Help! Ventilators

  1. Just started on a unit with ventilator patients. Having a hard time understanding the different types and modes--pressure and volume, IMV, SIMV, PS, PSV, AC, AMC, PC, IRV, HFJV. Any tips for understanding, web sites, explanations from experienced ventilator nurses would be GREATLY appreciated. Also, tips for nursing care of ventilator patients. Thanx...
    Last edit by VickyRN on Oct 29, '01
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  2. 11 Comments

  3. by   nilepoc
    If you don't mind reading, you should go to the medical bookstore or library and pick up Paul L. Marino's "The ICU Book".

    This book is the best reference I have ever read, it blows most nursing texts away. I recommend it over nursing references any day.

    Good luck.
  4. by   VickyRN
    Thanx!!!
    Will pick up that book ASAP!!!
  5. by   kimberle
    I've worked on a ventilator unit for 10 years. Get kind of spoiled 'cause you've already got an airway for a code if needed
    As we tell all new employees, "When in doubt, bag and shout!"
    Good luck! Ventilators are becoming a chosen way of life for many people now. (Definately not for me though!) I'm gonna check out "The ICU Book" too.
  6. by   thisnurse
    had a vented pt when i did my icu rotation. i knew all those settings tho only respiratory was to touch the vent. dont remember any of them now not having had to use them.
    im getting the icu book too. who knows i might just go into icu nursing.
    thanks
  7. by   Agnus
    AC is assist control. in this mode the machine does all the breating for the patient.

    In the IMV/SIMV mode the machine is set at a certain rate. If the patient does not initiate breaths frequently enough the machine kicks in to make sure he get a minimum rate. So if IMV is set at 10 and the patient is not initiating at least 10 breaths a minute the machine will kick in to make sure that he breaths at least this amount.

    PS (pressure support) is pressure that is delivered to the lungs.

    PEEP (peak end expioratory pressure) is pressure that is delivered at the end of the expioratory phase preventing atelectasis.

    Tidal Volume (also volume, V, Respitory volume) is the amount of air that goes into the lungs with each breath. this amount is usually based on body mass.

    Peep and PS if too high can cause a pneumo.

    FiO2 is the percent of oxygen being delivered.

    CPAP is when the patient is virtually off the vent and is just about completed his weaning. It only is there as a safty blanket at this point. All it does is keep continious pressure in the lungs to prevent atelectasis.

    As a nurse new to vents you will not be making decisions about vent settings. However, learn all you can, pick you RT's brain. Be aware the PS and PEEP should not be higher than 5-10 and 10 is VERY high.

    If in doubt about anything take patient off vent and bag him. You can never make a mistake by doing this. Again you will not be making decisions about setting but you need to be aware what they are suposed to be for your patient. Once you become more experienced you may begin to make suggestions as to when weaning can start and when termination can happen. You are not in a vacuum here you have your RT and your pulmonary Doc. Ask the RT to show you how to drain water from the tubing how to handle heater alarms. and know how to distinguish diffrent types of alarms.

    If a high pressure alarm sounds chances are you need to suction. If a low pressure alarm sounds you have a leak in the system. (Vent has probably pulld off from the pt) if you can't find the problem bag him.

    Watch your ABGs these will tell you how well your patient is ventilating. Remember chronic COPDers don't have normal ABGs no matter what and are difficult to wean.

