Equipment
■ 2 oxygen sources.
■ Air source that provides 50 psi.
■ Mechanical ventilator.
■ Resuscitation bag with oxygen connection tubing.
■ Humidification device.
■ Ventilator tubing, connectors, and adaptors.
■ Condensation collection device.
■ Pulse oximetry device.
■ Procedure gloves, protective gown, and eye covering.
■ Sterile gloves and suction equipment, if you will perform suctioning.
■ Suction equipment.
■ Sterile water for the humidifier.
■ Inline thermometer.
Assessment
■ Review the health record to make sure that mechanical ventilation is included in the options outlined in the patient’s advance directive.
■ Assess the patient’s understanding of mechanical ventilation therapy, if possible.
■ Assess:
■ Respiratory status, including rate, depth, and rhythm.
■ Breath sounds.
■ Color.
■ Pulse oximetry results.
■ Be Smart! Blood may be drawn for a baseline ABG analysis.
Post-Procedure Reassessment
■ After mechanical ventilation is instituted, assess for chest expansion and auscultate bilateral breath sounds.
■ Auscultate breath sounds every 2 to 4 hours, according to agency policy. Evaluate the patient’s tolerance of mechanical ventilation.
■ Verify adequate ventilation and that the patient is breathing in synchrony with the ventilator.
■ Be Safe! Check ABGs and respiratory status about 30 minutes after setup.
■ Monitor continuous pulse oximetry, capnography, and ABGs.
■ Be Smart! When monitoring VS, count spontaneous breaths as well as those delivered by the ventilator.
Key Points
Initial Ventilator Setup
■ Prepare the resuscitation bag; keep it at the bedside.
■ Respiratory therapists are responsible for setting up mechanical ventilation in most agencies. If you must assume the responsibility, refer to the manufacturer’s instructions.
■ Plug in the ventilator and verify settings with the medical prescription.
■ Be Safe! Make sure the ventilator alarm limits are set appropriately.
■ Fill the humidifier with sterile distilled water.
■ Attach the ventilator tubing to the endotracheal tube or tracheostomy tube; secure the ventilator tubing.
■ Attach a capnography device, if available.
■ Prepare the inline suctioning equipment (see Procedure 35-8).
After the Initial Ventilator Setup
■ Wear gloves, protective eye covering, and gown.
■ Check respiratory status and ABGs again about 30 minutes after setup.
■ Be alert for changes in ventilator settings and the patient’s compromised respiratory status.
■ Maintain the patient in a semirecumbent position (head of bed at 30° to 45°).
■ Check the ventilator tubing frequently for condensation.
■ Drain the condensate into a collection device, or briefly disconnect the patient from the ventilator and empty the tubing into a waste receptacle, according to agency policy.
■ Be Safe! Never drain the condensate into the humidifier.
■ Check ventilator and humidifier settings regularly.
■ Check the inline thermometer regularly.
■ Provide alternate form of communication (e.g., letter board, texting using a cell phone or keyboard).
■ Reposition the patient regularly (every 1 to 2 hours), being careful not to pull on the ventilator tubing.
■ Moisten the lips with a cool, damp cloth and water-based lubricant.
■ Provide regular oral care: brush teeth twice a day with a soft toothbrush, moisturize oral mucosa and lips every 2 to 4 hours, use mouthwash twice a day for adult patients.
■ Use a 0.12% CHG rinse twice a day for adult patients who have undergone cardiac surgery.
■ Be Smart! This regimen may help prevent VAP.
■ Ensure that the call light is always within reach, and answer call light and ventilator alarms promptly.
■ Monitor the tracheostomy tube for proper cuff inflation.
■ Monitor for gastric distention.
■ Give sedatives or antianxiety drugs as needed.
Documentation
■ Note:
■ Date and time mechanical ventilation was initiated.
■ Type of ventilator and the prescribed settings used.
■ Patient’s response to mechanical ventilation, including:
• VS.
• Breath sounds.
• Ease of breathing.
• Pulse oximetry.
• I&O.
• Skin color.
• ABG and chest x-ray results.
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| Preparing the resuscitation bag |
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| Verify ventilator settings |
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| Drain tubing into a waste receptacle, never into the humidifier |
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