the air they breathe is affected

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Providing HumidityWe can provide humidification via a trach tube in several ways:• Trach collar with a humidity bottle set-up – non-heated• Heat and moisture exchangers (HMEs)• Heated humidified ventilator circuit (Ventilation Module)

• In the hospital, your child’s equipment will be provided• At home, your health care team will help you with the equipment your child

needs

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Importance of Hydration• Managing your child’s fluid intake will also help to make sure they are

hydrated enough and getting enough fluids• This helps keep their secretions mobile

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Humidity Set Up• Trach collar with a humidity bottle

set-up – non-heated, hospital setting

• Humidity is provided by a gas source on the wall

• In the hospital, the bottle may be connected to a blender that could provide oxygen if required

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Photo Used with Permission, JD 2017Photo Used with Permission, JD 2017

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Humidity Set Up• Trach collar with a humidity bottle set-up – non-heated, home setting• Humidity if provided by a compressor gas source • If oxygen were required, it would be entrained with a connector – your

health care team will help with this

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Humidity Bottles• Humidity bottles used in the hospital are

different than the ones used at home –they both work the same to provide humidity

• The hospital humidity bottles are disposable and meant for short time use

• The home humidity bottles are more durable and meant to be cleaned and reused for a long period of time

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Home Hospital

Photo Used with Permission, JD 2017Photo Used with Permission, JD 2017

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Home Humidity Bottles• Humidity bottles are sometimes called cold nebulizers or large volume

nebulizers• Fill these only with commercially packaged distilled water• Do not use normal saline or tap water – this will create mineral deposits

over time• Your health care team and respiratory vendor will show you how to set

up and fill the bottles and how to prevent cross threading of the lids

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Home Humidity Bottles• You will clean the humidity bottles daily and fill only to the identified fill line• Don’t leave water in the bottles if the unit is not being used - empty, clean,

and rinse the humidity bottle and let it air dry when not in use to prevent bacterial contamination

• Refer back to your Module on Infection Prevention about cleaning equipment and preventing the risk of infections

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Home Humidity Bottles• The humidity bottles will produce a mist that you can see at the end of the

tubing where the trach collar connects if they are filled and working properly

• If you don’t see a good mist:o The nebulizer could need to be filledo The bottle and lid be cross threadedo There could be a leako There could be a problem with the compressor

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Humidity Tubing• Humidity tubing is sometimes called corrugated wide

bore tubing• This tubing should be cleaned and checked for leaks

and cracks regularly• Water (sometimes called rain-out) may collect in the

tubing o If rain-out is present, empty it into a trash

container – never empty this water back into the humidity bottle

• This tubing should be cleaned as per your cleaning guide

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• Trach collars are sometimes called trach cradles or trach maskso They have a swivel connector that connects

to your humidity tubing, which allows it to move easily with your child

o The elastic can be adjusted to fit your child’s neck

o They should be cleaned as per your cleaning guide

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Trach Collar Humidity Bottle Set Up -Home

HUMIDITY TUBING

HUMIDITY BOTTLE

HEAVY DUTY COMPRESSOR

TRACH COLLAR

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Trach Collar Humidity Bottle Set Up -Home

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• This type of humidity is not considered portable• It should be used when your child is at rest or

sleeping or on oxygen• You should fill your bottles with commercially

packaged distilled water• To minimize the risk of bacteria growing, we

recommend your distilled water be discarded after 24 hours

• Always discard left over water into a sink or trash container

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Children’s Home Care Edmonton Zone 2016, Used with Permission

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• Heat and Moisture Exchangers (HMEs) – hospital and home• HMEs are sometimes called artificial noses or Swedish noses

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Heat and Moisture Exchangers (HMEs)• HMEs provide humidity by trapping the heat and moisture that your child

breathes out and recycling it to be used on the next breath in – they will get moist while in use

• They also act as a filter to protect the lungs from dust and debris, they do not filter air irritants (e.g. perfumes, smoke)

• HMEs are very effective at providing humidification, but do not provide the same amount of humidity as a humidity bottle set up

• This device may not meet the needs of all children • Your health care team will determine if your child can use an HME and which

type is most suitable

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Heat and Moisture Exchangers (HMEs)

• HMEs are used to provide humidification when your child is active and mobile• When you use an HME – you cannot use any other source of humidity• These devices will not work properly and will make it difficult to breath if:

o They are overly saturated with fluid or secretions (i.e. too wet)o They become blocked with secretions

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• HMEs can not be used for longer than 24 hours of total use• Some HMEs can be cleaned within the 24 hour period if they become blocked

or saturatedo Only HMEs made of medical grade sponge can be cleaned and reusedo Paper HME’s cannot be cleaned or rinsed and must be discarded

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• If your HME is blocked with secretions, you must replace it

• If you can remove the HME before your child coughs, it will help prevent secretions from filling up the HME = remember to replace it after coughing

• The HME will provide humidity as long as it’s not too wet, visibly soiled, or blocked with secretions

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• When your child is wearing an HME, you should be checking them regularly to make sure the HME is not visibly soiled or blocked and that your child is breathing well through the HME

• HMEs can get very moist while in use - your child may need a break from the HME

• Some children will have thicker secretions after having their HME on – they may need suctioning afterwards


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Thermovent T:• For children with larger lung

volumes• Disposable, single use• Paper wick system to provide

humidity – do not rinse or clean!!• Discard when necessary• This HME has a separate

connector that can be used for oxygen if needed

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Thermovent 600:• Only used when a child is on a

ventilator • Is placed in the circuit before it

connects to the trach tube

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Aquesure Neonatal Hygroscopic Condenser Humidifier:

• Can be used for children with smaller lung volumes

• Sponge wick system to provide humidity

• Disposable, multi use at home – you can clean (rinse with water and air dry) and reuse several times during a 24 hour period before you discard

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Hydro-Trach T:

• Can be used for children with smaller lung volumes who require entrained oxygen if they can’t tolerate the Thermovent T

• Sponge wick system to provide humidity

• Covered suction port

• Disposable, multi use at home – you can clean (rinse with water and air dry) and reuse several times during a 24 hour period before you discard

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Tracheostomy and Ventilator Education Program Module 7...

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