New Nurse Vent Patients

JustBeachyNurse, LPN · Aug 19, 2015

Where are you having difficulty? What issues have you had? Do you panic? Do you not know how to troubleshoot technical issues?

newgradnurse1 · Aug 19, 2015

Yes - I think I panic and in doing so have trouble finding the problem. Also not knowing much about the vents is an issue contributing to not having confidence and not being able to detect the issue.

JustBeachyNurse, LPN · Aug 19, 2015

Your coworkers are right. You need additional training & support.

Then you need to request additional education whether with a nurse educator, respiratory therapist or vendor representative (usually a RRT or RN). You need to understand the mechanics of the vent, settings, what the physiologic needs are for different settings. Many vent manuals do a good job explaining the machine, settings, & trouble shooting. I do 1:1 pediatric vent cases and have spent more than one "break" while the child was asleep & stable reading the comprehensive manual for the LTV 1150/1200 vent. Came in handy more than once when mom asks about "alerts" other nurses have "accidentally" set off (most recently the nurse got to the set up menu "accidentally" and it was the volume adjustment screen)

You need to review pediatric airway and respiratory physiology and the most common reasons children are given a tracheostomy and need ventilator support. Once you have the background knowledge you can figure your own trouble shooting algorithms always starting at airway. What alarm?

Vitals? Pulse oximetry? Adventitious breath sounds? Trach in place? Suction? Mucus plug? Rhonchi? Wheeze? Rales/crackles? Color? Effort? Accessory muscle use? Cough? Stridor?

meanmaryjean, DNP, RN · Aug 19, 2015

I think you would benefit greatly from a systematic checklist- something you could laminate and wear behind your name badge for quick reference to approach vent alarms in a systematic manner. After a couple dozen episodes of approaching these situations systematically, I would wager that you'll feel much more confident.

newgradnurse1 · Aug 20, 2015

My other question is - is a week of training enough for ventilator / critical patients? Or is it normal to still be having questions about the vent / critical airways after two months.

JustBeachyNurse, LPN · Aug 20, 2015

My other question is - is a week of training enough for ventilator / critical patients? Or is it normal to still be having questions about the vent / critical airways after two months.

Experienced nurse yes. New grad no. Are you sure in a pediatric LTC these are critical kids or stable children that are medically fragile/complex

?

Stephia87RN · Aug 20, 2015

My first job out of nursing school was an RN at a SNF specifically for patients on ventilators. I had five shifts worth of training and a one hour vent training by an RT that wasn't until after I had been there for a month. I feel your pain OP. It can be very scary when the patient is not breathing normally when they are vent dependent because you have to figure out the issue STAT! There's so much to learn and it's all foreign information you've never heard before.

My question is how many of your patients end up having respirtatory distress on your shift? If there is a lot, maybe you are not intervening fast enough or early enough. Maybe your patients are requiring suction for coorifice lung sounds, develeoped wheezing and require a neb treatment, is there too much moisture in the circuit from the humidifier and the tubing needs to be shook out. If these kind of issues are not taken care of in a relatively short time frame, the patient can progress to a respirtatory distress episode.

Another thing to remember is if the vent is alarming and not delivering a breath, either take the patient off the vent if able unitl you figure out the issue, or immediately start bagging the patient and call for help. This ensures that the patient's immediate needs are taken care of while the vent can be troubleshooted. When that second nurse comes in, they can take over bagging the patient while you troubleshoot for the experience.

There are some books that can help if you search "mechanical ventilation" on Amazon if you're interested, but if you don't want to spend the extra money, ask if you can take a manual home to read through it and become more familiar with the settings.

It took me at least 9 months to really feel comfortable with the vent and confident to handle any situation. Feel free to PM me if you have any additional questions or want some more tips.

Hang in there! The only thing that will make it better is more experience and more training :)

newgradnurse1 · Aug 20, 2015

I've been having extra training with the the respiratory therapist. It has been super helpful but I feel singled out as the only new nurse with difficulties. I think it's just hurting my confidence.

Now my issue is just feeling down and incompetent.

JustBeachyNurse, LPN · Aug 21, 2015

I've been having extra training with the the respiratory therapist. It has been super helpful but I feel singled out as the only new nurse with difficulties. I think it's just hurting my confidence.
Now my issue is just feeling down and incompetent.

You don't know their background. Maybe they worked as an EMT or medic and used to the fast critical thinking. Maybe they had a family member that had a trach vent and just feel more comfortable. Maybe they are faking it. Don't determine your value by your perception of others. Take the training and move forward

amoLucia · Aug 21, 2015

Have you ever thought that maybe your peers are just more successful at HIDING their shortcomings than you? And that can be very distressing to you when they all seem to be gliding forward at warp speed while you're still stuck in neurtal, at best.

It can happen very easily - been there, done that , so I know how it looks to others.

Hang in= there, Bunky.