Airway, ventilator, trach, OH MY! Mechanical ventilation seems scary, am I right?! You’re working with the “A” of the ABC’s, so yeah, it’s normal to have a little extra adrenaline running through your veins. That’s okay! I’m going to walk you through the basics to ease that fear a bit.
I’ve worked with patients on ventilators for a little over a year now. The patients I see are ventilator dependent due to a number of different conditions including muscular dystrophy, cerebral palsy, post-polio syndrome, spinal cord injury, and COPD. When I first started working with these patients, I felt overwhelmed with the ventilator settings and knowing what to do if a problem arose. I now feel like I could handle most situations that come my way.
Here are the three key things every single nurse should know when working with a ventilator dependent patient.
- Locate that ambu bag immediately! Before it is needed. You do not want to be the nurse that is frantically looking for the ambu bag while your patient is rapidly de-sating. Your eyes won’t work when you’re in a frenzy, so locate the ambu bag at the beginning of your shift so that if the need arises, you can grab it quickly!
- High pressure alarm = blockage. You could also think of a kinked garden hose. If you have a kink in the hose (circuit or airway), the water (air) won’t get through! It could be a complete blockage where no air is getting through, or it could mean that the patient is coughing and there is a temporary blockage of air that will resolve on its own. Most of the time, it will indicate that there are some secretions in the airway that need to be cleared. Get that suction kit ready, and get the job done!
- Low pressure alarm = disconnect or leak. This alarm will sound when the circuit has disconnected somewhere along the line, there is a hole in the circuit somewhere, or the circuit connections are loose but not completely disconnected. Run your eyes down the circuit from the trach to the ventilator and see if you can quickly spot the problem. If you are having trouble spotting the disconnect, call respiratory therapy and/or get the ambu bag ready and connect the patient to the back-up ventilator.
Don’t get me wrong, mechanical ventilation is way more complicated than that. I could go on and on about assist control and pressure support and PIP and PEEP and MAP and…on and on.
If you are in the acute care setting, most nurses will not have to know details about ventilator settings because respiratory therapists are circulating the floor to assist the patient and address your concerns.
For most nurses, the three pieces above will be more than enough to begin caring for a patient on a ventilator!