Medical Technology

What is Medical Technology?

Medical technology refers to devices and modifications that replace or support physiologic function. Medical technologies typically require a written prescription from a licensed medical provider such as the primary care physician. Some medical technologies require surgery to access or bypass the involved body system. In this website, medical technologies refer to devices used by children with special health care needs for obtaining nutrition, eliminating wastes such as urine and stool, breathing (both oxygenation and ventilation), and modulating the central nervous system including controlling pain, spasticity or seizures. Each technology review will include information about medical indications for its use, examples of medical orders to prescribe the technology and effectively communicate with home health care, and common questions and concerns.
The Medical Home Portal also includes a section on Assistive Technology which includes items that increase, maintain, or improve functional capabilities of a child with a disability.
Please click on the links in the table below or choose from the links in the left menu to access detailed information about those Medical Technologies.

Types of Medical Technology

Respiratory System
CPAP and Bilevel PAP Continuous Positive Airway Pressure (CPAP): A non-invasive treatment using mild continuous stream of air (air pressure) to keep the airway open. Used frequently for obstructive sleep apnea and neuromuscular conditions, or underdeveloped lungs. A mask is worn over the nose and/or mouth, and the mask connects to tubing and air supply.

Bilevel Positive Airway Pressures (Bilevel PAP): Similar to CPAP but uses different air pressures during inhalation and exhalation (breathing in and out). Used for severe apnea and other respiratory or heart conditions.

Ventilators

A machine that provides life support by delivering oxygen to the lungs, removing carbon dioxide, and easing or doing the work of breathing for a person. Attaches to the airway through an endotracheal tube (goes through the mouth towards the lungs) or a tracheostomy tube.

Oscillators

High frequency oscillatory ventilators use different settings (shallower and faster breaths) to protect ventilated lungs in certain conditions. High frequency jet ventilators are another variety.

Tracheostomy

Surgically made hole in the neck that provides an alternative to the mouth and nose for breathing. The hole extends into the trachea, or windpipe.

Pulse Oximeters

Machine that estimates a person’s oxygen level non-invasively. May also provide a heart rate.

Apnea Monitors

Medical equipment that non-invasively measures heart rate and breathing pattern, and alarms if the heart rate drops or breathing stops. Mostly used for premature infants.

Cough-assist

A non-invasive device to help clear bronchial (lung) secretions for people who cannot cough well on their own, such as children with neuromuscular disorders or spinal cord injuries. Applies positive then negative airway pressure to stimulate a natural cough.

Vest Therapy

A vest that provides high frequency oscillations (vibrations) to help clear lung secretions (mucus) and prevent pneumonias. Often used for cystic fibrosis or cerebral palsy.

Suction Devices

A suction catheter (tube) to remove secretions and mucus from the airway. Can be used in the mouth or through a tracheostomy.


Gastrointestinal
System
Feeding Tubes and Gastrostomies A surgically placed tube through the stomach wall, used to provide fluids, nutrition, and medications.

GastroJejunostomy
Tubes

Surgically placed pair of tubes that provide access to both the stomach and the upper part of the small intestine, used to provide fluids, nutrition, and medications.

Ostomies (Ileocecal-,
Colo-, Appendico-, etc

Ostomies are surgically made holes in the body wall to put things directly into that body part (such as air, fluids, nutrition, and medications), or to remove wastes (gas, urine, stool). The first part of the word (the part before –ostomy) refers to the part of the body the hole goes to. For example, an ileocecostomy is an ostomy (hole) into the ileocecal area of the small intestine.

Feeding Pumps

Feeding pumps are machines that regulate the flow rate and volume of liquid nutrition through a feeding tube into the body. Requires a power source.

Gravity Feeding

Gravity feeding makes use of the force of gravity to deliver liquid nutrition through a feeding tube into the body. Changing the height allows for faster or slower delivery. Does not require a power source.

Total Parenteral
Nutrition (TPN)

Liquid nutrition given intravenously when the gut cannot be used for feeding.

Formulas

Different liquid nutrition options to give by mouth or through a tube into the stomach or intestine.


