Ventilator alarms

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Specializes in NICU.

I'm a new grad working in the NICU and just finished my level III orientation. Ventilators still kind of freak me out and when they alarm, I don't feel like I always know what to do/why they are alarming. I would love it if someone has good explanations for the different kinds of vent alarms (high volume, low volume, etc) the common reasons for the alarms, and what interventions should be done. During my orientation I didn't have an unstable vented kid, intubations, or extubations so I'm constantly afraid that a kid will extubate or alarms will be going off and I won't know what to do! Please help!

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at any time you have a ventilator alarm and you either don’t know why or your patient is decompensating, call your respiratory therapist immediately. and while you’re waiting on the rt, get help from one of the more experienced nurses working with you. i ask, and would much prefer that one of my coworkers ask for help early, rather than later.

learning ventilators is something that takes time. you are not going to do this during your orientation, at best you should have gotten a basic understanding. your best resource by far however is going to be your respiratory therapists. you will find that they are a wealth of knowledge, and it has been my experience that most of them will gladly help you any way they can if you only ask.

if you have not created an emedicine.com account, i highly recommend you do so. although you have to register for the site, there is no charge to do so.

i found the following article on emedicine.com. i only glanced through the article, and while it doesn’t discuss alarm issues, it does provide a good background on mechanical ventilation: assisted ventilation of the newborn. google: mechanical ventilation of the newborn.

you might also do this search on google scholar. if you do so from work, you might be able to access some of the full text articles if you find any that are interesting, if not your facility’s medical library might be able to obtain copies for you.

although the following articles refer to adult ventilation, you might find some of the information useful:

ventilation, mechanical and ventilator management.

good luck in your nursing career.

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Specializes in NICU III/Transport.

Everything that chare said! It would take quite a while to post all the alarms and their meanings for each of the settings on all the ventilator types. For example, on a Drager Babylog, a very common alarm in AC/VG mode is MV Low... and that usually means you have a large leak. You need to know which numbers on the display correlate with the alarms you're hearing. Interactive learning with your RT would be best.

If there's a specific alarm you'd like to know more about, post the alarm message (if you have one), type of ventilator, ventilator settings and what the baby was doing at the time of the alarm. (See how complicated your question really is??? :D )

Best piece of advice I can give... until you learn all the alarms and functions of the ventilator... learn how to properly use an ambu bag. It is your best friend and if anything goes wrong, you'll have peace of mind in knowing that all you really need to save that baby's life is the ambu bag. :up:

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Specializes in NICU, PICU, PACU.

Good Advice from all :) We just completed a mechanical ventilation competency pack that everyone has to complete. This was done with the help of our RT's. We use 4 different types of vents and I still have to ask questions if I haven't used one in a while. Don't be afraid to ask the RT's...they are your best resource regarding vent management!

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Remember DOPE: Displacement, Obstruction, Pnuemothorax and Equipment

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Specializes in Neonatal ICU (Cardiothoracic).

Decreased MV (minute volume) usually means the tube is occluded with secretions, or worse, out. Be sure to know where your tube is supposed to be taped, and where it ACTUALLY is.

"MAP high" usually gets set off when the baby is crying on the vent, calm him down, suction, etc...

"Frequency High" - means either your baby is upset/tachypneic and breathing fast, or there's water bubbling in the circuit tubing.

"Apnea" usually means the vent sensor isn't working right. Call your RT. A baby on a vent should never actually be apneic.

I work with Draeger Babylogs, but most newer vents like the Servo-i and Aveda XL tell you different alarm messages.

Always keep an intubation box near any intubated kid, and preferably a Co2 detector like the PediCap to check placement.

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Specializes in NICU.

Just to add to Steve's list on the babylogs...

"VT low" means your baby is using the max PIP that is ordered and not achieving the set tidal volumes with volume guarantee... usually because of a leak but sometimes because the kid's settings need to be reviewed.

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No need to be afraid, bag the baby and have someone call the RT. Vent management is the job of the RT ONLY. They are specially trained and LICENSED to handle all aspects of ventilator management. That should be a relief since it takes the pressure off nursing and puts it on the RT. Think of it as how appropriate would it be for an RT to walk in and start messing with the feeding tubes of your babies or medicating them when they aren't licensed to do so.

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"Frequency High" - means either your baby is upset/tachypneic and breathing fast, or there's water bubbling in the circuit tubing.

This also could mean the sensitivity is inappropriately set or something other than the baby's pulmonary system is triggering the ventilator which could even be from some beds or a chest tube.

"Apnea" usually means the vent sensor isn't working right. Call your RT. A baby on a vent should never actually be apneic.

