CARE OF VENTILATED CARE OF VENTILATED PATIENTPATIENT

Ajish K ThankachanAjish K ThankachanADULT ICUADULT ICU

KING KHALID MILITARY KING KHALID MILITARY CITY HOSPITALCITY HOSPITAL

• MECHANICAL VENTILATIONMECHANICAL VENTILATION – –It is a method to It is a method to mechanically assist or replace spontaneous mechanically assist or replace spontaneous breathing .it is typically used after an invasive breathing .it is typically used after an invasive Intubation ,a procedure wherein an Endotracheal Intubation ,a procedure wherein an Endotracheal or tracheostomy tube is inserted into the airway .it or tracheostomy tube is inserted into the airway .it is used in acute settings such as in the short period is used in acute settings such as in the short period of time during serious illness.of time during serious illness.

• Purpose:Purpose: Ventilators are used to provide Ventilators are used to provide mechanical ventilation for patients with respiratory mechanical ventilation for patients with respiratory failure who cannot breathe effectively on their own. failure who cannot breathe effectively on their own. they are also used to decrease myocardial gas they are also used to decrease myocardial gas consumption or intracranial pressure ,provide consumption or intracranial pressure ,provide stability of the chest wall after trauma or surgery stability of the chest wall after trauma or surgery and when patients is sedated or pharmacologically and when patients is sedated or pharmacologically paralyzed.paralyzed.

RESPONSIBLE PERSON: RESPONSIBLE PERSON:

• RESPIRATORY THERAPIES RESPIRATORY THERAPIES is generally the person who is generally the person who sets up the ventilators and changes ventilator settings sets up the ventilators and changes ventilator settings based on physician’s order .based on physician’s order .

• NURSENURSE is responsible for monitoring the alarms and the is responsible for monitoring the alarms and the patients respiratory status.patients respiratory status.

It is also responsible for notifying the respiratory It is also responsible for notifying the respiratory therapist when mechanical problems occur with the therapist when mechanical problems occur with the ventilator and when there are new physician’s order ventilator and when there are new physician’s order requiring changes in the settings or the alarms requiring changes in the settings or the alarms parameters.parameters.

PHYSICIAN PHYSICIAN is responsible for keeping track of the patient’s is responsible for keeping track of the patient’s status on the current ventilator settings and changing status on the current ventilator settings and changing them when necessary.them when necessary.

NURSING CARE OF VENTILATED NURSING CARE OF VENTILATED PATIENTSPATIENTS

1.1. MONITOR VITAL SIGNS CONTINOUSLYMONITOR VITAL SIGNS CONTINOUSLY

2.2. ENSURE THAT THE ENDOTRACHEAL ENSURE THAT THE ENDOTRACHEAL TUBE PLASTER WAS FULLY SECURED .TUBE PLASTER WAS FULLY SECURED .

• ENDO TRACHEAL TUBE PLASTER SHOULD NOT BE ENDO TRACHEAL TUBE PLASTER SHOULD NOT BE APPLIED TOO TIGHT OVER THE JUGULAR AREA .APPLIED TOO TIGHT OVER THE JUGULAR AREA .

• AVOID TIGHT ADHERENCE OF THE TUBE OF THE AVOID TIGHT ADHERENCE OF THE TUBE OF THE LIPS .LIPS .

• ENDO TRACHEAL TUBINGS MUST BE CHANGE WITH ENDO TRACHEAL TUBINGS MUST BE CHANGE WITH IN 72 HOURSIN 72 HOURS

3. ENSURE VENTILATOR SETTINGS 3. ENSURE VENTILATOR SETTINGS ARE ADJUSTED ACCORDING TO ARE ADJUSTED ACCORDING TO DOCTORS ORDER, DOCTORS ORDER,

4. SUCTION SECREATION AS 4. SUCTION SECREATION AS NEEDED.NEEDED.

5. CARRIES OUT THE FOLLOWING 5. CARRIES OUT THE FOLLOWING HYGIENIC NECESSITIES :HYGIENIC NECESSITIES :

6. ORAL CARE EVERY FOUR HOUR.6. ORAL CARE EVERY FOUR HOUR.

• CHANGES POSITION 2-3 HOURLY.CHANGES POSITION 2-3 HOURLY.• CHANGES DRESSING PRN IF CHANGES DRESSING PRN IF

VENTILATOR IS CONNECTED TO VENTILATOR IS CONNECTED TO TRACHEOSTOMY .TRACHEOSTOMY .

• CHANGES ET TUBE PLASTER PRN.CHANGES ET TUBE PLASTER PRN.• EVALUATES PATIENT’S PROGRESS EVALUATES PATIENT’S PROGRESS

DAILY.DAILY.

RATIONALERATIONALEPROVIDES INFO PROVIDES INFO REGARDING AIR FLOW REGARDING AIR FLOW THROUGH THE THROUGH THE TRACHEOBRONCHIAL TRACHEOBRONCHIAL TREE AND THE TREE AND THE PRESENCE /ABSENCE OF PRESENCE /ABSENCE OF FLUID MUCUS FLUID MUCUS OBSTRUCTION .OBSTRUCTION .NOTE: NOTE: FREQUENT FREQUENT CRACKLES OR CRACKLES OR RONCHI THAT DO NOT RONCHI THAT DO NOT CLEAR WITH CLEAR WITH COUGHING /SUCTIONING COUGHING /SUCTIONING MAY INDICATE MAY INDICATE DEVELOPING DEVELOPING (ATELECTASIS ,PNEUMO(ATELECTASIS ,PNEUMONIA ,ACUTE NIA ,ACUTE BRONCHOSPASM ,PULMOBRONCHOSPASM ,PULMONARY EDEMA .NARY EDEMA .

