Questions on Mechanical Ventilators

8jimi8ICURN · Feb 22, 2010

The answer to the first question is obvious. Which of those does not belong? While VAP is a real concern... it is not related to to much volume...

i dont know the answer to the peds questions, i work with adults!

and you should google those terms, at the very least.

my best guess on cleaning the ventilator is...

2) Soak in disinfecting agent for 15-20 mins

4) Air dry in .....

1) Wash with soap and water

3) Rinse with distilled water

5) After it is dry assemble and put components in a plastic bag

why do they have nurses cleaning ventilators?? You don't have time to do that if you are taking care of patients.

allnurses Guide · Feb 22, 2010

Hi, Floridarose- just saw your post here, and since you will be working with vent patients at home, NRS Karen has put together 2 great pages of links, here is one

:https://allnurses.com/home-health-nursing/tracheostomy-vent-information-92989.html

There is another one we just talked about in the Private Duty Nurse forum, I will look for. There tend to be a lot of trach and vent questions answered in the Home Health Nursing and PD Nursing Forums so you might want to post them there. Best wishes!

allnurses Guide · Feb 22, 2010

Here is the other

https://allnurses.com/general-nursing-discussion/what-best-book-457164.html

That plus links from responders should keep you busy. . .:)

Nurses who work with vent patients in homes usually wash and disinfect re-usable tubing, change disposable tubing and filters and assemble vent circuits.

floridarose · Feb 22, 2010

The answer to the first question is obvious. Which of those does not belong? While VAP is a real concern... it is not related to to much volume...
i dont know the answer to the peds questions, i work with adults!
and you should google those terms, at the very least.
my best guess on cleaning the ventilator is...
2) Soak in disinfecting agent for 15-20 mins
4) Air dry in .....
1) Wash with soap and water
3) Rinse with distilled water
5) After it is dry assemble and put components in a plastic bag
why do they have nurses cleaning ventilators?? You don't have time to do that if you are taking care of patients.

Thanks for your answers!

For the first question, it seems like I chose "oxygentoxicity" and got it wrong. When I did a research using google, it came up with complications like pneumothorax, overdistention, oxygen toxicity, among others listed under barotrauma. Did not get any sense that pneumonia is a complication for high volume or pressure limits. Though, it's confusing to note that one of the complications for mechanical ventilators is pneumonia. So, will it be right to choose pneumonia then? What do you think?

I definitely agree with your methods for cleaning a ventilator circuit.

I got it wrong, because I chose (wash with soap & water, rinse in distilled water, then soak in disfinecting agent...)

I guess when I read the wash with soap, I did think of the "water"....LOL, your choice makes perfect sense! Thanks!

This is a Home Health agency, where the nurse provides one-on-one care, so the nurse really gets to do everything, sometimes with the help of a home health aide, when available. But, for the most part you are on your own. From the training, we were told is best to clean the ventilators when the pt is resting comfortably.

Like you, I work with adults never taking care of peds/infants... but the test for vent certification covers both adults/peds. I really appreciate your input!

floridarose · Feb 22, 2010

Hi, Floridarose- just saw your post here, and since you will be working with vent patients at home, NRS Karen has put together 2 great pages of links, here is one
:https://allnurses.com/home-health-nursing/tracheostomy-vent-information-92989.html
There is another one we just talked about in the Private Duty Nurse forum, I will look for. There tend to be a lot of trach and vent questions answered in the Home Health Nursing and PD Nursing Forums so you might want to post them there. Best wishes!

Hi Nurse156, thank you so much! This is very informative, I'm sure it will help me a lot! My vent training only covering the hands on, not so much for the theory, basically "what you need to know for the JOB." But, this link covers so much more than just the basics, the what, why, how,....helps with critical thinking too!

Thanks for sharing:)

floridarose · Feb 22, 2010

Here is the other
https://allnurses.com/general-nursing-discussion/what-best-book-457164.html
That plus links from responders should keep you busy. . .:)
Nurses who work with vent patients in homes usually wash and disinfect re-usable tubing, change disposable tubing and filters and assemble vent circuits.

Thanks Nurse156, just read this thread you sent....wow...glad you sent this link! How interesting to note that the thread had warnings of keeping an eye on the "settings." I found this very striking, as the RT also warned us about this, and in fact, showed us how the settings can be locked using the control lock key to select a "lock hard or lock easy" to prevent accidental changes to the setting. After reading that thread, I'm kind of worried now, as the warnings is actually coming from nurses and not an RT.... is sure an eye opener:uhoh3: Thanks for such a great info!

allnurses Guide · Feb 22, 2010

Thanks for the thanks . Most of those are worst-case scenarios. But we certainly get our share of drama out of these families! The home vents are so small, but rarely ever do they malfunction. Sighhh. . . if only cars and airplanes were built that well. . !!