    Hope this provided a little insight. Don't be afraid of the vent. If in doubt bag. Rely on your RT. Ask the RT as many questions as you can. Let him know you want to learn. Don't expect to learn everything in one session with the RT. You don't have to tie up your RT with long teaching sessions, just be around and asking questions when ever he is at the bedside. He will be glad to teach because the more you know the easier his job will be.
  8. by   Peeps Mcarthur
    Healingtouch,
    I'm a former RT. I think that the most important concept that you should remember is to maintain the airway. Learning the variouse modes of delivery is important to your patients comfort, but not as much as seeing that the Tube is secure as your first line of defense.
    Observe the RT tape a tube. You'll want to see what a perfectly taped tube is SUPPOSED to look like. That way when it's in bad shape you'll be able to tell. Patients sometimes fiddle with them(it's shoved down their throat, after all) and that can work a tube loose enough to auto-extubate. Be aware of the tube when you turn a patient, Bathe them, When they are "out of it"............and when you first come on shift take note of the tubes position(what mark on the tube is at the bottom lip) and the condition of the tape.
    All the modes of breath cycling are intimidating to understand but remember that the key to the mode that a patient is set on is based on their ability to create acceptable negative pressure with their diaphragm, and the compliance(stretching ability) of their lungs. Your RT can explain why each patient is on the mode they are on. You'll learn the variouse stages of weaning as you see more and more cases.

    The most important skill to learn is when to be concerned....................ALWAYS LOOK AT THE PATIENT. It's easy to get involved looking at the vent with all the lights and alarms, but the only parameter that I can imagine you will need is the inspiratory pressures. 9.99 times out of ten it will be alarming momentarily a couple of times a minuet because the patient is coughing, or turning, sitting up, having a BM. Mostly the vent alarm is a good thing. Frequent short alarms usualy indicate either a need for suction, sedation, or weaning. Any duration longer than 10 seconds or so should draw your attention. LOOK AT THE PATIENT! I wish I had a dime for every time a scurried into a room with people looking intently at the vent to fix the problem when the tube was disconnected.

    Learn to suction your patients and how to do it right. You'll save your patients alot of discomfort and yourself a few grey hairs waiting for the RT with the three beepers and 40 patients to run up three flights of stairs! You'll also get more advice and personal service from an RT staff that feels valued for their expertise and troubleshooting abilities if you just call them when you can't handle it yourself.

    After you have a baseline of what normal pressures should be at the start of your shift just remember to look at the pressure of the airway when you are doing other things...................When your patients in distress and you haven't got a clue...........BAG them and get help. There's no shame in that if your patient feels better until you learn the ropes. If you are trying to learn how to handle alarms on your own, that's what counts. As you see more cases and build your understanding of ventillator settings and how that relates to your patients disease process, the more you will be comfortable with that.
    If you call respiratory every time a patient coughs, you'll get a reputation and after awhile it will be harder to take you seriousely, but if you take the time to learn and ask RT questions that will give your RT staff an irreplaceable sense of value and they will come help you even when you didn't ask. Try it and see.

    I hope some of what I said gives you some level of comfort. I remember what it was like to hear all those alarms and see all those settings and just be sure that my ignorance must be killing them. For the most part vent settings will only be where they are because those are all the parameters that your patient is comfortable at, so why screw with that?

    You can post your questions about anything Respiratory to me on the messaging system here or to beanbaby@altavista.com
    Happy oyster digging!

    Brad
    Columbia, MD
  9. by   MarkHammerschmidt
    May I humbly suggest my website, which has a series of FAQ articles on various subjects for ICU nurses - there's a pretty good file on vents and abgs: www.icufaqs.org Good luck!
  10. by   VickyRN
    Thank you all very much!!! Great help!!!
  11. by   VickyRN
    Mark Hammerschmidt--
    Your site is awesome!!! Thank you so much for taking the time, effort, and expense to put it together. What a great resource!
  12. by   KRVRN
    It's true about the LOOK at the pt thing!

    It's a little disconcerting when you are new in a NICU and your vent starts alarming every 5 seconds or so, then goes off by itself, then starts alarming, again, etc. The display says high insp. pressure, so you start looking all over for a problem, then you listen to see if the pt needs suctioning, then you start watching the sats on the monitor, but they're good...

    Without EVER actually looking at the pt.

    Then you start to get scared and consider calling for help...

    Then you actually DO look at the baby only to see that he's hiccuping and the alarms coincide with the hiccups.
  13. by   nur20
    Thank You so much guys. So very helpful. One of my weak areas..

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