Nurse changing vent mode

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There is a nurse that is changing the ventilator mode from volume (what the order is for) to pressure. Every time I come in, I have to change it back to what the order is for. I have a basic understanding of the two, but I'm wondering if any damage can be done with using a mode that the RT did not order. Also, changing the mode without an order is not in our scope of practice. I'm thinking of putting a sticky note on the vent simply stating that the order is for volume, maybe it's a misunderstanding? Or am I over-reacting?

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Not cool. I would ask the nurse about it.

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I don't think asking the nurse about it will help. I've posted a few times on here about this same nurse and it just seems like it's getting worse. I think it may be time to talk to my supervisor about them.

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This could be extremely dangerous. A ventilator in volume mode will give the patient a breath until the sensor senses that xxxxmL of air has been delivered to the patient.

In pressure mode, the sensor will cause the breath to end as soon as the pre-set pressure is reached.

If your client has lungs that are extremely inelastic and are in pressure control mode, the pressure could be reached long before any life-sustaining volume was actually reached.

Further, the settings are probably only correct when the vent is in the ordered mode. I doubt the RT and pulm went through and programmed settings for a mode that isn't used.

I, literally, on the spot would have told a nurse to leave and never come back and reported to the agency and BON any nurse that touched a single setting on my son's ventilator.

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Thank you ventmommy. This patient is morbidly obese and is on a ventilator due to chronic hypoventilation and increased CO2 levels because of it. I never am face to face with this nurse as the patient only gets 8 hours of care a day (while they sleep). I've brought this and other things up to the patient and in the communication log, but it seems each week something else comes up. First it was blood pressure being near perfect every shift, then sleeping, then not doing their maintenance work, then bad talking me and now changing vent modes.

So... and this is just a guess... since the patient is obese and already has a problem with obstruction... the vent being set on pressure is no good because if the vent senses resistance it will think the correct pressure has been reached and then will stop delivering the air?

edit: that question is for anyone that can help me understand. I'd like to be able to exactly tell this other nurse why what they are doing is wrong physiologically, not just "because the order says so" even though that is a perfectly good reason.

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Specializes in Complex pedi to LTC/SA & now a manager.
This could be extremely dangerous. A ventilator in volume mode will give the patient a breath until the sensor senses that xxxxmL of air has been delivered to the patient.

In pressure mode, the sensor will cause the breath to end as soon as the pre-set pressure is reached.

If your client has lungs that are extremely inelastic and are in pressure control mode, the pressure could be reached long before any life-sustaining volume was actually reached.

Further, the settings are probably only correct when the vent is in the ordered mode. I doubt the RT and pulm went through and programmed settings for a mode that isn't used.

I, literally, on the spot would have told a nurse to leave and never come back and reported to the agency and BON any nurse that touched a single setting on my son's ventilator.

I knew the voice of reason & experience would be by shortly ;). It is my understanding, and I have limited vent experience, but changing to pressure control when not ordered or set, can cause barotrauma and irreversible damage to the alveoli and lung tissue.

Time to go to the nursing supervisor. Failure to act can be considered compliance. It seems you have tried before with this nurse without success.

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Yikes... calling today then.

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Lol, JustBeachy!

You and NightNurse are both right.

If you patient is on a tiny volume say, 50mL because it's a tiny baby with very elastic lungs and you flip to pressure control which has some random setting, say 40mmH2O, your patient may get a volume of 400mL before the pressure sensor is triggered and by then her lungs may have been severely damaged.

Conversely, your patient may have very inelastic lungs and require a volume of 250mL. If you flip the vent to pressure control, even what seems like a "normal pressure" may be so inadequate that the pressure sensor limit is reached while your patient has received virtually no volume which could lead to chronic hypoventilation and respiratory acidosis.

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You are amazing ventmommy, I wish all parents were as knowledgeable as you. Thank you so much. I just called and left a message for my supervisor. I'm not going to point fingers, but just say "hey this is going on, not sure why, but figured I should tell you".

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You're welcome for the info and thank you for the compliment.

I hope your supervisor recognizes how seriously dangerous this is and acts immediately. Have you been documenting in your notes that the settings are incorrect upon your arrival?

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No I haven't been and feel like a fool now. There is a vent sheet to record vent settings every two hours... this nurse has been documenting volume even though it's been on pressure. I have spoken to the patient who is an adult though saying that I don't know why it keeps getting changed.

Just got off the phone with my supervisor and she is going to talk to the other nurse.

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Make a memorandum for record of your phonecon with the supervisor. If there is a next time send an incident report in writing.

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