Questions on Mechanical Ventilators

GreyGull · Jan 12, 2011

Our hospital no longer refers to it as SIMV. It is pressure support with a rate here.

What does the manufacturer of the ventilator call it?

By your screen name "Neo Pedi" I take it you might be referring to some of the Drager and Siemen products. In the neo and pedi world you get into augmented pressure support with volume guarantee and the ability to control inpiratory time. Some ventilators for adults may also have something similiar based on minute volume. There is also much new terminology with the new Bilevel or BiPAP machines that now have VAPS (Volume Assisted Pressure Support) and PAV (Proportional Assist Ventilation). But then the ICU ventilators also have Pressure Supported breaths within the other spontaneous modes such as BiLevel or APRV. So it basically still depends on the "mode" of the ventilator, the delivery with initiation and if it is goal directed.

The terminology and technology is also something to remember and clarify if you are giving/getting report to/from another hospital. One can potentially make a very serious mistake when setting pressures by just matching numbers if you don't know if the PS or PC was from a baseline of zero or above PEEP or if it was in some type of a guarantee mode.

I'm not trying to be argumentative but merely trying to point out the importance of the variations in terminology, technology and understanding how the mode actually works rather than a broad generic definition that might have been given in some a nursing text book without reference to make or model (or year).

NeoPediRN · Jan 12, 2011

We primarily use Servos for the kiddos who are weaning. You have the option to set pressure support and add a rate instead of SIMV. I understand your point. It has become a bit iffy because for the Servo we use pressure control plus peep, and with the LTV it's combined under PIP because of the way each vent is manufactured. However, get a nurse who is inexperienced or transfer a baby to a hospital that sets it differently and you have trouble. I did a transport the other day to a place that refer all of their vents by PIP (including Servo) and they almost programmed the settings to a dangerous level.

NeoPediRN · Jan 12, 2011

P.S. You have referenced nursing textbooks twice in this thread in a condescending manner. Please remember you are on a nursing forum, and while you are welcome to participate, you are a guest. We understand your need to interject, debate, and explicate the depth of your knowledge, however it's getting a little old to constantly be knocked down under the guise of "I'm not trying to be argumentative." If you look back on your posts, almost all of them have caused arguments and discontent. Perhaps your vast knowledge on almost everything in medicine would be better received on studentdoctor.com or a physician network. I mean no disrespect, but I believe I speak for most on here when I say we miss the days of freely expressing opinions and holdig nursing discussions without Dr. Feel-Good contantly taking subtle shots at out profession and writing pages of lectures and arguments in response to simple questions that other nurses answer accurately, concisely, and supportively.

GreyGull · Jan 12, 2011

P.S. You have referenced nursing textbooks twice in this thread in a condescending manner. Please remember you are on a nursing forum, and while you are welcome to participate, you are a guest. We understand your need to interject, debate, and explicate the depth of your knowledge, however it's getting a little old to constantly be knocked down under the guise of "I'm not trying to be argumentative." If you look back on your posts, almost all of them have caused arguments and discontent. Perhaps your vast knowledge on almost everything in medicine would be better received on studentdoctor.com or a physician network. I mean no disrespect, but I believe I speak for most on here when I say we miss the days of freely expressing opinions and holdig nursing discussions without Dr. Feel-Good contantly taking subtle shots at out profession and writing pages of lectures and arguments in response to simple questions that other nurses answer accurately, concisely, and supportively.

Are you saying as a nurse one can not be well versed in ventilators? How much ventilator information did the text book you have in your nursing program provide you with? If it went into great detail about every ventilator and every mode currently available on the market today please pass along the title of that book and maybe our nursing program can institute it.

