Ventilators

lovemyjob · May 9, 2006

I have been off of NICU orientation for 6 months and I still dont completely understand all of the settings or all of the vents. We take vents pretty quickly in orientation because a lot of our kids are on vents, I think the first couple of weeks. I thin six months is a little bit of overkill..there is only so much you can learn about grower feeders and NC and highflowNC(formerly known as vapotherm.)

I sort of focused first on the info I HAVE to know to do my part of the job...like, where is the button on each machine to give 100%, where is the button that gives manual breathes, got to feeling comfy w. suctioning and recovering a kid who tries to die whan you suction him, feeling comfy bagging and knowing when to give up on vent breathes and when to switch to bagging. The full understanding of vents will come with time. You are so overwhelmed with all you have to learn during those three months (which is what we get,) that you just cannot learn it all. So I figured it was most important to figure out how to save the baby first and learn the details of it as I go. Just think, RT's went to school for this. You arent going to learn their job in a few months on orientation. As you feel more comfy you will be able to retain more details about it. The main thing I get in report is the FiO2 and the Rate (rate =bpm.) So like if he is on a rate of 15 and an fio2 of 21%, he is on minimal settings and is on his was to being extubated either that night or the next day as long as he tolerates it. If he is requiring an Fio2 of 85%, he is most likely going to be a touch me not, and I know that I dont have as much room to move around...as in I can only give him 15% more O2 oppose to a kid on 30% who I can give 70% more to in a brady/desat situation.

I know I am just being long winded about this, but i guess what I am getting at is know the buttons you will be able to touch and what they do, leave the buttons you dont touch for a time when you are more receptive to the info.

babynurselsa, RN · May 9, 2006

Hang in there Rain.

If someone is not getting vent exp for 6 mos to a year they are probably on a unit that has a lot of tenured staff that basically wants to take care of the criticals and not the feeder growers so if the newbies don't have vent exp then they get to take care of the less desirable assignments.kwim....

Your comfort level will increase gradually. It will come.

PIP peak INSPIRATORY pressure- this is the breath going into the baby.

PEEP- positive end EXPIRATORY pressure this is the airway pressure on exhalation.

Here is a link that I found that gives some nice explanation of terms and some of the whys and wherefores of different types of ventilators.

http://neonatal.peds.washington.edu/NICU-WEB/vents.stm

Hope this is at least a little help. I am a hands on type learner but I need to know the whys and how comes of a situation or interventions. So I understand what you are talking about.

Good luck.

dawngloves, BSN, RN · May 9, 2006

I like to poke around this site for respiratory stuff.

http://www.geocities.com/ricks_rcp_resources/index.html

RainDreamer, BSN, RN · May 10, 2006

lovemyjob - That's what I've focused on so far ..... the stuff I HAVE to know. How to give manual breaths and turn up the FiO2. I feel more comfortable about suctioning now. I definitely do NOT feel comfortable bagging and knowing when to switch from vent breaths to bagging. But like my preceptor told me, that'll come with time. Any time one of my babies is desatting and not coming back up, someone always comes over to help out or asks if I need help, etc. I know I always have someone there to help me. Thanks for the info and encouragement!

Lisa - Thanks for the info and the link!

dawngloves - Thank you!

Another one of my problems with the vented kids is just the positioning. Everyone with experience can look at a kid and tell if the tube is positioned ok. I can't. I can't tell the difference between it being positioned ok and it being positioned terribly.

Love_2_Learn · May 12, 2006

I recommend two books for you to look into; I found them very helpful.

Assisted Ventillation of the Neonate, 4th Edition by Jay P. Goldsmith, MD and Edward H. Karotkin, MD, published by Saunders. ISBN# 0721692966.

Manual of Respiratory Care, 2nd Edition by Steven M. Donn, MD and Sunil K. Sinha, MD, published by Elsevier. ISBN# 03230131765.

(I've seen Drs. Goldsmith and Donn at neonatal nursing conferences and they are wonderful!)

