Is this normal or concerning for a vent peds patient?

[mari94]

I'm a home health nurse. This is a picture of a ventilator for a toddler. The red part that is circled is what I'm concern about. It will always show numbers. Recently, for a few minutes, it showed no numbers but no alarms went off but the child was visibly okay. This happened twice. It worries me because it never happens before while working on this case. Parents brush it off and don't want to further investigate. Parents don't want to make a doctor appointment or go to ER. Any advice about what to do? Is this concerning? 

[adventure_rn, MSN, NP]

Is there an equipment help line you could call? They might be able to help troubleshoot what's going on with the screen. If the child seems unaffected (and sats are fine), it could be that the vent is working fine, but the sensors aren't to read out those numbers aren't.

IMO, I'm more concerned that it's clearly a Trilogy vent, and a lot of those were recalled in June. We have some kids on our unit who are ready for discharge, but they can't leave because we don't have a home vent alternative to go home on. Maybe the error on the screen is related to the recall?

Regardless, I'd definitely follow up with either the doctors office or equipment person (tricky since it's a weekend), and obviously call 911 if the patient starts decompensating because of it. Worst case scenario, they could be switched at the hospital to a conventional vent.

[frozenmedic]

I can't see from the whole screen whether this ventilator displays a different Vte/MV/peak flow for spontaneous vs ventilator triggered breaths (if so perhaps the patient just had no spontaneous ventilations)  But, combined with the numerous circuit leak messages displayed below your circle, unless the sensors have failed, the circuit is indeed at least partially disconnected/loose/leaking from somewhere. Next time this happens I'd suggest starting at the patient; look at their neck/trach site for a evidence of an airleak/fistula, then carefully work backwards checking all the connections all the way to the vent.

I've assumed this patient is trached.....Do they have a cuffed trach? Has the balloon been taken down? Is it leaky? This could be another source of the circuit leak/lack of exhaled volume readings if the patient is now exhaling out their native airway instead of the vent circuit. 

Unless the alarm settings are completely wonky, any ventilator should eventually alarm for a low enough minute ventilation....in this case the patient should likely start looking sicker if they are truly being underventilated.

One more suggestion (that makes me sound like a jerk buuuuut), if you're going to be on this case it might be helpful to learn a little bit more about what those numbers mean and what's normal for your patient.  Don't get overwhelmed....choose one a week; start with something simple like Vte/exhaled tidal volume and keep going from there.

[LeChien, BSN, RN]

The vent itself should have a label with the DME phone number on it. I would call that. Next, I would call the RT assigned to this patient's case for his/her opinion and guidance.

Like others have said, check for leaks and obviously make sure your patient is stable. Sensors could be bad.

[montinurse, BSN]

Is it blanking out like that right around the time of an alarm? I think ours does this. I know this is an old thread-hopefully you got it figured out. I haven't been on this site for awhile! Good on you for paying such close attention to the numbers.

[Joe Kirby, RN]

Contact the equipment company and speak with an RRT. They are experts with vents.

[offlabel]

In the same photo, and at the same time youy data seems interrupted, just below your red circle are 5 minutes of 'circuit leak' messages from the ventilator. I'd look into that.