First night working with a vent

[Blackcat99]

Please give me the most important advice you can think of. Thanks

[artsmom, BSN, LPN]

When you suction, they will likely cough, appear to be choking, and their color looks quite poor. This is normal. It will stop as soon as you stop suctioning. Good luck!

[rkealy, BSN]

have a decent understanding of your vent settings, abg and how they relate. your not going to get it in one night.....:)

[turnforthenurse, MSN, NP]

First look at your patient - is the airway PATENT? how are they breathing? check your vent settings. know your pressure alarms. Typically high pressure alarms are due to coughing or a blockage (kinked tube, mucous plug). Low pressure alarms/low exhaled tidal volume alarms are due to dislodged tubing or a tubing/ETT (cuff) leak. Always check your tubing.

A high respiratory rate alarm could be due to a kink in the tubing or condensation that has built up in the tubing. The patient could be in respiratory distress, too so also look at your settings. If the vent rate is set at 10 and your patient is breathing 40 times/minute, they could be in distress! That may be due to inadequate sedation, too.

Apnea alarms are usually due to the tubing being disconnected, or the patient has actually stopped breathing.

Correlate your vent settings with the ABG. Respiratory therapists are your friend :)

[smurfynursey]

Don't ignore the alarms!!!!

I worked at a hospital once where the kid (vent dep.) was outside with child life and they kept silencing an alarm. They brought him in bc he was "agitated" and then "sleepy. His sats were in the 40s and he was grey, almost a full blown code because the psych intern (!!!) kept silencing his vent.

[RRT_IN_2013]

You are giving the p.t. 100% o2 during that procedure correct?

[echoRNC711, BSN]

hold your own breathe as you begin .When you need another breath so does your pt.

(We can all get a little over enthusiastic with "just another sec and I will have got the plug.")

Low alarm think Leak (LL)

High alarm plug.

Very often pt has disconnected first look for the leak in the system .We tend to think of complex problems. Start with the simplest solution by tracing o2 source from pt 1st THEN to machine.

You will be a pro in no time at all!

[echoRNC711, BSN]

oh also check your vent settings when you get report.

[roquen]

Do not hesitate to call the Respiratory Therapist.

[LADYVENGEANCE1]

When you get report check the settings but remember you want to make sure the settings on the EMR are same as in mechanival ventilator. Residents sometimes change the settings especailly if your system is touch screen which most 99% are touch screen.

check list, Ambu bag, 10cc empty syringe, hyper oxygenate before suctioning, don't be afraid if patient changes color and most important assess pt first then machine.

[dbella24]

Also if you are continuously monitoring their SpO2 don't be surprised if you see it dip a little while suctioning, but this should rebound pretty quickly. In addition to checking your vent settings, check all connections including power strips and alarm cords & check the top of the circuit & heat & moisture exchange filters. If they've coughed up any gunk hanging around in the circuit &/or the HME is saturated their pressure & breath rate will go up.

Circuits attached to a concha can also get full of moisture, make sure you are emptying the collection chamber & be careful with repositioning the pt & tubing so that you don't accidentally send the moisture back toward their trach. Keep tubes of sterile saline nearby in case the secretions are thick so you can lovage. If they are bleeding with sections cold saline lavages can work wonders but you may need a physicians order for the cold saline technique.

Don't be afraid to ask other nurses & the respiratory therapists when questions come up... Good luck