Nursing Care for a mechanically ventilated patient

Today I am going to give you tips about taking care of a patient in a mechanical ventilation machine. These type of patients are either in ICU on long term acute care facilities (LTAC). I will not go over vented patients in operating rooms because most of the times, these patients are only in mechanical ventilation for surgery only.

Here are some few good tips you can use when taking care of a patient on mechanical ventilation, commonly known as “vented patient”.

1. Always note the ventilator settings during report even before you go into the room the patient is.
2. Make sure that the physician orders for ventilator settings are correct and correspond with the settings you got in nurse-to-nurse report.
3. Never ever turn ventilator alarms off. These alarms are your patient lifesavers and without the alarms, it is hard to know an emergent ventilation problem.
4. Never ever ignore a ventilator alarm or dismiss it as a false alarm. Always make sure you review your alarms as this may give you indication of impeding event.
5. Low pressure alarm troubleshooting:
   1. Make sure your tubing connected to the ventilator are not disconnected or have air leaks.
   2. Make sure that the endotracheal balloon is inflated; hence, there is no air leak when the vent machine is delivering positive pressure.
   3. Make sure the patient has not pulled out the endotracheal tube (self extubation)
   4. Make sure the machine is functioning properly
6. High pressure alarm troubleshooting:
   1. High-pressure alarm may go off when the patient is coughing.
   2. High-pressure alarm may go off when the patient is vomiting.
   3. Make sure your vent tubings are not kinked.
   4. The patient may have sputum blockage and may need to be suctioned. To suction a patient with endotracheal tube;

                                                              i.      Auscultate breath sounds before suctioning. This gives you a starting point and a way to evaluate if your suctioning is effective.

                                                             ii.      Elevate the head of bed as tolerated. (Vented patients should always have head of bed above 30 degrees to prevent G.I system content aspiration causing ventilator associated pneumonia.

                                                           iii.      Pre-oxygenate the patient with 100% oxygen. Once you turn on 100% oxygen, wait for about 15 seconds before you begin suctioning.

                                                          iv.      Using in-line suction, advance fast but gently until you feel resistance. This resistance is the “carina” where the trachea divides into right and left bronchi

                                                            v.      Pull the catheter backwards with intermittent suction. Let the patient receive 100% oxygen for about 15-20 seconds before advancing suction catheter again.

                                                          vi.      If the heart rate start going down, quickly remove the suction catheter and give 100% oxygen. This rapid drop in heart rate is an indication of myocardial tissue oxygenation compromise and must be corrected immediately.

                                                         vii.      Auscultate breath sounds after suctioning and notice the difference with the lung sounds before suctioning.

                                                       viii.      Document the procedure stating the procedure, amount and color of sputum obtained, how the patient tolerated and the lung sounds change before and after auscultation.

1.  
   1. Pneumothorax can also cause high-pressure alarms to go off. If this is suspected, call physician immediately and emergency chest tubes may need to be inserted.
   2. If all trouble shooting have been tried and still getting high pressure alarm call the physician and put the patient on 100% oxygen while you continue looking for the cause of the problem

                                                              i.      Make sure the lung sounds are equal bilaterally. This will help catching pneumothorax.

                                                             ii.      Make sure the sternum is symmetrical. This will help you catch tension pneumothorax.

                                                           iii.      Absent lung sounds may indicate pneumothorax or complete airway blockage

1. Never change vent settings without physician orders. I like to let the respiratory therapist do the vent settings change.
2. Always have Bi-valve mask by bedside at all times connected to 100% oxygen for use incase of an emergency.
3. Never try to do it all by yourself. If your instincts tell you there could be something wrong, call for help. Obey your instincts as time passed may be the difference between life and death.
4. Never leave a vented patient un-attended. Always let another nurse know incase you decide to step out for a break or anything.

Enjoy taking care of vented patients