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VENTILATOR CARE.pptx
- 1. V E N T IL A T O R C A R E . REHANAT ABBASUM BSN (POSTRN) SPECIALIZATION IN ICU/CCN
- 2. MechanicalVentilator • Amedicalventilator isa mechanical ventilator , machine designed tomovebreathable air into andout of the lungs, to provide breathing for a patient who is physically unable tobreathe, or breathing insufficiently.
- 3. MechanicalVentilation • Mechanical ventilation can be defined as the technique through whichgasismovedtowardandfromthelungs outside throughan external device connected directly to thepatient.
- 4. VENTILATORY CARE •Caringforapatientwhorequires assistedventilation by meansof amechanicalventilation.
- 5. PURPOSE Toestablishandmaintaineffective ventilation Toprevent complicationassociated withartificialventilation To ensure position and patency of endotrachealandtracheostomytube
- 6. EQUIPMENTS • Bed locker withnecessary articles, • ventilator • Suctionapparatus • Continuous monitoring apparatus • Resuscitationchartwith defibrillators • oxygensetup • Manual ventilation bag (embubag) • Endotracheal intubationsset
- 7. PURPOSE/ OUTCOMES: Reversal ofhypoxemia Reversal of acute respiratoryacidosis Relief of respiratory distress Prevention or reversal ofatelectasis Resting of ventilatorymuscles
- 8. INDICATIONS Respiratory Failure Cardiopulmonary arrest Trauma (especially head, neck, andchest) Cardiovascular impairment (strokes, tumors, infection, emboli, trauma) Neurological impairment (drugs,poisons,myasthenia gravis,GBS) Pulmonary impairment (infections, tumors, pneumothorax, COPD,trauma, pneumonia,poisons)
- 10. Types ofventilation: . Negative pressure ventilation . Positive pressure ventilation
- 11. Types of Positive pressure ventilation Non Invesive Ventilation: 1. Continuous positive airway pressure (CPAP). 2. Bi-level positive airway pressure ( Bi PAP ). Invesive Ventilation: 1. Use of ETT Tube 2. Use of Tracheostomy Tube
- 12. Modes of ventilation: Invasive MV: VC : ( Volume Control ) or V/AC ( Volume Assist Control ) PC : ( Pressure Control ) or P/AC ( Pressure Assist Control ) PSV : ( Pressure Support Vantilation) SIMV : ( Synchronised intermittent Mandatory Ventilation ) PRVC : ( Pressure Regulated Volume Control) APRV : ( Airway Pressure Release Ventillation ) Automatic Mode : ( Approx height + Ideal Body Weight)
- 13. Easy way to remember;
- 14. V entilator settings Fraction ofinspiredoxygen(FIO2) Tidal volume Respiratoryrate Positive end-expiratorypressure(PEEP) Peakflow Peakinspiratorypressurelimit(highpressurealarm) Sensitivity Inspiratory: expiratory ratio Humidification and t emparature
- 15. Fractionofinspiredoxygen(FIO2) Percentageof O2in the airdelivered to patient Usually adjusted to maintain SaO2of greaterthan90% Instartit issettled to bemorethan60%but later less then 60%to prevent oxygentoxicity
- 17. Respiratoryrate Noofbreaths/mindeliveredto patient. Determinesalveolarventilation orminuteventilation,isequalto the respiratory rate multiplied bythetidalvolume. Adjustmentsineitherofthese parametersaffectthePaCO2.
- 18. Positiveend-expiratory pressure(PEEP) Control and adjustthe pressure thatis maintained in the lungsatthe endof expiration PEEP increases the functional residual capacity by reinflating collapsed alveoli Maintaining thealveoli in anopen position Improve lung compliance
- 19. Peakflow Flow rate, or peak inspiratory flow rate, is the maximum flow at which a set tidal volume breath is delivered by the ventilator. Most modern ventilators can deliver flow rates between 60 and 120 L/min. isthevelocityofgasflowperunitoftimeandisexpressedasliters perminute
- 21. Sensitivity Controls the amount of patient effort needed to initiate an inspiration,as measured bynegative inspiratoryeffort. Increasing sensitivity (requiring less negative force) deceases theamount ofworkthepatientmustdo to initiatea ventilators breath. Decreasing the sensitivity increases the amount of negative pressure that the patient needs to initiate inspiration and increasethe work ofbreathing.
- 22. Inspiratory: expiratoryratio( I:E ) •Operate with a short inspiratory time and a long expiratory time(1:2 or 1:3ratio) •Allows time for air to passively exit the lungs
- 23. Humidificationand temperature • Inspiratorygasmustbefiltered, warmedandhumidified before delivery to thepatient • Humidifier humidifies theinspiredgasbypassingit over or bubbling itthrough a head water . • Condensationshould beseen intheinspiratoryventilator circuit or the proximal ETT or both which indicates that the inspired gas is fully saturatedwithwatervapors.
