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Noninvasive ventilation devices management

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An overview of the different interfaces and devices used in noninvasive mechanical ventilation

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Noninvasive ventilation devices management

  1. 1. Francesco BARBERO - RN,CNS  may 2012
  2. 2. Ventilation is delivered to the patient throught differenttypes of interfaces, that connect ventilator circuit to thepatient’s face: - Nasal mask and nasal pillows - Face mask - Full-face mask - Helmet
  3. 3. Mask that cover the Soft cones whichentire nasal surface fit inside the nostril
  4. 4. Good tollerance Ensure supply, communication and sputum The patient Reduce must keep claustrophobic the mouth shut! feelingReduce dead space
  5. 5. It must be transparent to detect organic secretions that could cause patient chokingEquipped with an inner flange which facilitatesthe adhesion of the mask to the face There are various types of face masks, according to the face and nose shape
  6. 6. Headgear clips (4, top and bottom) Secure the mask frame to the head. They allow to remove the mask conveniently and safely without having to unfasten the straps of the headgear. Forehead support Flexible forehead support pad Choose between four positions the one-piece design distributes the that best fits patient head, pressure uniformly and fits the profile improving keeping, stability and of the patients forehead. comfort. Bearings with double wallmaintains an effective seal and follows Transparent mask frame patient movement during sleep. allows the provider to take care of the patient face and to take notice of any changes during therapy. Elbow with 360 ° rotation it provides more flexibility and controls the breathing circuit, improving usability, comfort and mobility.
  7. 7. Useful in the treatment of acute Claustrophobia respiratory failure Reduced tolleranceEnsure perfect stability by the patient Emesis Minor air leak during sleep Pressure sores
  8. 8. Minimizes skin breakdown Eliminates nasal bridge discomfortSeals the perimeter of the face, where facial contours are smoothers and pressure sensivity is lower
  9. 9. Less cooperationneeded by the patient Poor availability Panoramic vision of measures (S-M) No risk of Moisture can steam up pressure sores the device’s internal surfaceReduced conjunctivitis
  10. 10. Made of transparent PVC Adhesion guaranteed by a stretch collar that fits patient’s neckIs fixed to the patient with two adjustable straps passing under the armpits
  11. 11. No risk of pressure sores Difficult communication Good tollerance High dead spaceRisen oxygen flows
  12. 12. There are differents kind of circuits,according to the ventilator model. Dual Circuit Single Circuit
  13. 13. In a single circuit the air passes inside the Singlesame tube during inhalation and exhalation Circuit The exhaled air is removed throught systems like whisper or expiratory plateau valve, placed between the mask and the circuit
  14. 14. The use of a whisper or an expiration Singleplateau valve depends on the ventilator Circuitcharacteristic and the kind of device used In fact some masks are provided with a holed area: this solution avoid the re-breathing of CO2 and doesn’t need other devices
  15. 15. Dual CircuitIn a double circuit there are two differentways for inhalation and exalation. A continuos unidirectional airflow avoid the risk of rebreathing and an expiratory valve detects the tidal volume. In some ventilators, the exhalation way doesn’t return into the device: the expiratory valve is set up directly on the circuit.
  16. 16. ractice In P- Explain to the patient what we are doing and what to expect- Provide the assemblage of the circuit (mount, filter)- Check the circuit (OVT) and set the ventilator- Setup the alarms parameters (check alarm at every modify)- Keep the head of the patient’s bed at > 45 degree angle- Choose the correct interface
  17. 17. ractice In P- Hold the mask gently over the patient’s face until the patient becomes confortable with it- Strap the face mask on using the head strap and minimize the air leak without discomfort
  18. 18. ractice In P Keep monitoring acute patients’ during the NIV Heart rateBlood Pressure O2 SaturationRespiratory rate
  19. 19. ractice In Pand:- level of dyspnea- minute ventilation- exhaled tidal volume- abdominal distension,- ABG
  20. 20. Preservation of airway defence mechanism Patient can eat, drink and communicate Ease of application and removal Patient can cooperate with physioterapy Intermittent ventilation is possible
  21. 21. Improves patient comfortReduces need for sedationVentilation outside hospital is possibleEasy to teach health care staffPrevents complications of endotracheal intubation
  22. 22. Mask uncomfortable/claustrophobic Airway not protected No direct access to the bronchial tree for suction (sopraglottic)Time consuming for medical & nursing staff
  23. 23. - Patient can control airway and secretions- Adequate cough reflex- Patient is able to cooperate- Patient is able to coordinate breathing with ventilator- Unstable patients should be excluded- Absence of unstable facial fractures/extensive facial lateration- Management of anxiety (coping strategies, medications)- Provide continuos care and monitoring
  24. 24. - Air leak and eye irritations- Retention of secretions- Upper airway obstruction- Gastric distension- Inhalation of gastric regurgitation- Sleep fragmentation/noise- Mask intollerance & failure to ventilate- Skin breakdown/necrosis (i.p. over the bridge of the nose)
  25. 25. Increase patient comfort:- Use different interfaces- Ensure adequate handhold
  26. 26. Reduce risk of pressure ulcers: - Skin asepsis - Use of hydrocolloidsPrevent dryness of mucous membranes:- Use humidifiers- HME filters
  27. 27. d ailyClean all part of the mask daily: use a milddetergent soap and wash under cold water. Do not use alcohol or cleaning solutions containing alcohol, or any strong household cleaners!
  28. 28. For the next patient!If the mask is a multi-patient usereusable, refer to the instructions provided by the manifacturer.
  29. 29. For the next patient!
  30. 30. - Monitor haemodynamic status (reduced preload)- Monitor neurological status (tiredness, confusion)- Observe for sign of barotrauma (pnx, subcut.emph.)- Explain treatment and reassure patient

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