• AUSCULTATE CHEST AUSCULTATE CHEST PERIODICALLY,NOTINPERIODICALLY,NOTING PRESENCE G PRESENCE /ABSENCE AND /ABSENCE AND EQUALITY OF BREATH EQUALITY OF BREATH SOUNDS SOUNDS

•

• ELEVATE HEAD ELEVATE HEAD OF BEDOF BED

• ELEVATION OF ELEVATION OF PATIENT’S PATIENT’S HEAD WHILE HEAD WHILE STILL ON STILL ON VENTILATOR IS VENTILATOR IS BOTH BOTH PHYSICALLY PHYSICALLY BENEFICIAL.BENEFICIAL.

• CHECK CHECK VENTILATOR VENTILATOR ALARMS FOR ALARMS FOR PROPER PROPER FUNCTIONING FUNCTIONING

• VENTILATORS VENTILATORS HAVE A SERIES HAVE A SERIES OF VISUAL AND OF VISUAL AND AUDIBLE AUDIBLE ALARM.EXAMPLE :ALARM.EXAMPLE :O2 low/high O2 low/high pressure .pressure .

• Turning off /failure Turning off /failure to reset alarms to reset alarms places patient’s @ places patient’s @ risk for un observe risk for un observe ventilator failure or ventilator failure or resp. arrestresp. arrest

• INFLATE INFLATE TRACHEAL TRACHEAL /E.T.CUFF /E.T.CUFF PROPERLY PROPERLY

• CUFF MUST BE CUFF MUST BE PROPERLY PROPERLY INFLATED TO INFLATED TO ENSURE ENSURE ADEQUATE ADEQUATE VENTILATIONVENTILATION

• CHECK CHECK TUBINGS FOR TUBINGS FOR OBSTRUCTION OBSTRUCTION

• KINKS IN TUBINGS KINKS IN TUBINGS PREVENT ADEQUATE PREVENT ADEQUATE VOLUME DELIVERY VOLUME DELIVERY AND INCREASE AND INCREASE AIRWAY PRESSURE. AIRWAY PRESSURE.

• WATER PREVENTS WATER PREVENTS PROPER GAS PROPER GAS DISTRIBUTION AND DISTRIBUTION AND PREDISPOSES TO PREDISPOSES TO BACTERIAL GROWTH.BACTERIAL GROWTH.

• KEEP KEEP RESUSCITATIORESUSCITATION BAG @ N BAG @ BEDSIDEBEDSIDE

• Provides /restore Provides /restore adequate adequate ventilation when ventilation when patient or patient or equipment equipment problems require problems require patient removed patient removed from ventilator.from ventilator.

• ASSIST PATIENT ASSIST PATIENT IN TAKING IN TAKING CONTROL OF CONTROL OF BREATHING IF BREATHING IF WEANING IS WEANING IS ATTEMPTED ATTEMPTED VENTILATORY VENTILATORY SUPPORT IS SUPPORT IS INTERRUPTED INTERRUPTED DURING DURING PROCEDURE PROCEDURE /ACTIVITY/ACTIVITY

• Coaching patient to Coaching patient to take slower ,deeper take slower ,deeper breath practice breath practice abdomen /pursed lip abdomen /pursed lip breathing assume breathing assume position comfort and position comfort and use relaxation use relaxation techniques can be techniques can be helpful in helpful in maximizing maximizing respiratory function.respiratory function.

• To promote comfort.To promote comfort.

SUCTIONINSUCTIONINGG

The patient with an artificial airway is not capable The patient with an artificial airway is not capable of effectively coughing, the mobilization of of effectively coughing, the mobilization of secretions from the trachea must be facilitated by secretions from the trachea must be facilitated by aspiration. This is called as suctioning.aspiration. This is called as suctioning.

OPEN SUCTION SYSTEM:OPEN SUCTION SYSTEM:

Regularly using system in the intubated patientsRegularly using system in the intubated patients.. CLOSED SUCTION SYSTEM: CLOSED SUCTION SYSTEM: This is used to facilitate continuous mechanical This is used to facilitate continuous mechanical

ventilation and oxygenation during the suctioning.ventilation and oxygenation during the suctioning. Closed suctioning is also indicated when PEEP Closed suctioning is also indicated when PEEP

level level above 10cmH2O.above 10cmH2O.• (((Set vacuum regulator to appropriate negative (((Set vacuum regulator to appropriate negative

pressure. For adult a pressure of 100-120 mmHg, pressure. For adult a pressure of 100-120 mmHg, 80-100mmhg for children & 60-80mmhg for 80-100mmhg for children & 60-80mmhg for infants)))infants)))

• OBTAIN CHEST OBTAIN CHEST X-RAY AS X-RAY AS ORDERED.ORDERED.

• TO CHECK THE TO CHECK THE TUBINGS IF TUBINGS IF PROPERLY IN PROPERLY IN PLACEDPLACED..

Carefully explain all Carefully explain all procedures procedures

to theto the

patient, prior to their patient, prior to their

commencementcommencement;;

At all times, the nurse should attempt to:

Orientate the patient to their environment and events;

Provide a suitable means of

communication for the patient.

Involve the patient and their family in the planning and

implementation of nursing care;

Facilitate a proper day / night

rhythm for the patient;

Patient ComfortPatient Comfort

CommunicationCommunication Finding alternative means for the patient to communicate.

• The patient should be encouraged to try alternative methods such as mouthing words, writing, or pointing to letters, words, or pictures on a communication board.

• Communicating with these patients takes great patience and creativity, as well as dedication to helping them feel like their needs are being met.

DOCUMENT ALL NURSING DOCUMENT ALL NURSING ACTIONS ACTIONS

THANK THANK

YOU!YOU!