There is absolutely nothing wrong with admitting your education did not provide you with all the information you needed to go directly into critical care. Admitting your weaknesses and seeking out more information is just part of being a professional. My points are to make some think rather than assume everything they read on an anonymous internet forum it the end all to all knowledge rather then asking more questions from reliable sources. I see I struck a nerve when I countered you with "what your hospital called a ventilator mode rather than what the manufacturer did". I would like other nurses to not make mistakes by the confusion of what one hospital calls something and the manufacturer or another hospital calls it differently. I do not believe in setting people up to fail just because they have insecurities about learning more. You will also notice I rarely participate in discussions that have political overtones and would rather stick to those which have a bases for advancing one's knowledge with more information about technology and medications which can also be easily confirmed through references and other sources. I think you can still find hundreds of threads which I will never post on for you to freely express you opinion on. However, when it comes to technology and correct use of it and medications, it should be just about opinion and there should some base education to support an opinion. A person with 10,000 kudos might state "I like SIMV best" but if they offer not further explanation as to why, I don't find that opinion of much use and I will be inclined to ask for more details. I did just that with you also and it appears to have offended you.

I do believe nurses can learn ventilators and have in many places. Isn't it rather insulting to the others on this forum to state that my information would be better on a physician network? None of this stuff should be out of the reach of a nurse and especially not one who might be given the responsibility of working with a ventilator on transport, in a rural hospital without RTs and most definitely not the beside ICU RN who works with a ventilator everyday. The more they know just makes their jobs that much easier for charting and anticipation of sedation and BP issues or just the over all care of their patient.

At 26 y/o, you are just starting and still have a lot to learn. Don't limit yourself by believing the information your textbooks gave you is all there is.

NeoPediRN · Jan 12, 2011

You have an interesting way of twisting things to make nurses feel like they have to prove themselves. I don't buy into manipulation, and I stand by what I said in my previous post.

GreyGull · Jan 12, 2011

You have an interesting way of twisting things to make nurses feel like they have to prove themselves. I don't buy into manipulation, and I stand by what I said in my previous post.

You attacked me when I pointed out that the nursing textbooks did not provide detailed ventilator information. If there is one that does which you know about, please post it.

Maybe I should take it as a compliment that you think I am a doctor or "like a doctor". However, I still stand by the fact that RNs who work with ventilators should know as much as they can about them and that is is not beyond their educational abilities. I really do not want nurses and their patients to become a headline:

U.K. nurse shuts off ventilator

http://www.bbc.co.uk/news/uk-england-wiltshire-11612402

New Jersey Squad Accused of Improperly Applying a Ventilator

http://www.state.nj.us/health/ems/documents/actions/2010-438.pdf

http://www.pressofatlanticcity.com/news/breaking/article_1d9a4a82-144e-11e0-8021-001cc4c03286.html

You might also take note of JCAHO's sentinel event alert on ventilator safety.

http://www.premierinc.com/safety/safety-share/04-02_downloads/19_JCAHO_SE_ventilators.doc

If you have information that contradicts my points on providing more information or patient safety, please post it.

NeoPediRN · Jan 12, 2011

Fundamentals of Mechanical Ventilation: A Short Course on the Theory and Application of Mechanical Ventilators, by Robert L. Chatburn.

AACN Advanced Critical Care by Mary Tracy, RN has an excellent section on vents

GreyGull · Jan 12, 2011

Fundamentals of Mechanical Ventilation: A Short Course on the Theory and Application of Mechanical Ventilators, by Robert L. Chatburn.
AACN Advanced Critical Care by Mary Tracy, RN has an excellent section on vents

Are these standard in all the nursing programs in your area? Is the ventilator class a whole semester and what term? Is it along with a critical care clinical? Please post or PM me a link to these programs. I would like to see how they are set up. Very, very few new grad RNs have this knowledge straight out of a nursing program so it would be interesting to see how your school is set up. We've also been trying to get a basic ventilator course together for transport nurses on flight and CCT teams but that also comes with a big responsibility for covering the right material for the experience, education and application. Some employers sometimes assume too much and then their employees (and patients) end up paying the price.

You didn't put Robert L. Chatburn's credentials with his name but he is a Respiratory Therapist and not a nurse. His book is an excellent introduction to ventilators. However, it is still good to learn about the terminology and how each mode functions with the ventilator you are using. You will also notice in Chatburn's introduction he states:

"You can kill or injure somebody with a ventilator just as fast as you can with a car."

