MF
19
November

By Adem Lewis / in , , , /


We are here to talk about non-invasive, application
for nicu patients, right? And how non-invasive works and also how this Miniflow works but
some people have confused and the talk I had yesterday some people were thinking that Miniflow was
a mode or a feature on the ventilator. Is anyone think that? No, that they know that miniflow is
the apparatus. So this is just a substitute for Hudson prongs or Inca prongs or any other prongs you talk about. And I always thought you know even when I was a therapist that
you should have more than one devices because some times kid’s faces are different and,
you know, this one doesn’t work but this interface does. But this one doesn’t and this one does
and so and so forth. So it is nice to have an option. I’ve been to a couple hospitals where, I think
it was initially it was at Baptist all they had was the RAM cannula. And then they go, Ive been
having trouble, you know we have leakage or whatever with the RAM, what can we do with
the ventilator, and I go…well, I don’t think you can do anything with the ventilator, just
try a different interface. And they go, oh we don’t have a different interface to use.
I go, you don’t have any other prongs or anything you can use for babies. No we are just using
that one RAM cannula. So eventually they got a different, so they have different options
now. So anyway, to use this interface it um, what you want to do first in these kits or
when you order these. You know, initially when we sent it to you the first time we sent you are starter
kit and it had all the different sizes in it. But um after you do the start kit, you say,
well we are never going to use this size or that size so then the reorder would be whatever
sizes you would use more consistently. The small or the big prongs. Or whatever prongs you
get. So all the ordering numbers are here and that is how you would order them. And
so you have placed reorders I think you have placed reorders because you have used these
on occasion. So the way you do this is you simply use the tape measure and first to measure.
And you find what color would be appropriate for this baby’s head, ok. So once you find
the color then you find the bonnet size, or the head size, that would be the right size.
And then, this part goes up top, on the top of the head. Let me just put that little stocking
cap on. Like that. Now, this part comes apart and its got this little divider in it and so what
you will end up doing eventually is doing this. And positioning it appropriately before
you tighten down. So that the miniflow is ready to be in the right position for the
nares. And then the top of the hat, has little ties on it so you can tie a bow and keep the
heat in at the top of the head. That is what these are for. Then in the kit you will also
have these little straps that depending on what appliance you use. And your kits won’t,
things that you get wont look like, they will be in packages so this is my little traveling
salesman kit. So let’s say you wanted to start with the prongs first. So you would then pick the appropriate
size prongs using once again your little tape measure, so you can put this up to the nare
and try to estimate what size prong you would use based on these, nares. So then you say,
ok this baby is pretty small so I’m going to use the smallest prong. So you find, I think that is the smallest prong, and they have holes in the back of them. So the
way this works… is these are hard plastic here but what you will end up doing is putting
the prongs in, like that and now the prongs. Comment: is that a fool-proof that you can only put
it one way? Jim: no you can put it two ways but this way, let me get this right, you want
to orient it so that the curve down end is going towards the mouth. And when you insert
the prongs you don’t want the prongs, you dont’ want to push this all the way in. And
so it is all the way up against the septum. You want to put them in about half way. Alright,
so if you select the right size put it in half way and what you would do is
put this in first because this requires a little bit of push to get them in to the hard
plastic. So once you do this has a little bit of movement to it. A little bit more than
the other ones did. So you have a little bit more flexibility so that when you do that
you get it in, you put it in the nares half way. Then you put that through this piece
here and then, but before you do that, I would imagine it would be easier to do this first. And these are Velcro so they will attach right to the hat. And so then you position it properly
before you secure it to the hat. And then you have another one that goes on the other
side. Ok, you all following me. So like any of these appliances you have to work with
them a little bit to get them just right so they are not pulling back and you move this so
you give yourself a little bit more room, a little bit more play here. So after you
get it all set, you may have to do some adjustments. So I would recommend not putting this, not
clamping this down, not tightening initially. Because you are going to have to move it.
Ok, easy enough? Comment: So what comes in not the initial kit, if they go to grab something, what is all in that? Jim: Well, with a device like this and also FP has a similar system
the problem that I see as a therapist is that, a practical therapist is, what you have or what
you would have, you would say, I’m going to order twenty smalls, twenty mediums, and twenty
large let’s say of the prongs. And then you would have a little box. And you would put
them in there so that when you went to do this on a baby, you would have to grab a miniflow
out of the miniflow box. You would have to grab a small because you have already measured
so you need small prongs and then you’d have to have another box that had the different
hats in them. So when you order them you would order them in that way. Ten of this or five
of that or eight of this. Or whatever. Comment: So is the tape measure in with the miniflow?
Jim: Yeah, yeah. You would get that with. …with this yeah…so that is what it comes with And then you do your measurement.
And then what I didn’t mention is let’s say now, and one of the nurse practicitioners yesterday
said, oh well this will work and what we can do then is we can alternate every four hours between
prong and the nasal masks. So if you see some breakdown occurring. You can simply take the prongs off the miniflow and then put the mask on, and put the mask on. And then four hours
later, you know you can save those prongs, that you took off and then put them back on,
and then use the prongs. So you can avoid or minimize the amount of breakdown you might
see at the nose. Comment: Are we going to have prongs? Comment: No, we do not have prongs.
Is that all we are going to have? Right now all we have are masks. Jim: Right now, all you
have is masks. But there are four different sizes of masks. There is 1,2,3,4,5,6,7 different sizes of prongs. And I will get you the powerpoint for this so you can show it to other people that weren’t here. But also it tells you make sure it is not all the way, if you are using
the prongs, but if you are just using the masks then it is not an issue. But if you
are using the prong, don’t force them all the way in. And other little tips about making
sure the the bonnet doesn’t come down over the ears. It comes to the ears so you are not squishing the ears.


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