Ventilator Circuit Assembly and Function???

HawaiiRRTRN · May 25, 2005

I'm taking a self study trach vent course for homecare, I found several resources but can't find any real info on the circuit- set up, parts, etc. Maybe I'm worrying too much about varient details, but I'd like to know what to expect before the hands on portion of my (short, short) course. I don't even know why the (heavy corrugated) tubing is bifurcated a few inches from the trach? What about the micro-tubing? I think that attaches somewhere with luer adaptors? Other attachments- filters, humidifiers, neb spacers? Do my questions even make sense?
I know to have the circuit ready to go before disconnecting anything (well duh!) And to disconnect the pt first then the vent end but set up to the vent first, then the pt, right? But I want to feel comfy with the function of all the parts, not just an automatic, mechanical piece A goes to piece B.
Thanks so much!
Joanna

Joanna,

The best way to get comfy with vent circuit changes is to do it over and over until it becomes a mechanical procedure! You will find that different vents require different circuits and nowadays the home vents are pretty well labeled as to what goes where. Usually you will have a patient insp. port for the large bore corrugated tubing, and an exhalation valve port, a nebulizer port, and possibly a pressure monitoring port. These are for the smaller tubings and you just have to know what goes where. Be sure you have your tubing ready to go and have an ambu bag ready just in case. Make the change and then immediately reassess your patient's breath sounds and chest rise. If you hooked it up correctly, you'll see chest rise and hear breath sounds. As far as nebulizers are concerned, depending on facility policy, the best place for them is as close to the trach on the inspiratory line. Filters are found going from the vent insp. port to the large bore tubing and fit only on that connection. Humidifiers can be attached to the insp. limb using a heated humidifier and heated circuit (expensive) or they can be HME's (heat-moisture exchangers-cheaper) found at the Y where the vent circuit attaches to the patient's trach. The large bore tubing is bifurcated a few inches from the trach so the patient has a way to exhale. The line coming from the vent is the insp. limb and the other is the expiratory limb and will have the expiratory valve attached.

Each vent is a little different so it's important to become familiar with the type your patient uses and practice setting it up. Some will have features others will not so don't sweat the small stuff.Hands on is the best way to learn.

Hope this helps....

Hawaii RRTRN

kids · May 28, 2005

Hawaii said it all better than I can. Vent circuitsare highly personalized, especially home vents.

When it comes to assembling a clean circuit you will just about always have the in-use one as a visual guide.

Over in the Pediatrics forum there is a stickie titled "Pediatric Vent Info". It contains a lot of links you may find helpful.

lajean · Feb 9, 2007

So many circuits so little time...

I would team up with an RT. See if you can get one of those folks to show you the ins-and-outs. Get your paws on a vent and play with it: make adjustments, take it apart, put it back together again, have someone switch things around on you - and then go to it and fix it. Do this over and over again until you know it as well as you can count to ten. Good to hook it up to a test lung also.

poohbear6301 · Feb 13, 2007

I'm taking a self study trach vent course for homecare, I found several resources but can't find any real info on the circuit- set up, parts, etc. Maybe I'm worrying too much about varient details, but I'd like to know what to expect before the hands on portion of my (short, short) course. I don't even know why the (heavy corrugated) tubing is bifurcated a few inches from the trach? What about the micro-tubing? I think that attaches somewhere with luer adaptors? Other attachments- filters, humidifiers, neb spacers? Do my questions even make sense?
I know to have the circuit ready to go before disconnecting anything (well duh!) And to disconnect the pt first then the vent end but set up to the vent first, then the pt, right? But I want to feel comfy with the function of all the parts, not just an automatic, mechanical piece A goes to piece B.
Thanks so much!
Joanna

I work for an agency that handles both adults and pediatrics on vents in thier home. I am the preceptor for the adults with vents as the lady Icare for has an unusual type of trach tube and has been on her trach/vent for more than 3 years. Depending on your DME (durable goods company) the most comman home vent is the Puriten-Bennet LP-6 or LP-10. It is used for adults or children over the age of 15 or so. It can be used with an HME (or as we refer to them 'the nose') or with a heated water cascade that is mounted beside it. Important to know and remember no oxygen or vent should be used without some sort of humidifcation. Another common vent in home care, due to its portability, is the Newport HT-50. It has the ability to also be used with HME or can be adapted to use with heated cascade. It has an additional reminder in that each circuit MUST be recalibrated as the exhale valve for this vent is in the circuit and must be matched with the vent with each circuit change.

With children, or people who have lost most of thier breathing muscles (MD, ALS, or spinal injury) the most comman vent in home care has been the T-bird. This vent uses an HME and is the newest of the three I've mentioned.

There are several other older vents for children but they are individual to each case and choice of the doctor. A good web site to check on the differnt types of vents you might come across is Ventworld.com. Or you can go to the above manufactures and they will have more information.

Mallinckrodt is another company that may give you further information. They sell both trach tubes and vent supplies.

I hope this helps, PM me if you have any other questions.