Ok here we go again... New case different story but same old stuff on a different day...
It is 0400 am... working with homecare pt I notice that the vent circuit is leaking somewhere. I can't find the scource... Pressures are hitting 10 at best and the low alarm sounds like Beethoven's Fifth.... No vent circuit ready in the closet... bagged pt and grabbed stuff to make new circuit,... continue to bag pt using Knee with gentle pressure and never missed a beat while I cut pieces off and applied pieces to the new circuit...Had that buzzard together in less than 90 seconds.. like Vents are my living.. I cannot count how many of them I have changed circuits on the last 10 years... I was taught if you don't know the exact scource of the low pressure CHANGE THE CIRCUIT! Better safe than sorry.
Feeling rather proud of myself I told aforesaid pt mother what happened,,,, " Oh well I have NEVER had that happen to me" and "Oh this piece is backwards"...( forgot to turn a inhalation tube right side up) GEEE! SHoot Me!
Well get this... the PEEP on this circuit ( mind you we have a CUFFLESS trach here) is set a 4. Mom notices on a test lung that PEEP is hitting 8. I got yelled at for having it set too high... I was accused of turning the PEEP up to "blow" his lungs. I NEVER touched the dang thing. I too checked it with the lung not 5 miutes before she walked in the room it was hitting 4.
Ok... am I out of line in being angry??? Am I being over paranoid because 10 years of vent experince are being sliced and diced.
After she walks out of the room I get the old circuit and tear it apart peice by peice. I found out the Exhalation valve had split down a side. When I showed her that a bit later like 30 minutes ago she said that was impossible"I have NEVER in my life seen that happen"... Now tell me am I crazy or can wierd things ACTUALLY happen that a pt's family hasn't seen before???
Well I'm open for diplomacy and rason so Shoot....
Aug 20, '02
Poop happens that the parents have "never" seen all of the time...because the PDNs are taking care of their kids 14-24 hours a day. As for the PEEP valve...when you retest a valve that is in use to test it on a rubber lung you have to give the lung a couple of good squeezes before you try to get a reading...
besides the number with the test lung doesn't mean anything...it doesn't match the patients lung compliance.
Hopefully you have a Clinical Coordinator who will back you on it all (if not come to work for me...I have a knack for backing off freaky families and making them think it is their idea).
Last edit by kids on Sep 4, '03