ARTP 10 Flashcards
Where do you place the circuit after a circuit change?
Needs to be treated as a biohazard and put in biohazard bag
When is a circuit change done?
It is no longer done routinely because it increases the chance of germs getting inside the system. Instead it is changed as needed (when soiled).
Three things that a ventilator pre check ensures
- Ensures there is no leak
- Determines tube compression- makes sure patient receives all the volume of air they are supposed to
- Ensures machine is running correctly.
What are the 4 settings that can affect the i:e ratio
Flow, Ti, TV, RR
***If in VC- you CANT change Ti. And in PC you cannot change flow
If flow increases, i:e does what?
i decreases, e increases
If you increase TV, i:e does what?
i increases, e decreases
If you increase the Ti, i:e does what?
increases the i time, decreases the e time
If RR is increased the i:e does what?
As RR increases, BOTH the i AND e time will decrease
What will cause a sudden spike in RR?
Auto-cycling, which is usually due to the sensitivity being too low
Where is the HME placed?
Placed between the Y and the artificial airway of the pt
Disadvantage to using an HME
Adds additional dead space to the system
Disadvantage to using an HME
Adds additional dead space** to the system and you have to remove it in order to give a SVN.
PS of 7 or less does what?
compensates for the increased WOB due to the increased airway resistance from the ETT tube
What are the most important alarms in CPAP and PS ventilation
Low TV, RR, Pressure, apnea
What do you do if your pt is air trapping?
Want to increase the flow rate
If there is a leak in your system, what two values would you compare?
Their would be a big difference between the VTi and the VTe.
***Which vital sign will help you best evaluate the unwanted cardiac side effects from changing PEEP?
Whenever you are adding additional PEEP, you increase the chance of increasing the pressure set on the heart, decreasing CO. You can best monitor this by looking at the BP*
What does a PS of 8 or more do?
It will help AUGMENT the breath
***If a patient appears to be in distress or asynchronus with the ventilator, what value could you change to improve the situation?
Change the flow….by increasing it?
What temperature is the WICK set at?
35-37
What will increasing the temperature of the heater do?
It will increase the humidity level in the circuit which can help with thick secretions.
***Correlation between expiration time and increased lung compliance
Diseases that increase lung compliance will require a longer expiration time in order to fully exhale the entire volume in their lungs. (Think COPD patients)
***What are your main goals you shoot for as far as initial FiO2 setting?
You want to achieve an SpO2 of 92% and PaO2 of 60-70mmHg
If your patient has auto PEEP, what is likely causing the problem?
If they have auto PEEP, they are probably ‘air trapping’
What is extrinsic PEEP?
This is the initial PEEP setting you input, which is usually 5cmH2O
Initial TV setting
Preferred TV is 6-8ml/Kg. Start at 8mL/Kg.
Initial flow rate setting
60-80Lpm
Initial setting for inspiratory time
0.8 seconds (0.6 to 1 second)
FiO2 setting for someone with COPD
Don’t want to go above FiO2 40%
Flow Trigger setting
1-2Lpm
Pressure trigger setting
-0.5 to -2.0 cmH2O
High Pressure
+15cmH2O (10-15)
Low pressure
5-10cmH2O below
Apnea
20-30 seconds
High RR alarm
set at double the set RR
Low RR alarm
2 below the set RR
High minute ventilation alarm and low minute ventilation alarm
10-15% above or 2L
10-15% below or 2L
TV alarm (high and low)
100-200mL above and below the set TV
Low PEEP alarm
2-3 cmH2O below set PEEP
What happens when you trip over the ventilator plug and disconnect it?
The vent will alarm and will go into backup ventilation via the battery back-up
What is included in a vent order
Mode, set rate, FiO2, TV, PEEP
What two settings are typically not included in a vent order?
Flow & i:e ratio
Which mode is pressure limited and time cycled?
PC
Where is dead space found in the ventilator circuit?
Anything after the ‘Y” is considered dead space
When changing PEEP, what do you need to do?
Change in increments of 2, and monitor BP whenever adding additional PEEP. Also reassess your alarms!
What two things does PS do?
Compensate for extra WOB (from ETT tube) and increase your TV
**What are the 5 contraindications for using an HME?
1 low body temp 2 bloody secretions 3 copious thick secretions 4 increased minute ventilation 5 has a leak greater than 70%
what alarm causes bradypnea?
low minute ventilation alarm
normal LC
60-100
***Low pressure alarm is most important for which mode?
CPAP
