3. Describe and refer the proper endotracheal
tube and intubation methods
Maintaining an establishing a patent secure
airway viaVentilator Protocol
Assessing and taping artificial airways in PICU
Identifying airway cuff pressures
Tube placement and markers via CXR
Ventilation via endotracheal tubes on Servo-I
With He02 and Nitric Oxide
5. Can come in pediatric
and infant sizes
Size ranges from 2.5-
8.0 in most facilities
The inner diameter is
6.0-18.mm
Tape or Neo-bars
maybe utilized in PICU
6. Visualizing the vocal
cords is key in a
successful intubation
EtCo2 detector will
turn yellow
Humidification in ett
tube will appear
7.
8. Etoc2 Detector
will be purple
before
intubation
ETcO2 will
change colors
to yellow with a
successful
endotracheal
intubation
9. Age Based formula for predicting
endotracheal tube size in children.
(mm)={age in years+16}/4= preferred
endotracheal tube
You may estimate ETT size from patients
pinky finger
10. You should measure
the cuff pressure with a
Cufflator at bedside
11. NEO - BAR
NEO-BARS CAN ONLY BE UTILIZEDWHEN
PATIENTS ARE LESSTHAN 5 KILOGRAM CHANGE
Q7 DAYS OR PRN
ADULT AND LARGE PEDIATRIC
TUBE HOLDERS
5 kg or less
only
Retape Ett
every 3 days
and PRN
Change Bar Out
every 5 days
WATER PROOF TAPE
12. Suction catheter is 2
times the ETT size.
Example: ETT is a size
4.o you will use a size 8
suction catheter.
13.
14. In-line suction
catheter
*Alternative suction
depth calculation
Align the same printed
number on the ballard
and the endo-tracheal
tube then pull back
1cm.The number
across from the
irrigation port
connector is your
suction depth
(www.choa.org, 2013)
Look into the
Window of the
suction elbow; this is
your depth
15. PROXIMAL NUMBER ON ETT
Locate the printed depth
number closest to the end of the
endotracheal tube adapter
Add 5
Advance the catheter until the
number(with 5 added) appears in
the area directly across from the
irrigation port connector
Note the nearest color band.
This is your suction depth
marker.
Refer to Policy 20.00
ADD 5 FORTHE PROXIMAL
NUMBER ON INLINE SXN
16.
17.
18. Bag/Mask
Endo tracheal tube size one the right size and
one smaller
EndTidal Co2 detector
Stethoscope
Tape ,Neo – Bar or Anchor Fast AdultTube
Holder
Stylet in Endotracheal tube
Flexible suction 8-12 French
Laryngeal Scope (Disposable) only O.O non-
disposable
21. HASVARIOUS SIZES OF
BLADES
C-MAC BLADES ARE NON
DISPOSABLE
Must be taken to Central
Processing for cleaning
Are located in the ED and
PICU
Costly if blades are lost
RCP should wipe down
blade and check it into
central processing
22. Review Basic Mechanical
Ventilator Modes PIP, PS, PEEP
and techniques for setting up
and weaning life support
Discuss concepts and tools
related to Servo-IVentilator and
its components (connectors &
capabilities
Increase educational outcomes
among floor therapists
Skills related Case Study
Presentation associated with
treating and caring for neonates,
pediatrics and adult patient
populations
23. MechanicalVentilators
can cause an array of
problems and possible
death when not set up
properly based upon a
patients weight, lung
disease and the
appropriate settings
Can causeVolu-
trauma, Baro-Trauma
and Pneumothorax’s
26. Continuous Nebulizer
Treatment inline or
via HFNC
Syringe Pump Continuous
Nebulizer should be set at
10ml /hr
Only utilizes the 60cc
syringe
Can be utilized with
Ventilators, BIPAPS, HFNC
Aero-gen Nebulizers maybe
utilized for continuous
treatments
PlaceAero-gen in
Continuous Nebulizer Mode
Place on dry side of the
circuit
General Peds, More, Enter
10ml per hr
Syringe Size Max 60cc for 6
hour infusion delivery of
medications
Bolus Syringe and press start
27. SELECT NIV MODE FROM
SCREEN
PLACE PS ABOVE PEEPYOU
CAN ADD A BACKUP RATE
AND ITIME
Select
NIV
input
PS/PEEP
also set
backup
rate
30. Face Screen on
Servo-I upon
Initial Set up
Initial Screen allows
therapists to choose from the
Adult or Neonatal patient
selection screen
Infant Mode maybe utilized
among infants and children
that weigh a maximum of
10 kilograms and under
(Utilize Infant
Circuit)***
AdultVentilation Modes
require children that weigh
over ***10 kilograms and
therapist must have an
Adult Circuitto deliver
mechanical ventilation)***
Patient Size
Selection Therapist
Can Select
Adult/Neonatal
Modes
Non-
Invasive
Mode
Selection
31. Aero-Gen
Nebulizer
Treatments on
Servo-I
1. Ventilator Must
Have Internal Aero-
Gen Nebulizer
Module
2. Tap the Nebulizer
Option on the top
of screen
3. Select 10 minute
nebulizer or
Continuous
nebulizer
4. Select Accept
5. Place aero-gen
power source into
Aero-gen neb
32. Servo-i does Non Invasive
MechanicalVentilation
Therapist must only utilize
Respironics Mask with
Blue ElephantTrunk Only;
no exhalation valve is
present for patient
exhalation
Ventilator Must be in NIV
Mode will alarm with leak
Also, a Back-Up rate and
pressure can be set for
apnea
From
face
Screen
Select
NIV and
Select
settings
33. PRESSURE REGULATED
VOLUME CONTROL
TheVentilator delivers a
pre-set tidal volume while
the pressure is
automatically regulated to
the deliver the pre set
volume but limits itself to
5 cm H20 below the upper
pressure limit
The patient can trigger
extra breaths; inspiratory
flow is decelerating
VOLUME CONTROL
VENTILATION
Pt. receives a pre-set
Minute/TidalVolume
Airway pressure is
dependent on the tidal
volume, insp.Time,
resistance and compliance
of respiratory system.