GilaRRT · Feb 24, 2010

Hello:)
I need help with answering the questions for my vent training certification. I'll appreciate any help you can give. Please if you know of any websites that can help a newbie, pls send it my way. I have experience with trache care, but my agency is now signing up more vent patients, they only offered a free 6hr vent training class, given by an experienced RT. The only tutorials received during the training was mainly based on the LTV 950 & LTV 1150 ventilator circuits, because these are the types of ventilators we are likely to encounter in any of the assigned cases. However, these tutorials does not cover the questions given by the agency for certification. Please help, need certification asap:eek:
Thanks!
Complications of high volume or pressure set in pediatrics or infants on mechanical ventilators are all of the above except
1) Pneumothorax
2) Overdistention
3) Oxygentoxicity
4) Pneumonia
What is the mandatory mode for setting pediatrics or infants on mechanical ventilation?
1) Pressure set
2) Tidal Volume
3) SIMV
4) Control
What is the best cleaning agent for cleaning ventilator circuits?
1) Soap and water
2) Control III
3) Hydrogen Peroxide
4) Distilled water
What is the method for cleaning a ventilator circuit? Arrange the method given below from start to finish.
1) Soak in disinfecting agent for 15-20 mins
2) Air dry in .....
3) Wash with soap and water
4) Rinse with distilled water
5) After it is dry assemble and put components in a plastic bag
What is the function of the exhalation valve/manifold in relation to the ventilator circuit?
Need help with these terms: (need terms defined in simple terms)
Control modes
A/C mode
SIMV
PEEP
FiO2
Breathing effort
Inspiratory time

Pneumonia is not typically associated with high volumes and pressures.

Infants are generally ventilated with pressure targeted modalities. Ventilate to a pressure and monitor volumes as opposed to ventilating to volumes and watching pressures, as is the case with many adult patients.

You may want to spent some time with a RCP is you are not familiar with basic concepts such as inspiratory time, AC and SIMV. Explaining these concepts goes well beyond what can effectively be presented of a forum thread.

If you have fundamental knowledge look at the modes as a continuum of patient, ventilator interaction. CMV would have the least interaction where the ventilator simply gives you a store bought breath at a set volume and set rate regardless of your respiratory needs. SIMV is more or less in the middle, where you still have a backup rate with a store bought volume and rate, but the ventilator can sense the patients breathing or breathing attempts and will attempt to synchronise with the patient, allowing the patient to decide what breath to take in between the store bought breaths. I tend to say AC is the most interactive, where the ventilator not only senses a patient attempting to take a breath, but will augment by giving the patient a set volume if it senses an attempt to breath.

Clearly pros and cons for the modes exist, and SIMV/AC are the tip of the iceberg. For example, SIMV can lead to increased WOB and distress, where AC can lead to stacking and auto PEEP. Then, you can complicate things further by adding pressure support, rise time, flow, graphics, and other concepts into the mix. Not to mention more exotic modes such as APRV and Oscillatory modalities.

You can check out respiratory sites such as vent world for additional information. Sites such as flightweb also have very active RCP's that are typically keen to point people in the right direction.

FrankM · Dec 16, 2010

Hi. I live in the Los Angeles area. I was wondering if you know where I can take a good vent training. Maybe if you can give me the name of the company that you took the training with. seems like a really good training they gave you. thanks

GreyGull · Dec 16, 2010

LTV 950 & LTV 1150 ventilator circuits,

The circuits for these ventilators are disposable. Soaking them in water and soap may cause them to improperly monitor the patient leading to bad consequences. These circuits should be the responsibility of the agency supplying the ventilator which also should have a Respiratory Therapist on call for your questions.

The question posted about cleaning the circut probably pertains to a nondisposable circuit. Again, you should follow the recommendations of the manufacturer and the DME company supplying that specific ventilator and not a generic statement which does not give details for the make and model.

Complications of high volume or pressure set in pediatrics or infants on mechanical ventilators are all of the above except

High volume and high pressure can lead to overdistention and pneumothorax.

Oxygen toxicity is caused by prolonged exposure to a high FiO2 usually > 0.50.

PNA is a consequence of mechanical ventilation and measures should be taken to prevent it like aspiration precautions and being mindful where you lay the circuit when not connected to the child.

What is the mandatory mode for setting pediatrics or infants on mechanical ventilation?

The answer for this question will vary the size of the child and the disease process. Infants will normally be on a pressure setting but that can also be a very difficult mode to monitor in home care which can do harm while trying to also prevent it. Strict alarm adherence must be in place for this mode...as with all ventilator setting.

GreyGull · Dec 16, 2010

Hi. I live in the Los Angeles area. I was wondering if you know where I can take a good vent training. Maybe if you can give me the name of the company that you took the training with. seems like a really good training they gave you. thanks

The best way to get sound training is to contact the clinical rep through the ventilators manufacturer. Then have an RT department conduct an inservice for your agency along with the clinical rep. One can not learn very much about ventilators and the theory behind them. Six hours are definitly not enough. Some states are trying to recommend that Paramedics get at least 16 - 24 hours to operate the very simplistic transport ventilators which doesn't even include training for one like the LTV 1200. Our RTs spend 6 hours in training with the clinical rep each time they get a new ventilator and that is with over 2 years of a Respiratory Therapy degree as their base. Our ICU RNs will then get at least 1 hour for an inservice on each new ventilator.

Also, Pulmonetics (LTV ventilators) have their manuals and a great video on their website for viewing.