As far as trying to understand if your baby is positioned well with their tube, be sure you have measured it lip-to-tip correctly and then try to use x-ray vision as you try to imagine how the tube looks in the baby... Is there any tension on it? Does it look like it's sort of bent inside their mouth or throat? Is the equipment connected to the outside end of the tube look like it's pulling or twisting in any way?

I'm glad to hear you asking these questions now because now is the time to ask things like this... Your first year or two will be spent asking all kinds of questions so don't be hard on yourself for it... just keep asking and also looking for information like you are doing on this web site and in reference books, etc. I also highly recommend you join NANN and ANN (National Association of Neonatal Nurses and Academy of Neonatal Nursing) and receive their jounals (Advances in Neonatal Care and Neonatal Network). I can't tell you how much I've learned from them along with the books recommended in the journals. Also both have national nursing conferences where you can learn loads of stuff. Once you get on a mailing list through them you will receive all kinds of suggestions for ways to grow as a neonatal nurse.

So, keep asking those questions and looking everywhere you can for answers. Believe it or not, one day will come when a newbie will come to you asking these same questions and you will want to be able to give them the correct information too.

Good luck, hang in there, and read all you can find on the subjects!

Mags4711, RN · May 13, 2006

I recommend two books for you to look into; I found them very helpful.
Assisted Ventillation of the Neonate, 4th Edition by Jay P. Goldsmith, MD and Edward H. Karotkin, MD, published by Saunders. ISBN# 0721692966.
Manual of Respiratory Care, 2nd Edition by Steven M. Donn, MD and Sunil K. Sinha, MD, published by Elsevier. ISBN# 03230131765.
(I've seen Drs. Goldsmith and Donn at neonatal nursing conferences and they are wonderful!)

Excellent books to suggest!

And a side note, Dr. Donn is a great guy on a personal level, and a brilliant and well-published neonatololgist. But try having him for your attending...Arrrgghhh!!!! (He's our program director)

Love_2_Learn · May 16, 2006

Thanks for the vote of confidence in the two books I like. :thankya:

Even though Dr. Donn may be "Arrrrggggghhhh" to work with as an attending (and a wonderful guy on a personal level), I have to say I'd love to have a chance to work with a neonatologist who seems to have such a passion for his art. I've worked with some "goober" neonatologists over the years and they have made me feel really "ARRRRGGGGHHHH"! :banghead:

On the other hand I've worked with a few who were absolutely wonderful personally and professionally and I'm so very glad for that experience!

:smiley_aa

Mags4711, RN · May 16, 2006

Oh yes, they really are great books!

Dr. Donn rarely is on the floor, he's doing lots of writing and research these days. Which makes him much more accessible to conference goers, and he is great to watch. He is quite dynamic.

You are sooooo right, the "goobers" make you crazy, and unfortunately around these parts the "absolutely wonderful" ones seem to be few and far between. Of course that may be a skewed opinion as I work nights and it is soooo rare that we ever see an attending. But we are very fortunate to have some wonderful fellows right now.

To come back on topic, can you ask your RT's or an RT Supervisor to sit down with you and go through some ventilator basics? We have some great RT's here who are more than happy to teach what they know. And whenever I saw (or see) an oscillator, or especially a jet (rare) I grab an RT for a refresher and why in that specific patient we are using that mode of ventilation. It helps keep me up-to-date.

lovemyjob · May 16, 2006

I dont think I have ever seen a jet...I have seen plenty of oscillators, but never anything called a jet. Could someone explain to me the difference, I havent had much luck with google..

TIA

Mags4711, RN · May 16, 2006

Jets aren't used that often anymore, it seems. Here's a link to a good site that runs down a comparison of HFOV, HFJV and HFPPV

http://www.uihealthcare.com/depts/med/pediatrics/iowaneonatologyhandbook/pulmonary/highfrequencyhfv.html

Mags4711, RN · May 16, 2006

Here's another nice one:

http://www.nemc.org/RespCare/istar950.htm