NOOTAN COLLEGE OF NURSING

SUBJECT : CHILD HEALTH NURSING

TOPIC : PROCEDURE ON VENTILATOR CARE

SUBMITTED TO SUBMITTED BY
Mrs, Mahalkshmi . B. Mrs, Sayma Mansuri
Associate professor 2nd year m.sc nursing
NCN, visnagar Roll No: 03
NCN, Visnagar

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INTRODUCTION:

Vesalius is credited with the first description of positive pressure ventilation,

but it tooks 400 years to apply his concept to patient care. The occasion was the
polio epidemics of 1955, when the demand for assisted ventilation outgrew the
supply of negative – pressure tank ventilators (known as iron lungs). In Sweden, all
medical schools shut down and medical students worked in 8 hour shifts as human
ventilators, annually inflating the lungs of afflicted patients. In Boston, the nearby
Emerson Company made available a prototype positive-pressure lung inflation
device, which was put to use at the Massachuates general hospital, and became an
instant success. Thus began the era if positive – pressure mechanical ventilation
(and era of intensive care medicine).

The first positive –pressure ventilators were designed to inflate the lungs
until a preset pressure was reached. This type of pressure – cycled ventilation fell
out of favor because the inflation volume varied with changes in the mechanical
properties of the lungs. In contrast, volume – cycled ventilation, which inflates the
lungs to a predetermined volume, delivers a constant alveolar volume despite
changes in the mechanical properties of the lungs. For this reason, volume – cycled
ventilation has become the standard method of positive – pressure mechanical
ventilation.

DEFINITION:

VENTILATION: - The exchange of air between the lungs and the surrounding air,
the amount of air inhaled per day.

MECHANICAL VENTILATOR

Functions for below thoracic cage & diaphragm. It can maintain ventilation
automatically for prolonged time. It is indicated in patient who unable to maintain
safe level of oxygen or CO2 by spontaneous breathing even with assistantance.

TYPES OF VENTILATORS

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There are two type of ventilator, it is as followed:

1. Negative pressure ventilators

2. Positive pressure ventilators

1. Negative pressure ventilator: it applies negative pressure around the chest

wall. This causes intra airway pressure to become negative, thus drawing air
into the lungs through the patient’s nose and mouth. There is no artificial
airway is necessary; patient must be able to control and protect own airway.
Indicated for selected patients with respiratory neuromuscular problems, or as
adjunct to weaning from positive pressure ventilation.

2. Positive pressure ventilators : During mechanical inspiration, air is actively

delivered to the patient’s lungs under positive pressure. Exhalation is passive.
It required use of a cuffed artificial airway.

PURPOSES OF MECHANICAL VENTILATOR

1. To restore the pulmonary function.

2. To restore cardiac function.

3. Minimize Dyspnea.

4. To correct blood gas.

5. To restore the brain function.

INDICATION OF MECHANICAL VENTILATOR

1. NEUROLOGICAL :

a) Organ phosphorus Poisoning

b) Snake bite

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 c) GuillainBarre syndrome

d) Head injury

e) Unconscious due to other cause and causing respiratory obstruction.

2. RESPIRATORY :

a) Acute attack of ASTHMA.

b) C.O.P.D.

c) Pulmonary edema.

d) Acute respiratory distress syndrome.

e) Airway obstruction.

f) Apnea or hypopnea.

g) Respiratory distress.

h) Pulmonary arrest.

i) Clinically apparent increasing work of breathing unrelieved by other

interventions.
j) Obstruction of airway.
k) Aspiration

3. CARDIAC :

a) Cardio pulmonary resuscitation.

b) Severe circulatory shock.

c) Heart failure.

4. RENAL :

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 a) Chronic renal function.

5. POST OPERATIVE VENTILATION :

a) Deep sedation

b) Thoracic / cardiac / upper abdominal major operations.

c) Obesity and abdominal distension.

6. The decision to incubate and mechanically ventilate.

7. To institute non-invasive ventilation support is generally made purely on

clinical grounds without delay for laboratory evaluation.

8. For both HYPERCAPNIA respiratory failure and HYPOXEMIA

RESPIRATORY FAILURE.

9. For intentional hyperventilation in the setting of major head injury with

elevated intracranial pressure, for suspicion of clinical brain herniation from
any cause, or for a patient in critical condition with cyclic antidepressant
toxicity.

10.Laboratory criteria.

PARTS OF VENTILATOR

a) Ventilator circuit

b) Humidifier

c) Nebulizer

d) Adjustment controls – knobs

e) Screen

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 f) Air compressor

g) Central gas supply port nearby: ventilator needs air as well as oxygen.
There is an air – oxygen blender inside the machine so that desired Fio2
(0.2-1.0%) can be delivered accurately. Gas supply is at constant
pressure of 45-65 PSI. If supply is not in this range ventilator gives
alarm and may switch to either air or oxygen as may be the case.

FUNCTION OF MECHANICAL VENTILATOR

1. Initiation of inspiration – triggering.

2. Control inspiratory time – trigger end of inspiration and expiration.

3. Adjust pressure expiration (PEEP).

4. Monitor various parameters like :

a) Tidal Volume.

b) Respiratory Rate.

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 c) Minute Volume.

d) Peak Aspiratory Pressure.

e) Mean Pressure.

f) End Expiratory Pressure.

g) Resistance.

h) Compliance of Lung.

