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Eleanor Haskey Mechanical ventilators are an integral part of any intensive care unit. There are a variety of patients that may benefit from mechanical ventilation such as patients that are hypoxaemic (Pa02 <60mmHg) in spite of oxygen therapy, hypercapnic (PaC02>60mmHg) or at risk of impending respiratory failure. Mechanical ventilation is expensive and requires a dedicated nurse to care for the patient. This nurse must have an understanding of respiratory physiology, principles of mechanical ventilation, terminology, setting up the ventilator, troubleshooting problems, providing nursing care to meet the individual patient requirements and recognising signs of complications. Such cases require thorough clinical records and communication between staff members. They are labour intensive cases but can be extremely rewarding to nurse. How to nurse the intensive care unit ventilator patientDownload Now
Patients who are critically ill and need oxygen support are usually attached to mechanical ventilator. That’s why, nurses who are in the assigned in the intensive or critical unit should be competent in caring for the patient with mechanical ventilator. Though there are technicalities that a nurse should consider, in this article, we will be learning about this machine in a nutshell. Purpose of Mechanical Ventilation
So, what are the usual indications why patients are intubated and attached to life support device? Indication for mechanical ventilator use:
(Reference: Smeltzer, et al. 2010) What are the different mechanical ventilator modes?Volume-cycled ventilators Volume-cycled ventilators guarantees volume at expense of letting airway pressure vary. Once preset volume is delivered to the patient, the ventilator cycles off and exhalation occurs passively. Preset tidal volume is delivered unless a specified pressure limit is exceeded (upper airway pressure alarm is set) or patient’s cuff or ventilator tubing has air leaks that cause a decrease in tidal volume delivered. (Grossbach, 2011) Examples of volume-targeted mechanical ventilator mode are:
One advantage of SIMV is that it allows patients to breath on their own. SIMV is usually associated with greater work of breathing than AC ventilation and therefore is less frequently used as the initial ventilator mode Like AC, SIMV can deliver set tidal volumes (volume control) or a set pressure and time (pressure control). Negative inspiratory pressure generated by spontaneous breathing leads to increased venous return, which theoretically may help cardiac output and function. Pressure-cycled ventilatorPressure-cycled ventilator guarantees pressure at expense of letting tidal volume vary. Inspiration is also terminated when preset pressure reached. Volume is variable and determined by set pressure level, airway resistance, and lung compliance factors, specified time or flow cycling criteria. (Grossbach, 2011) Example of this mode
What are basic ventilator settings and controls?Nurses especially in the critical care unit must understand the basics of mechanical ventilation settings and controls. Ventilator settings and controls:
Now, that you know the technical terms of this machine, let’s move on in discussing the things a nurse should consider while caring for a patient with life support device. How to troubleshoot ventilator alarms?Alarms are designed to warn nurses that there is something wrong either to the patient or to the mechanical ventilator. But sometimes, alarms can give nurses apprehensions especially if the alarm is non-stop and we don’t know how to troubleshoot the problem. So as a nurse, how will you manage if there’s an alarm? First, assess the patient if he/she is in distress. Identify the alarm whether high pressure or low pressure. Some mechanical ventilators have their own indicators and shows the cause of the alarm, so it’s important to check your machine as well. A. Low Pressure alarmLow pressures alarm may indicate leak in the patient’s tube, disconnection of the tube, or the patient stops to breath. What are your interventions for low pressure alarm?
B. High Pressure alarmHigh pressure alarm may indicate displacement of the ET tube, increased secretions, obstruction in the tube, bronchospasms, or the patient is coughing or biting the tube.
What are the bundles of care to avoid Ventilator-associated Pneumonia (VAP)?Bundles of care for VAP should be strictly observed by the Critical Care Nurses or nurses in any department.
How to perform closed system suctioning?Equipment
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Caring for a patient with mechanical ventilator can be challenging but also very manageable. This should be learned by nurses not only at the critical care unit but also nurses in every department. Complications of long-term ventilation(Smeltzer, S., et al., 2010)
Plan of Care for Ventilated Patients
At first, technicalities may overwhelm a novice nurse, but experience is a very good teacher. If you are unsure of what to do, always go back to the fundamentals of nursing. Don’t be afraid to ask. Check standards and guidelines of your hospital. As you hone your skills of taking care of patients with life support, you are also gaining competence and confidence. Never settle down. Never cease to learn! References
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