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in ventilator airway pressure is high n continous alarming what nurse should do to control ???

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Specializes in Oncology/Haemetology/HIV.

Critically think- what could cause the pressure to be high?

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due to increase suctioning????????

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what you have to think of is not that it's increased machine pressure, it's increased pressure inside the lungs that the machine has to overcome to deliver the volume somebody told it to deliver. that's its job-- to deliver a set volume, a set %age of oxygen, at a set rate.

now, can you think of a bunch of things would offer greater resistance to a hard-working machine who just wants to put air in that chest?

(you think and reply, i'll answer!)

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in ventilator airway pressure is high n continous alarming what nurse should do to control ???[/quote]

I could have written this question. I was doiing my critical care rotation and I had a pt who was on a vent and was often alarming. I kept reporting the alarms to my RN preceptor, and she was not at all alarmed. She said he was just, "Bucking the vent." (the pt was on a vent but awake.) As the morning progressed, the RN continued to ignore my requests for a pt assessment and ignoring the high vent alarms. Finally, RT arrived and when she realized the problem, she disconnected the vent and started bagging. Quicker than a blink of an eye the attending and others arrived. Fortunately, for the pt the solution was easy with a few resp drugs. You can't imagine how happy I was to see RT. After all was over, all my RN preceptor said was that I didn't understand vent alarms. :rolleyes:

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Specializes in Critical Care / ICU.

If a patient is not sedated they could breath over the vent if conscious. Also in conscious or unconscious they can cough which would make the alarm sound. Also if the vent is heated and humidified the vent traps could be full, how does the waveform look? Could the pressure balloon of lost pressure, allowing some of the pressure support to escape? Could need ETT suction or sub-glottal suctioning. Its late thats about all I can critically think through at this moment. Im sure I forgot some others, I would just have to live the experience if you will. haha.

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That is true in general, but it did not apply to my pt. What was sad is the RN never checked the pt only assumed. By the time RT arrived he was about to code.

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what "respiratory drugs"? if the pressure was up because he had bronchospasm and he needed something for that, that's one thing. (see, there's one potential answer-- tight airways will decrease the ability to ventilate). if he was fluid-overloaded and his lungs were increasingly wet and heavy, that would increase vent pressure too. (my #1 check). other things to check asap: look for pneumothorax or intrathoracic bleeding or other space-occupying things inside the chest that could be growing fast.

if it was because he was "bucking the ventilator" (usually by coughing-- answer #2), the action could be to sedate so the tube doesn't make him cough so much, and/or clear secretions

#3 if his intraabdominal pressure was rising (so diaphragm was raised), that would make the vent alarm go off. always assess for that in anyone with the least reason to have something go wrong in the abdomen (ummm, that would be pretty much anyone)

pressure is a mechanical thing, whether it's in your tires, water pipes, kid's birthday balloon, or blood vessels. in this case it's in the airways and chest. think about what could be causing that and you're on your way to thinking about nursing assessment and care.

ventilators can be set to cycle with a patient's own breathing efforts, or to deliver a set number of breaths at a set volume per minute if the patient does not move air on his own, or to support the patient's own breathing with a little pressure to decrease work of breathing but not to deliver the big breath, and many, many, many other modes. you need to know what this patient was getting from this vent setting to troubleshoot.

(and you might still have not understood vent alarms even if she was wrong-- i still don't know what was wrong with this patient. just because rt decided to bag him and then more things happen we don't know why, what the findings were, or that he was really "about to code" :D)

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what "respiratory drugs"? if the pressure was up because he had bronchospasm and he needed something for that, that's one thing. (see, there's one potential answer-- tight airways will decrease the ability to ventilate). if he was fluid-overloaded and his lungs were increasingly wet and heavy, that would increase vent pressure too. (my #1 check). other things to check asap: look for pneumothorax or intrathoracic bleeding or other space-occupying things inside the chest that could be growing fast.

if it was because he was "bucking the ventilator" (usually by coughing-- answer #2), the action could be to sedate so the tube doesn't make him cough so much, and/or clear secretions

#3 if his intraabdominal pressure was rising (so diaphragm was raised), that would make the vent alarm go off. always assess for that in anyone with the least reason to have something go wrong in the abdomen (ummm, that would be pretty much anyone)

pressure is a mechanical thing, whether it's in your tires, water pipes, kid's birthday balloon, or blood vessels. in this case it's in the airways and chest. think about what could be causing that and you're on your way to thinking about nursing assessment and care.

ventilators can be set to cycle with a patient's own breathing efforts, or to deliver a set number of breaths at a set volume per minute if the patient does not move air on his own, or to support the patient's own breathing with a little pressure to decrease work of breathing but not to deliver the big breath, and many, many, many other modes. you need to know what this patient was getting from this vent setting to troubleshoot.

(and you might still have not understood vent alarms even if she was wrong-- i still don't know what was wrong with this patient. just because rt decided to bag him and then more things happen we don't know why, what the findings were, or that he was really "about to code" :D)

you want me to be specific about something that happend years ago. quite honestly i do not know what the attending administered via inhalation. i know he started out with bicarb and then other inhalation drugs. sorry. memory is aging....the pt was not coughing, there was no condensation in the tubs, but his sats were decreasing down at the same time the high vent alarms were going off. as a student, i reported the problem but the nurse never took the time to evaluate her pt. she had already declared in her mind that he was bucking the vent and she would not evaluate. it was fortunate that rt just happened to stop by. when she evaluated the pt, she wasted no time disconnecting the vent, bagging him (which was very difficult because of the pressure she had to place on the bag to get o2 into his lungs), and put out an alarm. btw, the rn preceptor never even graced us with her presence.

what i do remember was the clique of rns on that floor and how they would gather throughout the day in the nurses lounge--for breaks, breakfast, lunch, dinnee, or to chat. my rn spent more time in the lounge than on and really was not concerned about the patient. the funny thing is i rotated back on the icu some years later. sure enough, the same clique was there and with the same behavior. btw the hospital was not some small facility in the outback. it was a magnet hospital with more than 900 beds in a very prestiious area of the country.

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It could have been a mucus plug. Maybe the pt was not suctioned as he should have been. Ambu bagging the pt and then saline lavage prior to suction would get the plug.

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]it could have been a mucus plug. maybe the pt was not suctioned as he should have been. ambu bagging the pt and then saline lavage prior to suction would get the plug.[/[/b]quote]

we could go through a list of what if's (and btw the pt was correctly suctioned). cleraly, i cannot recreate an information that happend years ago. nevertheless, what remained in my mind was the bsn on the case, while i was a student, was not in the least concerned about her pt and never went in to check on his condition. she just kept stating, bucking the vent--which it turned out was not correct.

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No worries I don't expect you to remember all the details. I just wonder what the protocol was for vent check....at my hospital RT does vent check every 2 hours and suctions the patient. In between it is the nurses responsibility to suction the pt if needed. I've seen scenarios like you mentioned where the nurse would ignore the alarms and not even think to call RT for help but just wait until they happened to drop by or came around for vent check.

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