Mechanical Ventilation Flashcards
Mechanical Ventilation
-provides support of breathing for clients who have impaired lung function
-delivered through:
-an endotracheal tube (ETT)
OR
-a tracheostomy tube (Trach)
Why would a client require mechanical ventilation?
1) for respiratory support during hypoxemia and hypoventilation caused by such things as:
- airway trauma
- exacerbation of COPD
- acute pulmonary edema
- head injuries
- stroke
- coma
- neurological disorders that cause muscle weakness/impaired breathing:
a. multiple sclerosis
b. myasthenia gravis
c. guillain-barre
d. general anesthesia or heavy sedation
Common Modes of Ventilation
1) assist-control (AC)
2) synchronized intermittent mandatory ventilation (SIMV)
3) pressure support ventilation (PSV)
4) positive end expiratory pressure (PEEP
**continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BiPAP) only supply positive pressure during spontaneous breaths and thus do not assist with respiratory rate. CPAP and BiPAP can be adminstered via nasal or face mask as well as by ETT or Trach
Ventilator Alarms
- signal that the client isn’t receiving the correct ventilation
- never turns alarms off
3 types:
1) low pressure alarms:
- indicated low exhaled volumes
2) high pressure alarms:
- indicated increased pressure from things like excessive secretions, client biting ETT, kinks in the ventilator tubing, coughing, pneumothorax
3) apnea alarms:
- ventilator doesn’t detect any spontaneous respirations from the client
Care of the Client on a Ventilator
1) maintain a patent airway:
- assess and document position and integrity of ETT/Trach tube
- use caution when moving client
- suction oral and tracheal secretions
- support ventilator tubing to prevent pressure on client’s tissues and displacement of tube
2) assess respiratory status and oxygen saturation levels frequently
3) monitor and document ventilator settings:
- rate and mode of ventilation
- FiO2 (amount of inspired oxygen being delivered)
- tidal volume
- alarm settings
4) maintain adequate volume in cuff of ETT/Trach tube
- excessive air in cuff can cause tracheal necrosis
- too little air in cuff will result in inadequate ventilation
5) administer medications as prescribed
- analgesics
- sedatives
- paralytics
- stress ulcer prevention
6) provide a non-verbal method of communication such as a dry erase board
7) provide adequate nutrition
- enteral (tube feedings)
- parenteral (TPN)
Performing endotracheal suctioning through a tracheostomy or endotracheal tube
1) ask for assistance
2) if in-line suction not in place, obtain a suction catheter with an outer diameter of no more than 1 cm (0.5 in) of the internal diameter of the tracheostomy (Trach) or endotracheal tube (ETT)
3) hyperoxygenate client using a bag-valve mask (BVM) or specialized ventilator function with an FiO2 of 100%
4) remove the BVM or ventilator from the Trach or ETT and insert catheter into the lumen of airway. advance catheter until resistance is met. catheter should reach level of carina (location of bifurcation into main stem of bronchi)
5) pull catheter back 1 cm (0.5 in) prior to applying suction to prevent mucosal damage
6) apply suction intermittently by covering and releasing suction port with thumb for 10-15 sec
7) apply suction only while withdrawing catheter and rotating it with the thumb and forefinger
8) reattach the BVM or ventilator and supply the client with 100% inspired oxygen
9) clear catheter and tubing
10) allow time for client to recover between sessions
11) repeat as necessary
12) document client’s response
Important Safety Tip
-if you cannon determine the cause of a ventilator dysfunction, disconnect client’s ETT/Trach tube from the ventilator and manually ventilate client using an Ambu bag connected to supplemental oxygen while waiting for emergency support
Complications of Mechanical Ventilation
1) fluid retention due to decreased cardiac output
2) oxygen toxicity from prolonged FiO2 settings >50%
3) hemodynamic compromise due to increased intrathoracic pressure
4) risk of aspiration due to sedation, increased secretions, and enteral feedings
5) increased stress response can lead to GI irritation and bleeding