That depends on the mode the ventilator is set to and its sensitivity or the way it calculates an expected breath. Even neonates can be in a spontaneous mode and your statement would lead some to not be mindful of the chance of apnea when sedating a baby.

Every RN should have a decent inservice on the specific ventilator they are using. Blanket statements are okay for some ventilators but with the many newer makes and models, some information is misleading. When analyzing any situation, work from the baby back to the machine. If the baby is in distress, immediate action with the bag will probably be necessary. That may also help you identify any problems with the tube. Note, if you hear the baby crying, you no longer have an artificial airway.

Understanding how some things like airway MAP are derived and what it represents will also in trouble shooting as does a basic understanding of how the ventilator works as it relates to the disease process will also help. For some situations an increase in MAP is expected with an increase in settings and the pulmonary status changes. Your own charting or that of the RTs may also indicate a trend and you can anticipate some events. The MAP alarm should not be taken lightly as just "the baby's crying" if you have other data that might indicate otherwise.

The RT may also have not changed their ventilator alarms parameters or have set them too tight to where if a baby just thinks about , the ventilator will alarm.

Always keep an intubation box near any intubated kid, and preferably a Co2 detector like the PediCap to check placement.

Pedi Cap has been controversial in NICU and of course it has had it share of problems with the FDA recently. I believe the AHA journal Circulation has published more studies using colourimetric devices and the limitations noted. Also, any device determining position and patency of a tube is only as good as the knowledge and abilities of the operator.

The RN should also know his/her closest resource help be it an RN or an RT. Respiratory Therapists are not always present in the NICU when they have other areas to cover or their NICU duties may be very limited. Some NICUs only have RTs to set up the equipment for the RNs then leave the unit and not return except to pick up the ventilator once it has been weaned off the baby. I do not believe there is a CMS requirement to have an RT in the NICU nor is it a requirement in most states where RNs have ventilator management within their scope of practice. Individual hospitals can make their own requirements but leave flexibility when it comes to staffing cutbacks and the RTs are then no longer required. The RN's training should at least match the level of responsibility they have for working with a baby on a ventilator. Then, anything above that is always great to have.

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great comments greygull,

i think everyone is making this more complicated than it should be. first and foremost, always look at your patient. what are they doing, or not doing? how are their vs? sats, bp, hr?

stevennp said: decreased mv (minute volume) usually means the tube is occluded with secretions, or worse, out. wow! let's with the simplest explanation: the mv is lower than when the rt set the alarm initially. mv is rr x vt. so, one of the two has to be affecting the alarm. whether the pt is breathing slower than initially, or there is a leak effecting vt, this is when the mv alarm will sound. i guess the tube being out is a leak; however, most of the time, alarms are not the worst-case scenario.

the easiest indicator of your tube being out is the etco2 going to 0. however, we live in a world of leaks, so be careful it's not just a leak causing the et to read 0.

it will take time to understand what the different alarms are for your vent, and what the different alarms signify, so take advantage of your rt's, and ask questions. we love teaching!!!

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Specializes in Neonatal ICU (Cardiothoracic).
great comments greygull,

i think everyone is making this more complicated than it should be. first and foremost, always look at your patient. what are they doing, or not doing? how are their vs? sats, bp, hr?

stevennp said: decreased mv (minute volume) usually means the tube is occluded with secretions, or worse, out. wow! let's with the simplest explanation: the mv is lower than when the rt set the alarm initially. mv is rr x vt. so, one of the two has to be affecting the alarm. whether the pt is breathing slower than initially, or there is a leak effecting vt, this is when the mv alarm will sound. i guess the tube being out is a leak; however, most of the time, alarms are not the worst-case scenario.

the easiest indicator of your tube being out is the etco2 going to 0. however, we live in a world of leaks, so be careful it's not just a leak causing the et to read 0.

it will take time to understand what the different alarms are for your vent, and what the different alarms signify, so take advantage of your rt's, and ask questions. we love teaching!!!

thanks for your input. unfortunately i have never worked in a nicu that has been able to accurately monitor etco2 levels off a vent circuit. so pretty much most of my experience thus far has been at the bedside of a ventilated neonate...and in my experience, when the tube is occluded, tv is unable to be adequately generated, and/or the vent is unable to sense rr through secretions. this is why i included these in my comments regarding "low mv" alarms.

i bounce ideas off our rts all the time... they are great resources!

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Of course you must use other numbers, as well as looking at your patient when you do not have certain numbers. I'm not sure what you have for vents; however, the Servo-i is really spot on for EtCO2; however, sometimes the Vt alarm goes haywire unless you have the flow sensor inline. Unfortunately, you cannot have both. So if your Exhaled Vt's are okay, the EtCO2 on the Servo-i is great. Most of the time, unless the kid is severe, we'll spot check with each Vent Check.

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