Gastrostomy, tracheostomy and central-line troubleshooting — viva

Opening (must-hit)

"Troubleshooting a child's gastrostomy, tracheostomy or central line means recognising the failure mode and running the right algorithm after airway, breathing and circulation are secured. For the tracheostomy I run the National Tracheostomy Safety Project algorithm — suction, remove the inner cannula, deflate the cuff, remove the tube and ventilate — and I never force a tube down an immature tract, defined as within the first seven to ten days. For the gastrostomy I replace a tube that has fallen out of an immature tract (under six to eight weeks) within hours before it closes, and I recognise a buried bumper by leakage with resistance to feeding. For the central line I categorise occlusion as mechanical, thrombotic or a drug precipitate — a clot gets a weight-based alteplase dwell for two to four hours, a precipitate gets the matching solvent, and a fracture gets an immediate clamp between the child and the break." ^{[4] [8] [12]}