AACN Advanced Critical Care with Karen Carlson RN as the Editor and Mary Fran Tracy along with many other contributors does provides a good overview.

The AACN Advanced Critical Care journal, Mary Fran Tracy, RN Editor in Chief, is also an excellent source of critical care information.

zcoq72mehs · Jun 19, 2011

Glad I missed on the previous hoopla.

:)

For some reason, today, I received an email that there was a new post in this thread, but i missed all these in January. The post had this in the reply to my email:

"Includes Trach and other Pulmonary Education. 4 hour class with Certificate and Continuing Education hours"

Yet i see no reference to this in this thread--i assume it was deleted by an admistrator.

In regard to GreyGull..........

He is undoubtedly very knowledgeable on the subject matter.

He brings up many good points, both specific and general (see what this nurse did, see what this transport team did, etc), in regard to ventilator management and patient safety.

I do share his concern, but perhaps not his method of instruction. First, it is important to acknowledge that most non-RTs do not possess the knowledge of RTs--they do go thru a rigorous training program, board certification licensure (or whatever you want to call it), and then have many hours of training specific to this subject matter usually first in a controlled or supervised/peer setting.

It is very unlikely many nurses possess his depth of knowledge on the subject matter--for that matter, i doubt many new grad RTs do either.

In my opinion there does need to be some sort of specific training and/or 'universal'ization to address the matter as much as possible.

For instance, a given transport team and home nursing agency should limit themselves to SPECIFIC ventilator models as much as possible, and all involved personnel should be trained as much as possible, with hands-on scenarios, with 100% competency, on each model prior to usage whenever feasible. This should be done with some regularity, perhaps every 6months as to ensure patient safety. Alternatively there could be some sort of emergency on-call RT that could be at the scene or some sort of videoconferencing technology wherein the RT could give specific on-site (or virtual) assistance/instruction.

My insight on the solution is limited, and there may be better alternatives.

But in regard to GreyGulls method or approach--i think it could be refined. In order for proper change to occur with the least resistance, a more subtle/refined approach may be more helpful and get more change actually done.

Really our basic psychology does not change much. Their is a science to maximize the effect of change. He does not understand this concept, IMO, as his actions do not demonstrate it. There are textbooks and college courses and perhaps even inservices on the subject matter.

It is not my responsibility to find the necessary resource for him. A college professor teaching the subject would be in a better position to make recommendations than myself.

By gaining a deeper understanding on how ppl make decisions and the process of effective change, he could be much more instrumental in addressing patient safety and providing a deeper sense of self-fulfillment.

Of course, I could be entirely wrong. I am not a 'change manager'/professional, nor a psychologist, and my egotistic POV could be misleading.

It is just something i perceive--an uninformed opinion.

Here I see somebody with a substantial knowledge-base, who is aware of the myriad of problems that have and can occur in ventilator management by non-RT staff, and based on his education is in a position to do something about it.

And yet we find him in this forum, expressing himself in a way that seems limiting to his potential at communicating with the very ppl that may be making some of those clinical application 'shortcomings'.

All i am saying is that there may be a better way...........

well, i am outa here.

take care.

GilaRRT · Jun 19, 2011

What makes you think GreyGull is a dude?

zcoq72mehs · Jun 20, 2011

or whatever IT is. gender is meaningless on intellectual matters. Unfortunately i dont know a gender-neutral pronoun and i am lazy s/he

furthermore, the writing style is more aggressive/forward than not, and my experience has been that this is a masculine trait moreoften than not.

but to put it bluntly, i dont give a hoot whether IT is male or female.

and who should?

call me a man, if you want?

or a woman?

i dont care.

call me an idiot and you and i will have a problem......

screw gender issues.

and hope they screw each other too.

GilaRRT · Jun 20, 2011

I don't deny that the person in question has been rather aggressive with certain posts; however, responding with continued aggressiveness will rarely help matters.