PRINCIPLES OF MECHANICAL VENTILATOR

1. Avoid high concentration of oxygen. 100% oxygen is toxic to the body after
24 hrs.

2. Hyperventilation can lead to sudden reduction of PCO2 which causes changes

in arterial pH which can cause sudden cardiac arrest.

3. Humidification is an important part of artificial ventilation. Due to intubation

normal warning and humidification of gases is bypassed, thus leading to
inhalation of dry air which causes drying of secretions, makingtosh blockage
of small airways and lung collapse. Sedation of a patient on a ventilator is
necessary when muscle relaxants are given.

4. Neuromuscular blockage is useful in cases of head injury, .

5. Respiratory monitoring is essential and includes Arterial Blood Gas (ABG)

analysis.

6. Care of lungs involves clearance of secretions by postural drainage.

7. Psychological care is essential when the patient requires long term

ventilation.

8. Keep your eyes on Ventilator alarms

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WEANING :-

Weaning is the word used to describe the process of gradually removing

the patient from ventilator and restoring spontaneous breathing after a period of
mechanical ventilator.

Criteria For Weaning Trial :-

- Respiratory criteria :-

Minute ventilation <15/min

Respiratory rate <38 breaths / min

Tidal volume >325 ml

Max aspiratory pressure <-15 cm H2O

FiO2 < 50%

disease process.

Nutritional and fluid balance maintained

Adequate physical strength & mental alertness.

Stable cardiovascular, renal & cerebral status.

Optimal level of alertness blood gases electrolytes, hemoglobin & other

laboratory tests.

Steps of weaning :-

 A B G Evaluation

 CPAP mode

 T- piece

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  Extubation:- Do suctioning Give chest physiotherapy & nebulization keep
crash cart & Intubations tray ready Remove ETT, do suctioning &
nebulization & oxygenation.
 Non invasive ventilator if required.

COMPLICATIONS OF VENTILATION :-

i) IntubetionRealated :-

Early :-

Hypoxia

Oesophagal intubation

Upper airway trauma

Hypo-tension

Aspiration

Late :-

Cuff leak, sinusitis

Upper airway stenosis

Self extubation

ii) Ventilator related :-

Disconnection

iii) Suctioning related :-

Hypoxemia

Arrhythmias

iv) Ventilation related :-

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 Nosocomial Infection

Homodynamic effect

Pneumothorax

Oxygen toxicity

Respiratory Alkalosis

Increased I.C.P.

Care at patient on ventilator :-

Endotracheal tube care

Feeding

Hygiene

Avoid bed sores by

Maintain patients safety

Records and reports

NURSES RESPONSIBILITIES

1. Monitor the respiratory status by

I. ABG analysis

II. Chest films

III. Auscultation

IV. Tracheal aspirate cultures

2. Ensure that ordered arterial blood samples are taken for regular ABG
analysis.

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3. Document & inform ABG result to physician.

4. Assess and document for

I. Vital signs for cardiovascular depression

II. Inspiratory pressure

III. Breath sounds

IV. Arterial oxygen tension

5. Report trends or abnormal findings to the physician.

6. Maintain Patency of Endotracheal and tracheostomy tube by suctioning as

required.

7. Supplying adequate humidification.

8. Prevention from trauma.

9. Prevention from infection, use aseptic technique.

10.Prevent the ventilator circuit from loose connection.

11.Prevent the Endotracheal tube and ventilator circuit from linking.

12.Nurse should check the machine frequently to ensure proper functioning and
the adequate operation of all alarm systems.

13.Check the electrical cords frequently to avoid disconnection, and safely place
them so that they can’t be pulled loose or cause falls.

14.A self inflating resuscitation bag should always be readily available. Manual
ventilation may be used during tracheobronchial suctioning, temporary
disconnection of the ventilator for tests or treatments, when an apparatus on
the machine is being changed, or to ventilate the client if the ventilator fails.

15.Observe the client very closely.

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 16.Change the position of patient every two hourly.

17.Use a bite block or oral airway.

18.Assist in changing endotracheal tube.

19.Perform range of motion exercise ambulate to chair when feasible.

20.Place nurse call device.

21.Provide distraction (T.V., Radio).

22.Explain procedure & monitor for physiologic &behavior signs and symptoms
that indicate increased levels of anxiety.

23.Respect client’s rights and opinions.

24.Provide oral care every 2 hours.

25.Drain water from ventilator tubing; do not drain water back into the
humidifier.

26.Monitor laboratory values, e.g. – CBC

27.Monitor sputum for changes in colour, constancy, amount, colour and odour.

28.Provide adequate nutrition.

29.Monitor intake and output.

30.Assess for complication e.g. – aspiration, diarrhea, constipation.

REFERENCE

1. Brady Marg, Manual of nursing practice, Lippincott, Philadelphia, 7th

edition, 1996, pp-233-258.

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2. Brunner &Suddhartha’s, text book of medical surgical nursing, Lippincott
Williams & Wilkins Philadelphia, edition 10th, 2004, pp – 280-281,463-
467,616-617
3. Joyce m. Black, Medical Surgical Nursing Clinical Management of
Positive Outcomes, Elsevier, St.Louis, Missouri, 7th edition, 2005, pp-
1737-1738.
4. Lewis l. Sharon, medical surgical nursing, Mosby Elsevier New Delhi, 7 th
Edition, 2007 pp -1759-1770.
5. Polaski l. Arlene, luckman’s medical surgical Nursing, Saunders,
Philadelphia, 1st Edition, 1995, pp 480, 533-545.

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