Why would someone desat on ventilator and be fine off? Obviously I am thinking settings or circuit ...this is home care and have asked rt to come and observe what is happening without response..yes this is unacceptable and etc however true am stuck with what I have to work with and pt needs help...I think I need to troubleshoot this myself and then call for the appropriate orders? Has a backup vent tried that changed circuit changed changed everything has to be settings but don't know what I'm looking for am lpn in homecare...wanted to send to hospital but refuses and doing well off vent for now but not a long term solution needs the vent support to sleep...also thought of plugs has good air exchange and why would improve off vent if a plug?
Last edit by moonovermiami on Jul 12, '15
: Reason: clarification
Jul 13, '15
Hello, I'm sorry you can't get an RT there to troubleshoot, it sounds like the home care company is slacking or simply short staffed. This question is open-ended, there can be many reasons why a patient may desat while back on the vent, including incorrect mode, or not enough oxygen bled in while on the vent. I presume the patient goes on the vent at night to sleep. Some pulmonary patients require supplemental oxygen only at night while asleep.
Commonly, vent settings need to be adjusted over time, because what may have worked when they were discharged simply doesn't cut it now, especially if the patient's confounding pulmonary disease gets worse over time. There are various settings on the vent that can improve oxygenation alone, aside from adding in oxygen- which frankly should be the last step as it is a drug. A review of current vent settings by the provider should be in order, coupled with a chest xray to see if the patient is underinflated or has atelectasis. If the patient has secretion issues, the patient may benefit from more PEEP, or a higher tidal volume, which should help with oxygenation. It could even mean that while asleep on the vent the patient may need to be suctioned, or given bronchodilators.
There's no sure fire answer here as there could be several answers. In short, really have an RT get out there, even if it means filing a complaint- because it is the patient that is suffering.
Jul 13, '15
I don't think it's a good idea to troubleshoot this yourself. In my state vent settings are doctor's orders as well. I've been in home health (or more accurately private duty) for over 10 years and I wouldn't start experimenting with the vent settings.
He needs an RT visit, so hound people until he gets one. I would also call his Case Manager and make them aware of what is going on and what you are planning to do and request their input. Document all of your phone calls, too. Best wishes!
Aug 7, '15
Thankyou! A meeting happened with the whole team with alot of issues addressed ; doing significantly better with a few med changes . Thankyou for taking the time to reply!