Operating Instructions for Microprocessor Controlled Ventilators
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1 Page 1 of 5 Operating Instructions for Microprocessor Controlled Ventilators Purpose Audience Scope Physician's Order To provide guidelines for the procedure for the use of microprocessor controlled ventilators. Physicians, Nursing staff, and Licensed Respiratory Care Practitioners. Current ventilators are microprocessor controlled, pneumatically powered, and modified flow generators. They may be volume or time cycled with Assist/Control, Pressure Control, PRVC, Pressure Support, SIMV, PEEP, and CPAP capabilities. Respiratory Care Services provide microprocessorcontrolled ventilators for patients requiring ventilatory assistance or continuous mechanical ventilation. Accountability: Ventilator adjustments/management is limited to the following individuals: Licensed RCPs who have undergone training and competency evaluations of the microprocessor controlled ventilator with understanding of age specific requirements of patient populations, Faculty physicians and/or fellows who have undergone training and competency evaluations of the Avea microprocessor controlled ventilator. Special Training Training must be equivalent to the therapist entry level in Respiratory Care Service. Special Consideration: A licensed registered nurse who has undergone in-service orientation to the ventilator control panel may make ventilator changes limited to FIO2 changes only. Any changes made in FIO2, must be the result of a physician order; a change in FIO2 must be communicated immediately to the RCP assigned to the area and documented in the patient s electronic medical record. Must include Mode of ventilation, Rate, FIO 2, Tidal Volume, and amount of PEEP desired, and Pressure Support if applicable in cmh 2 O. Inspiratory time and peak inspiratory pressure settings are required if pressure control ventilation is used.
2 Page 2 of 5 Indications Apnea Impending (acute) respiratory failure Exacerbation of chronic ventilatory failure Severe hypoxemia Need for hyperventilation Lung conditioning during ECMO Goals Maintain patent airway Improve alveolar ventilation Improve oxygenation Decrease work of breathing Support ventilation of apneic patients Hyperventilation of patient with increased ICP Lung conditioning during ECMO. Adverse Effects The adverse effects of mechanical ventilation can be divided into four categories: Pulmonary Barotrauma: Tension Pneumothorax/Pneumothorax Pulmonary Interstitial Emphysema Pneumomediastinum Pneumopericardium Pneumoperitoneum Cardiovascular Effects: Decreased Venous Return Decreased Cardiac Output Increased Pulmonary Vascular Resistance Psychological Effects: Inability to communicate (See Patient Teaching) Psychological dependency on ventilator Removal of natural defense mechanisms with intubation: Contamination of ventilator circuits Contamination through suctioning Vocal cord paralysis, tracheal stenosis, tracheomalacia, trachealesophageal fistula
3 Page 3 of 5 Equipment One microprocessor controlled ventilator One high-output humidifier with temperature feedback circuit. One disposable breathing circuit with heated wire. Procedure Refer to the appropriate equipment manuals for assembly instructions. Step Action 1 Attach the power cord with ground to a 115 volt 60 cycle AC electrical outlet. 2 Attach air and oxygen lines to the appropriate 50-psi wall source. 3 Fill the humidifier with sterile distilled water. 4 Turn on the power. 5 Perform an Extended System Test (EST). Correct the leaks if present and recheck to insure that there are no further leaks. 6 Set up the ventilator with the orders prescribed for the patient. 7 Set the pressure limit control. While making the adjustment, block the patient Y connection, deliver a breath, and observe the pressure display on the control panel. It will stop at the set pressure, and an audible and visual alarm will sound. This setting will vary from patient to patient but is usually in the range of 40 to 60 cm H 2 0. Should usually be 10 cm above patient generated pressure. 8 Adjust the ventilator to the desired FIO 2 using the OXYGEN % control on the ventilator. The alarm is activated by a 6% from set FIO 2. 9 Adjust the PEEP control until the display reads at the desired PEEP level.
4 Page 4 of 5 10 Sensitivity Control Adjustment: Set to flow trigger to ensure synchrony of the ventilator with patient effort. 11 Adjust all alarm limits and verify they are functional. Note: Ensure that appropriate apnea alarms limits are set on spontaneous breathing patients. These alarm limits are meant as general guidelines. Patient condition and ventilator settings may warrant minor deviations in alarm settings. 12 Document date and time of ventilator set-up along with set ventilator parameters in Epic, per RCS Policy Note: These ventilators can deliver a tidal volume using different flow patterns. The inspiratory flow pattern are constant flow or decelerating flow Can be tapered by adjusting Rise Time % Assessment of Outcome Infection Control Safety Precautions Arterial and Mixed Venous Blood Gas Values Pulse oximetry and end tidal CO 2 valves Respiratory mechanics Chest x-rays, auscultation work of breathing evaluation Sputum: Culture, amount, color, consistency Follow procedures outlined in Healthcare Epidemiology Policies and Procedures #2.24; Pulmonary Care Services. Alarms on the ventilator will be activated at all times.
5 Page 5 of 5 References Ventilator Operating Manuals. AARC Clinical Practice Guidelines; Respiratory Care;1992; 37: Patient-Ventilator System Checks Donald F. Egan, Craig L. Scanlan, Robert L. Wilkins, James K. Stoller, Section Egan's Fundamentals of Respiratory Care, 8th Edition 2003 Hess, Dean R. et al, Respiratory Care Principles and Practice, W.B. Saunders Company, St. Louis, Jimmy M. Cairo, Susan P. Pilbeam, Mosby's Respiratory Care Equipment Mosby; 6th edition (March 15, 1999) Dean Hess, Robert Kacmarek, Essentials of Mechanical Ventilation, McGraw-Hill Professional; 1st edition (March 1, 1996)
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