Any one use ventilators? can i ask you a question please?

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Specializes in critical care.

We have come across HME's to replace wet circuits.

Has any one changed over to these and if so what is your experiences?

Good/bad i would like a bit of info before going looking for the research etc.

Should i save myself the bother, its just that they sound fab in the reduction of VAP, rainout and nursing time in the setting up as they are just so simple in comparrison to the wet circuits.

Thanks.

Dissle

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Specializes in ICU.

For short term ventilation ie post op warm and wean we routinely use HMEs, and we try to avoid the use of humidified circuits unless it is absolutely necessary. HMEs can get waterlogged surprisingly quickly.

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Specializes in Paediatric Cardic critical care.

We use HME's for short term, then after 48hours switch to wet circuits.

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Specializes in critical care.

Thats basically what we do now, but these Hme's are such good quality that they can be used instead of heated wire circuits.

They are at a fraction of the cost of the disposable wet circuits.

Any one heard of them or heard of them?

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Specializes in critical care.

Soryy, "used" them or heard of them?

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We use HMEs on everyone, no matter how long they are on the vent

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We use HMEs on everyone, no matter how long they are on the vent

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That is a terrible policy. HME's are contraindicated in Pt's with thick, excessive or copious amounts of secretions, and children under 50lbs I think. They also disrupt flow measurement and increase peak pressures. Some manufacturers recomend not using them with peak flows above 60 L/m. HME's should not be used for more than 48 Hrs or so. It's also very inconvienent for pt's getting in-line neb Tx, and leads to multiple circuit disconnections. Also, HME's DO NOT provide nearly as much humidity as a heated humidifier. Completely eliminating rain out is nearly immpossible, but it can be substantially decreased, usually I set the heater at 33 - 34 degrees and set the circuit at 36 - 37 degrees, this reduces any condensation to a minimum. HME's can be effective and cost efficient for short term vent Pt's.

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Specializes in NICU.

We have used them for short term needs in older kids.

I dislike them greatly. The change schedule for us is Q12, but the reality is more like Q1-2 for anyone who is wet at all. The get clogged SO fast, and are just....icky. Once they get wet, that's it.

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Specializes in critical care.

I have sourced a high quality HME that has withstood vigorous trialling and has many papers written about it.

It can be used to replace wet circuits for patients who will be ventilated for longer than 24 hours.

Taking up your point about thick bloody secretions, the company do state that in this case heated circuits should be used.

At present our policy is to change to heated wire after 24 hours. This is costly in terms of nursing time and circuits.

The circuits that we use have MDI ports, and so when administering inhalants, there is no break in the circuit at all, this will not change with the HME.

There are many ICU's changing over to these HME's in England.

They seem (on paper) to be a great controlled alternative to the wet circuits.

With proper protocol and procedure in place, i think that these will save us a fortune and reduce VAP.

BUT as always i have reservations and need to know of peoples experiences.

Dont forget that these are not your every day ordinary HME's, that is not what i am talking about here.

I agree with what people have said about the pitfalls of ordinary HME'S, this is not our policy.

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Dont forget that these are not your every day ordinary HME's, that is not what i am talking about here.

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OK, now you've made me curious!! Do you have a link for these???

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That is a terrible policy. HME's are contraindicated in Pt's with thick, excessive or copious amounts of secretions, and children under 50lbs I think. They also disrupt flow measurement and increase peak pressures. Some manufacturers recomend not using them with peak flows above 60 L/m. HME's should not be used for more than 48 Hrs or so. It's also very inconvienent for pt's getting in-line neb Tx, and leads to multiple circuit disconnections. Also, HME's DO NOT provide nearly as much humidity as a heated humidifier. Completely eliminating rain out is nearly immpossible, but it can be substantially decreased, usually I set the heater at 33 - 34 degrees and set the circuit at 36 - 37 degrees, this reduces any condensation to a minimum. HME's can be effective and cost efficient for short term vent Pt's.

They asked the question, and I simply answwered.

I didn't write our facilities policy, I knew the info that you provided in the above post but I have to use what I have been given. In patients with copious secretions we change the HME's as often as necessary, and we have in-line suctioning. We give "nebs" HHN through a small port that is placed between the HME and the pt so that we don't break the circuit. We also do not ever have children in our hospital so kids on vents is not ever an issue.

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Specializes in critical care.

I cant do links, sorry, im rubbish at computers.

Its by Covidian who were Tyco and they are called "Hygroster"

I have got some in my office and have been looking at them on and off for months. Now papers are bieng published about how good they are and other units are buying them.

Price wise, they are about £3 each as opposed to £19.99 for one wet circuit. However, wet circuits stay in place for 7 days, these are changed daily or if visibly contaminated.

The nurses in my unit change the circuits (we do not have any respiratory technicians in England that you seem to have in the USA) Here, the nurses do all of the ventilator care.

Thus, to change a HME every day is SO much easier than changing a whole circuit once a week.

Do you see what i mean, it sounds great on the surface...but is it?

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