- 25. Noninvasive ventilator modes Continuous positive airway pressure(CPAP) Bi-level positive pressure(BiPAP)
- 26. Continuous positiveairway pressure (CPAP) SimilartoPEEP Suppliespressurethroughouttherespiratorycycle,helpto improve oxygenation inspontaneouslybreathingpatients. Usedforintubatedornon-intubatedpatients. Weaningmodefrommechanicalventilationand to opentheupperairway Preventingupperairwayobstructioninpatientswith obstructive sleep apnea
- 28. Bi-level positive pressur e (BiPAP) Providedbymeansofnasalmask,nasalprongs,orfull facemask Twolevelsofpositivepressuresupport Aninspiratorypressurereferred toIPAP AnexpiratorypressurereferredtoasEPAP Used in patient with acute, short termrespiratory problemstoavoidintubationandmechanicalventilation
- 32. TYPES OFALARMS •High peakpressure •Low pressure; lowPEEP/CPAP •Low exhaled tidalvolume •Low minuteventilation •Apnea •Heater alarm
- 34. CAREOFETT/ TRACHEOSTOMY • Securepositioning ofETT/tracheostomytubewith adhesivePlaster • Inflatecuff oncecorrect positioninghasbeenconfirmed • Cuffisinflated with airusingsyringe
- 36. MAINTAINING VENTILATION Ventilator makecharacteristics soundduringinspirationandexpiration which nurse must be capable of identifying Effectsofventilationareassess byobservingptcolor ,chest movements,BP ,pulserate,oxygen saturation Administer sedation as prescribed to ensuread equate artificialventilation and promotionof rest
- 37. SUCTIONING Explain procedureto patient and family Frequency of suctionto becarried outdepending on pt’s pulmonarystate Trachealsuctionisan aseptic procedure
- 38. Sterile cathetershouldbeuse Onesterileglove tobeused foreachsuctioning Sessionsuctionis applied whilecatheteris Beingwithdrawn Usingintermittent techniquenotmorethan10 to15seconds
- 40. Measure blood,IVinfusionsandfluid intake everyhour Measure bloodloss,urine,chest drainage bottles, Maintainintakeandoutputeveryshift Assessbowelactioneverythirdday 8hourlywounddressingshouldbedone Care of ventilatored pt
- 41. •Change IVadministration sets and dressing of puncture sites everyday •Change suction bottle and connecting tubing everyday •Record pt’s conditions and events that have occurred during each shift in nurse progress sheet •Give detailed hand over to nurse on following shift.
- 42. PSYCHOLOGICALASPECTSOF PATIENTCARE •promote good relationship with patient and family •Encourage them to express fear , stress factors and feelings •Motivate patient and relatives to participate in daily care activities
- 43. WEANING •the term "weaning" is used to describe the gradual process of decreasing ventilator support.
- 44. READINESSTOWEAN • Underlying cause formechanical ventilation resolved • Hemodynamicstability;adequatecardiacoutput • Adequate respiratory musclestrength • Adequateoxygenationwithout ahighFiO2and/orhighPEEP • Absence offactorsthatimpairweaning • Mental readiness • Minimal needfor medicines thatcauserespiratory depression.
- 45. GUIDELINESFORWEANING • weaning isgenerally initiated inthemorning whenthepatient is rested • Theuseof sedativesandnarcoticsduringweaning islimited • Thenurseraisestheheadofthebed,ensures apatentairway,and provides suction ifnecessary. • Thenurse remainswiththepatient throughouttheweaning trial to provide supportand reassurance • Attheconclusion ofthetrial,thenursealsoevaluates and documentsthepatient’s response toweaning
- 46. WEANING METHODS • Synchronized intermittent mechanicalventilation • Pressuresupport • T-piecetrials • CPAP
- 47. STOPTHE WEANING PROCESS Respiratory Respiratory rate> 35or < 8breaths/min Low spontaneous VT< 5mL/kg Laboredrespirations Use of accessory muscles Abnormalbreathingpattern Lowoxygensaturation< 90% Cardiovascular HRorBPchanges> 20%from baseline Dysrhythmias ST-segmentelevation Bloodpressurechangesmorethan20%frombaseline Diaphoresis Neurologic Decreased level ofconsciousness Anxiety/agitation Subjectivediscomfort
- 49. A I R W A Y M A N A G E M E N T
- 50. AIRWAY MANAGEMENT • Positioning • Devices • Oralairway:Anoropharyngealairwayisa hardplasticdevicethatisinsertedthrough themouthandextendstothepharynxtopreventthetonguefromoccludingtheairway whenmuscletoneisdecreased.Neverinsertin consciouspatient • Nasopharyngealairway:Anasopharyngealairway(nasaltrumpet)isaflexibletubethat isinsertednasallypastthebaseofthetonguetomaintainairwaypatency. • Endotrachealintubation:Anendotrachealtubeisasemi-rigidtubethatisinsertedthroughthe noseormouthandextendsintothetrachea • Tracheostomy:Atracheostomytubeisinserteddirectlyintothetracheathroughastomamade inthe neck
- 51. ENDOTRACHEALINTUBATION • Insertionof anendotracheal tube(ETT)throughthemouthor nose • Orotracheal routepreferredto reduceinfections • Usedto: -Maintain anairway -Removesecretions -Prevent aspiration -Provide mechanicalventilation
- 54. ENDOTRACHEAL INTUBATION Right sizetube 6.5to7.5mmfemale;7to8.5mmmale Checkballoon ontubeforleak Stylet Lubricatetube Laryngoscope andblade Sniffingposition Topical anesthetic/ paralyticmedication Ventilatepatient Suction oropharynx Intubate within 30sec Inflate balloon Verify placement
- 55. VERIFY PLACEMENT Auscultate epigastricarea Auscultatebilateral breathsounds ETCO2detector Esophageal detectordevice Chestx-ray—3to4cmabovecarina Securetubewhenplacementisverified Recordcmattheliplineforreference
- 56. ENDOTRACHEAL SUCTIONING • Suctionasindicatedbyassessment • Visiblesecretions • Coughing • HighPIPonventilator • Ventilatoralarm • Conventionalversusclosed suctionProcedures • Hyperoxygenatethroughoutprocedure • Avoid normalsalineinstillation • (346-362 book vol1 )