Urinary and Renal
System
Urinary Catheters Tubes that allow urine to pass out of the body.

Vesicostomies

A hole that goes through the body wall into the urinary bladder. Used to drain urine from the bladder.

Dialysis

A life-support treatment to filter (clean) the blood of wastes, salt, and extra fluid, when the kidneys cannot. Hemodialysis (and peritoneal dialysis are both used in children.


Nervous System
Intrathecal Baclofen
Pumps
Surgically implanted pump that delivers baclofen, a muscle relaxant medication) into the spinal fluid to treat spasticity. Allows more control over the medication effects than oral or enteral baclofen. The pump is usually located inside the abdominal cavity. The pump is refilled using a syringe, through the skin.

Vagal Nerve
Stimulators

Surgically implanted device that uses electrical pulses to stimulate the vagus nerve. Used for treatment of epilepsy (seizures). The device is usually located in the left chest wall and does not go into the brain. Settings are adjusted externally with a magnetic device.

Ventricular Shunts

Surgically placed tube inside the body that drains excess cerebrospinal fluid from the brain's ventricles (fluid-filled spaces) away to the peritoneum (belly) or atria (upper chambers of the heart). Relieves hydrocephalus, (increased fluid pressure in the brain).

Ketogenic Diet

High-fat, low carbohydrate diet used to help control seizures in hard-to-control epilepsy. Requires close medical supervision.


Cardiovascular
System
Pacemakers Surgically implanted device that uses electrical pulses to contract the heart. Used to control rate or rhythm disturbances. The device is typically usually located in the chest or abdomen. Settings are adjusted externally with a magnetic device.

Extracorporeal
Membrane Oxygen
(ECMO)

ECMO is a life-support treatment that works to bypass the heart and the lungs in a critically ill child. Blood from the body passes through an artificial lung outside the body. Oxygen mixes with the blood which is then returned to the body. ECMO allows rest for the body's vital organs during life-threatening illness or before organ transplant, and to help recover after major surgery.

Selecting and Obtaining Medical Technology

Every child is unique. Selecting the right medical intervention is a multi-step process that takes time and communication.

  1. State your main goal. What do you want to accomplish with the intervention? What will the technology enable the user to do that he or she is currently limited in doing? Does it prolong or improve the child’s quality of life? The child and family’s goals and the medical goals should be aligned at the start of this process.
  2. Assess the situation. Get input from the child, family members and caregivers, school staff, and medical professionals- anyone who will frequently work with the child or the technology or has experience/expertise to offer. The assessment should include thinking about the abilities and limitations of the child as well as any alternative choices. For how long will the intervention be needed or useful? Will repairs be expected? Is it effective and safe? Do the benefits outweigh the risks? Is it in the child’s best interest?
  3. Choose the intervention. Does the device or surgery represent the safest, most efficient and reliable way to accomplish the task? Does it require electricity, refrigeration or sanitation that is readily available to the child’s care team? Advice from acquaintances, such as other parents with technology dependent children, can be useful but may not apply under these specific circumstances.
  4. Select the care team. If using home health care, is the home health care service familiar with the technology and can act as a resource to the care team? Do other home health care services in the area have more expertise or resources to support the technology? If a surgery is required, is the surgeon familiar with the procedure and what are the surgeon’s concerns? If purchasing equipment, consider the dealer’s responsiveness, professionalism, and service guarantees, training, and technical support.
  5. Organize funding. The costs of medical technology vary, but can be extremely expensive. The intervention may require preauthorization from insurance or Medicaid.
  6. Identify training needs. The user and anyone else who works with the device should receive appropriate training. This may be provided by a staff person from an educational or medical institution or home health care. Once trained, the primary caregiver may need to train school or daycare staff, or other caregivers.
  7. Conduct follow-up. Short-term follow-up should be performed within a couple of months. Long-term re-evaluation should also be performed on a regular basis, perhaps annually. Users who experience changes — either in themselves or their environment — that affect the usefulness of their equipment should seek a re-evaluation.

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