Questions about ventilation

meanmaryjean, DNP, RN · Feb 18, 2018

I'll let an RT chime in for the first two, but saline lavage with suction is not recommended except in a few specific circumstances. Your RTs should do some education around this- no bueno. (Admittedly, it is a VERY hard habit to break)

Ruby Vee, BSN · Feb 18, 2018

Hi all I'm a relatively new PICU nurse(only 6months in the unit), so recently I've started to look after patients who are intubated but I still find ventilator/ventilations very confusing. Here are some of the questions I've been having.
1. what's the difference between CPAP/PS and BiPAP?
My understanding is that with CPAP/PS gives you a EPAP (PEEP), and a IPAP (aka the PS) once the patient has initiated a breath. So CPAP/PS is technically BiPAP as they are exactly the same? however if you have a PS of 5 and PEEP of 5, doesn't that mean there is no difference between the IPAP and EPAP therefore it is simply CPAP?
2. SIMV PC/PS
If i have a pressure control of 10 and a pressure support of 10, does that mean if a breath from the patient is synchronized with the ventilator, the patient is going to receive a total pressure of 20 for that particular breath?
if my patient is not initiating any breaths, then the ventilator is going to generate only a pressure of 10 for each breath since i have a pressure control of 10?
3. Suctioning an ETT with saline.
This one is actually quite stupid (I'll admit). I've seen many nurses do this but I always wonder, won't you put the patient at risk of aspiration? At the end of the day saline is still liquid?

You may get many good answers to your questions on this forum, but I would encourage you to seek out one of the respiratory therapists who works on your unit and ask these questions of her. First, you'll get on-the-spot explanations and you can ask follow-up questions as they occur to you. Second, I don't think I could answer the questions without hand gestures and/or drawings and use of terms like "thingy", "whatchamacallit" and the ilk. And third, you'll be developing a good work relationship with the respiratory therapists, who in many places don't get enough respect. In fact, ask the questions of multiple respiratory therapists. It's a part of developing good working relationships. They'll be flattered that you asked and additionally, may take it upon themselves to show you and explain something rare or unusual when it happens on your unit. That's priceless.

In fact, I'll take this a step further. Since you're new and obviously have the knack of asking intelligent questions, ask questions of everyone who doesn't seem rushed off their feet or unlikely to be able to give you a good answer. NPs, physicians (I've found that residents and fellows love to show off their recently-acquired expertise!), RTs, Social Workers, and anyone else you encounter at work.

And now, I'll actually answer the saline question, since I'm old school enough that when I started in ICU, suctioning with saline was the gold standard. Saline loosens the secretions so they can more easily be sucked out. Yes, it's a liquid, but it's a sterile liquid and you suction it back out immediately. I still use it sometimes, but it's a habit that was instilled years ago and isn't considered best practice any more.

Kitiger, RN · Feb 18, 2018

... And third, you'll be developing a good work relationship with the respiratory therapists, who in many places don't get enough respect. In fact, ask the questions of multiple respiratory therapists. It's a part of developing good working relationships. They'll be flattered that you asked and additionally, may take it upon themselves to show you and explain something rare or unusual when it happens on your unit. That's priceless.
In fact, I'll take this a step further. Since you're new and obviously have the knack of asking intelligent questions, ask questions of everyone who doesn't seem rushed off their feet or unlikely to be able to give you a good answer. NPs, physicians (I've found that residents and fellows love to show off their recently-acquired expertise!), RTs, Social Workers, and anyone else you encounter at work.

This is one thing I really miss, doing private duty home care. I'm on my own. I seldom even see the other nurses, since our shifts don't overlap.

We used to have a medical supply company that used their respiratory therapists to deliver supplies as well as to troubleshoot equipment. It was wonderful to be able to speak face to face with an RT who knew the client.

Now, a respiratory therapist comes to the house only to check equipment. Since I don't work every day at the same home, I seldom get to see them.

meanmaryjean, DNP, RN · Feb 18, 2018

This is one thing I really miss, doing private duty home care. I'm on my own. I seldom even see the other nurses, since our shifts don't overlap.
We used to have a medical supply company that used their respiratory therapists to deliver supplies as well as to troubleshoot equipment. It was wonderful to be able to speak face to face with an RT who knew the client.
Now, a respiratory therapist comes to the house only to check equipment. Since I don't work every day at the same home, I seldom get to see them.

When I did peds PDN, I had my RT friends' numbers in my phone for quick text questions. I also worked PICU (concurrently) and became the resident expert on the LTV vent as the RTs hated them and only saw them once in a blue moon.