ET Tube & Vents Flashcards
Proper suction for ET tube
Consider administering 100% oxygen via the ventilator for 30 to 60 seconds before suctioning.
Advance inline and pull back as suctioning for no more than 15 secs
PRVC
Pressure-regulated volume control (PRVC)
Pressure-controlled and tidal volume (VT)–targeted breath using a decelerating flow waveform pattern that allows unrestricted spontaneous breathing with or without pressure support (PS).
PRVC is considered an advanced dual-control or adaptive mode because the ventilator uses both volume and pressure to automatically adjust to the patient’s ventilatory needs breath by breath.
Pressure, flow, or volume delivery depends on variables such as lung compliance, airway resistance, and respiratory effort.
The mechanical ventilator delivers the lowest pressure and appropriate flow to meet the set VT target for each delivered breath.
A mandatory rate is set for the patient. The patient may breathe above the set rate.
All breaths are patient triggered or time triggered.
SIMV
Synchronized Intermittent-Mandatory Ventilation Mode (SIMV)
Referred to as weaning mode
If a client underwent an operation and anesthesia was required, the client will first be placed on AC mode then, as the client’s condition improves, the ventilator will be switched to SIMV mode.
With this mode, the ventilator will deliver a mandatory (set) number of breaths with a set volume while at the same time allowing spontaneous breaths.
PS (mode and setting)
NIV PS is a spontaneous mode of ventilation where the patient initiates the breath and the ventilator delivers support with the preset pressure level.
The patient regulates the respiratory rate and tidal volume so the alarm parameters must be set appropriately.
Use FiO2 and PEEP settings according to the patient’s needs.
Setting: Driving pressure control 5 to 8 cmH20, PEEP 5 to 8 cmH2O, and FiO2 less than or equal to 40%
Pressure Control
Pressure-controlled ventilation (PCV) is a pressure-targeted, time-cycled mode of ventilation.
During inspiration, the ventilator adjusts the flowrate to keep the airway pressure at the set level.
The clinician sets the peak inspiratory pressure (PIP), respiratory rate (f), inspiratory time (TI), positive end expiratory pressure (PEEP) and fraction of inspired oxygen (FIO2).
Each breath, whether it is delivered at the set respiratory rate or an additional breath triggered by the patient, is delivered at the set PIP (peak inspiratory pressure) and the set TI (inspiration time)
Volume Control
Volume-controlled ventilation (VCV) is a volume-targeted mode in which the tidal volume, respiratory rate (f), PEEP, inspiratory flowrate, flow waveform, inspiratory pause time and inspiratory time are controlled.
The most common mode of VCV is volume-targeted assist-control (VC-CMV), in which a minimum f is set, but the patient is allowed to trigger additional breaths.
Each breath, regardless of whether it is patient or machine-triggered, will be delivered at the set tidal volume
- This may cause volutrauma
PEEP
Positive end-expiratory pressure (PEEP) is the alveolar pressure above atmospheric pressure that exists at the end of expiration. There are two types of PEEP:
●Extrinsic PEEP – PEEP that is provided by a mechanical ventilator is referred to as applied PEEP
●Intrinsic PEEP – PEEP that is secondary to incomplete expiration is referred to as intrinsic PEEP or auto-PEEP
Rate Ventilation
A respiratory rate (RR) of 8-12 breaths per minute is recommended for patients not requiring hyperventilation for the treatment of toxic or metabolic acidosis, or intracranial injury.
Tidal Volume
Tidal volume is the volume of air delivered to the lungs with each breath by the mechanical ventilator.
Tidal volume is a measure of the amount of air a person inhales during a normal breath.
Traditional preset tidal volumes higher than 10 ml/kg have been proved to be associated with increased risk of pulmonary barotrauma and should be avoided.
High tidal volumes also decrease venous return and reduce cardiac output.
Low tidal volume or so-called lung protective ventilation is recommended for all patients with ARDS.
Peak airway pressure alarm indications:
Kinks in the patient circuit or tracheostomy tube.
Water in the ventilator circuit.
Increased or thicker mucus or other secretions blocking the airway (caused by not enough humidity)
Bronchospasm.
Coughing, gagging, or “fighting” the ventilator breath.
ABG interpretation
pH: 7.35-7.45
pCO2: 35-45 mmHg
pO2: 80-100 mmHg
O2 Saturation: 95-100%
HCO3-: 22-26 mEq/L
Base Excess: + or – 2
Respiratory acidosis
PH ↓ CO2 ↑ HCO3- Normal
Metabolic aciddosis
PH ↓ HCO3- ↓ CO2 normal
Respiratory alkalosis
PH ↑ CO2 ↓ HCO3- Normal
Metabolic alkalosis
PH ↑ HCO3-↑ CO2 Normal
Respiratory acidosis with metabolic compensation
PH ↓ / ↔ CO2 ↑ HCO3- ↑
Respiratory alkalosis with metabolic compensation
PH ↑ / ↔ CO2 ↓ HCO3- ↓
Think:
Resp opposite involving CO2
Metabolic same involving bicarb
Airway management in crisis
Assess visible issues to fix ex suction patient or give o2 boost, elevate HOB to high fowlers
Head tilt and chin lift or jaw thrust maneuver
If unsuccessful have ambu bag at bedside and deliver 100% o2
Assist with intubation if needed
Nurse role for intubation
Prepare the patient and equipment, administer the medications, help manage the airway (although this is usually the job of respiratory therapists), and monitor the patient.
Afterwards, they are required to keep the patient sedated with titratable sedatives.
Weaning protocol and appropriate parameters
NIF: Negative Inspiratory Force
FVC: Forced Vital Capacity
RSBI: Rapid Shallow Breathing Index
NIF : the breathing circuit is closed following a manually extended expiration by the patient. The ventilator then measures the maximum inspiratory effort made by the patient. The NIF value is measured as a pressure relative to PEEP.
FVC: Forced vital capacity normal range Average normal values for healthy males age 20-60 range from 4.75 to 5.5 liters. For females age 20-60, the normal range is from 3.25 to 3.75 liters.
RSBI: is simple to use as it has only one cut-off point, 105. If the RSBI score is lower than 105 is a good prognosis that the future weaning from mechanical ventilation will be successful.
- Take rate/TV = RSBI