SetTidalVolume will
always be delivered
Pt can trigger extra breaths
34. PRESSURE CONTROL
VENTILATION
Pressure Control ensures a
preset inspiratory pressure
level is maintained
Preset pressure level is
controlled by the
ventilator, delivered above
PEEP and allows for
spontaneous patient
ventilation
PRESSURE SUPPORT
Pressure support is patient
initiated via constant
pressure
Patient regulates
respiratory rate andTidal
volume with support of the
ventilator (Macquet, 2012
pg. 112)
36. POSITIVE END EXPIRATORY
PRESSURE HELPSTO
PEEP increases a patients
ability to Oxygenate
Increased Alveolar
Ventilation
Atmospheric Pressure in
the Lungs
Affects patients MEAN
AIRWAY PRESSURES
In ARDS Protocol PEEP is
High whileVolumes are
Low from 5-20cm H20
PEAK INSPIRATORY
PRESSURE
PIP can directly after at
patients MAP
Ranges from 5-10cmH20
in normal lungs
10-20cmH20 in
Obstructive patients and
15-30cmH20 with ARDS
37. Pressure Control
and Pressure
Support
*Combination Mode
PCV/PS always
regulates pressure
control ABOVE PEEP
and PS ABOVE
PEEP!
*Ventilates in both
Pediatrics and
Neonatal Modes
*Utilized when PIP
pressures are
increased
* Can be combined
with inverse ratio
ventilation
Select Pressure
Control when placing
patients on SIMV/
PCV/PS allows
patients to
SPONTANEOUSLY
Breath
38. Peak End
Expiratory
Pressure
Helps to Increase patient
Compliance
Increases Functional Residual
Capacity
Improves Oxygenation (Pa02)
problems associated with
shunting
Improves myocardial
oxygenation and cardiac
output
PEEP/CPAP levels start out at
2-10 cm H20 physiologically
Optimal PEEP is the lowest
amount necessary to provide
good Oxygenation (PO2)
without lowering BP or any
other side effects.; stable PAP,
PWP
PEEP is too HIGH when
Cardiac Output decreases,
compliance
39. Utilized with Spontaneous
Breathing Patients; can
not perform ApneaTest
with Servo-i
Maintains Positive
Pressure in Airways,
prevents collapsing of
airways.
Always set Apnea time and
Backup Rate
Select CPAP/PS
for Weaning
10/5
40. VENTILATOR PARAMETERS
Rate: Neonate (0-6mth) 30
Infant (6mo-12 m0) 25
Child (1-12yrs) 20
Adolescent (13yr+) 15
PIP set forVt 4-7ml/kg for
pt <10kg can max @
10ml/kg
Vt : set for 4-7 ml/kg for pt
<10kg max up to 8ml if
>10kg (choapolicy. 20.53)
VENTILATOR PARAMETERS
Ti: Neonates .4 sec
Infant .50 sec
Child .75 sec
Adolescent 1.0 sec
Pressure Support 10 above
PEEP targetVt for exhaled
5-8ml/kg
41. VENTILATOR PROTOCOL
SetTidalVolumes for
Pediatrics 4-8ml per/kg
and 4-7 ml/kg for
Neonates
Respiratory Rate for
Pediatric patients 15-20
BPM and Neonates 25-50
BPM
InspiratoryTime for Peds
are .80-1.00 and
Neonates are .40-.75
APPROPRIATE CIRCUITS
Utilize smaller circuits with
patients that weight 10kg
and under
Adult Circuits should be
placed on patients 10kg
and greater for Servo
ventilator
Co2 parameters are 45-65
and ph>7.25
42. Utilize PICUVentilator Protocol
May place patient on SIMV,PCV,APRV,PSV
Co2 parameters (45-65) **exceptionTBI
patients per Dr. order
Utilize 4-7 ml/kg
Maintain ph >7.25
Call MD if Co2 >75 (www.choa.org, 2013)
46. FLOW SENSOR
* When initiating RAM
Cannula on theV-500
and Baby-log you
must pull the flow
sensor
•So that theVentilator
does not alarm Low
MinuteVentilation and
TidalVolume; flow @
10-15 lpm
•* Chose SIMV/PCV or
PSV for Bilevel
Settings 15/5, rate of
20 and inspiratory time
can all be set on RAM
Cannula;s via DragerV-
500 and Babylog
