Ventilator Questions

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I'm a new ICU nurse studying up on ventilators today. We have resp therapists on our unit, but I'd still like to have a good idea about what is going on with my vent patient. I'm familiarizing myself with modes, indications, the intubation process, ect, but what are some things as nurses you watch for with a vent patient? What are some to-do's you add for the day when you have a vent pt? How do you handle alarms, troubleshoot, help pt in distress on the vent, ect? It will be a few weeks yet before I take these patients but I'd like to be prepared. Thank you!

Specializes in Oncology, Rehab, Public Health, Med Surg.
Thank you very much for answering my questions. This is exactly what I was looking for.

I'm sorry about sounding rude, but every single time I post a question, I'm bombarded with comments that question whether or not I'm going to be a safe nurse and we go completely off topic. I hate the idea of having to explain myself or adding a disclaimer first...

A response asking if you are aware of your hospital's policies isn't a post questioning your ability to be a safe nurse.

It's a starting point, a way to determine what you do know before giving further information. Your response to that query helped amplify the situation and what you call the bombardment of comments you didn't like.

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One of the most important aspects in dealing with intubated patients is being able to understand their end tidal capnography and waveform, if that is in use in your ICU. I know in some facilities it may not be a standard of care, however a good way to learn about how to immediately tell if your intubated ventilated patient is in any distress would be though capnography, and of course their tracing on the cardiac monitor. Sites like YouTube have many educational videos on this and it could help you out a lot with your critical patients. Spo2 is meh in terms of dealing with respiratory cases. ETCO2 is the gold standard for us critical transport paramedics (who are hoping to get into nursing) and it's actually pretty fascinating stuff.

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I presume you were referring to my post, and I assure you I was trying to be helpful by first trying to ascertain what knowledge/training and resources were available to you. It is common practice to ascertain someone's knowledge base if one wishes to offer an appropriate reply to a question they are asking, particularly one that may require a complex answer, such as ventilator management. However, your rather rude comment has dissuaded me from offering any further suggestions. Good luck to you, and I suggest, in future, being more polite.

I found nothing rude about what the OP wrote.

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Specializes in Burn, ICU.

When you get to start working with vented patients, try to pay attention to what sounds "normal" so you'll start to hear what isn't normal. Also, look at the patient, not just the vent!

Examples-

-when the vent is going chug-chug-chug-chug like a freight train, something is disconnected and your patient isn't getting any air. The vents at my hospital have a (short) delay before any audible alarm sounds, and then the alarm messages only appear one at a time on the screen. So by the time I get to the room the alarm message on the screen might not be the one that says "Disconnection Pt Side" and if I spend more time looking at the screen, I won't notice the obvious- the ET tube or trach isn't connected to the vent tubing!

-hear gurgling in the back of the mouth, even after you've done your scrupulous oral care? The ETT cuff is probably deflated.

-rattly, wet cough? Time to suction!

-"High Pressure" alarms are often caused by the patient biting on the tube or the tube being kinked somehow. If you can get the tube outside of the teeth it will help, but also adjust your sedation accordingly (if possible).

Other stuff that comes to my mind-

-Keep in mind your normal VS parameters. [i'm assuming you're going to work with adults.] A normal respiratory rate is 12-20. If your patient is breathing 40 times a minute on the vent, something is wrong. They are not sedated enough, or they are taking very shallow volumes for some reason that needs to be addressed, but something needs attention. [i recently heard a 1st year resident tell a med student "oh, the rate doesn't matter in this mode because there's no set rate..."]

-The vent can deliver air at a much higher pressure than normal inspiration. This increases intrathoracic pressure and can (among other things) drive down blood pressure. Sedatives like propofol can also drive down blood pressure. Look at your vital sign trends and also changes that have been made to the vent settings...did the BP drop after a vent change? Your patient might not need a fluid bolus or a different sedative; they might need their settings changed.

-Different vents have different names for the modes, so my hospital calls 'CPAP' mode 'SPONT' and 'APRV'='DuoPAP+'...doctors and nurses who trained in another hospital may use terms you're not familiar with.

-If your facility allows the use of wrist restraints, use them...on patients who are actively moving around in the bed and are at risk to extubate themselves. However, I don't keep them on patients who aren't moving around and on whom we're not weaning their sedation. If you use them, document on them appropriately!

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Specializes in CVICU.
One of the most important aspects in dealing with intubated patients is being able to understand their end tidal capnography and waveform, if that is in use in your ICU. I know in some facilities it may not be a standard of care, however a good way to learn about how to immediately tell if your intubated ventilated patient is in any distress would be though capnography, and of course their tracing on the cardiac monitor. Sites like YouTube have many educational videos on this and it could help you out a lot with your critical patients. Spo2 is meh in terms of dealing with respiratory cases. ETCO2 is the gold standard for us critical transport paramedics (who are hoping to get into nursing) and it's actually pretty fascinating stuff.

We use capnography to verify the placement of the tube upon insertion, but do not use consistent capnography monitoring after the initial intubation.

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Specializes in Rehabilitation,Critical Care.

Ventilators, hard to grasp concept for me though I have been learning day by day about it. The most important concepts you have to remember are the modes, A/C pressure control vs. volume control, Spontaneous/pressure support, etc. If you would like to know more about this. I suggest going to youtube and find videos such as critical care videos about this concept. Also, look up Dr. Jeffrey Guy podcast online, he explains it succinctly.

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Specializes in PACU.

Beatsperminute:

Also, I found this this amazing YouTube ventilator series. It really helped me to understand the setting and what you want to accomplish from them. My first exposure to a ventilltor was less scary after watching these! Here's the first one and then subscribed to medcram and you will find the other 6 parts.

good luck!

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Specializes in Nephrology, Cardiology, ER, ICU.

Posts have been edited to keep better to the topic at hand: helping a nurse understand the intricacies of caring for a ventilated pt. Thanks.

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Specializes in Cardiac/Transplant ICU, Critical Care.

Honestly, the only way you truly learn almost ANYTHING with the vents is with actual experience and talking to your RTs because they are the masters of that domain. Intubating, proper management of an intubated patient, and extubating are 3 different parts to the same art that takes a very long time to master.

I made a video about ICU nurse's role during endotracheal intubation in the critical care setting that might help you out.

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