The preferred gestational age, in the NICU, FOR THE Draeger VN 500 ventilator is 22-34 weeks, because with the proximal flow sensor, the ventilator is able to sense, respond and monitor volumes generated by very premature infants. As well as provide leak compensation to allow for ventilation with uncuffed ETTs up to 80%.
The automatic tubing compensation is off on the Draeger. When the tubing compensation is on additional pressure may be needed to deliver the ordered tidal volume especially with the size 2.5 ETTs. The neonatologists decided that the extra pressure would cause additional harm and opted to leave the tubing compensation off
Fisher & Paykel RT265 Evaqua 2 is the circuit used with the Draeger VN 500.If the incorrect circuit is placed on the ventilator, the circuit would pass calibration, but the heater will start to alarm
Colors on the ventilator screen
Teal green= ordered settings
Blue=ventilator initiated
Brown=infant initiated
Yellow= indicates a change and a confirmation, pressing the control knob, is needed to initiate the changing parameter
The battery display is located on the upper left hand corner below the picture of the baby and ventilator mode display
4-6 ml/kg is the range for tidal volume used in the NICU for the preterm infant. If higher, inform the MD. The excessive volume over time can cause damage to the lung. Possible pneumothorax
If an infant is on the Draeger VN500 NIV mode and reintubation is imminent, the circuit is to be changed and calibrated because NIV ventilation is an open circuit and invasive is considered a closed circuit.
It is important to always have the flow sensor in an upright position because the flow sensor housing part can become full of water. This can dampen the reading from the flow sensor to the ventilator compromising ventilation. If the infant is repositioned with the excess water around the flow sensor housing, excessive water could advance down the ETT
Using Nebulizers
An order be needed to administer a nebulizer treatment if the infant is in a volume mode of ventilation because the flow sensor and the volume guarantee will be turned off during the treatment and in order for the ventilator to cycle and ventilate the infant, a pressure mode must be ordered. Preferably PC/AC with order PIP, PEEP, I-time and rate
To run an inline nebulizer treatment on the Draeger VN500 if the infant is in a volume mode of ventilation:
A filter is placed on the expiratory limb of the circuit
The flow sensor is turned off
Remove flow sensor
The volume guarantee is turned off
The ventilator is placed in a pressure mode for the duration of the treatment
If the flow sensor is left in line with the circuit and the flow sensor is turned off, there is no way for the ventilator is sense volume, in turn the ventilator will not cycle correctly increasing the work of breathing
If the flow sensor is not removed it can become soiled causing error in the readings and flow sensor failure
PMAX
A pressure limit
When in volume ventilation it is the maximum pressure limit allow to deliver the ordered tidal volume
If the RT needs to deliver additional breaths to the infant, this is the pressure which those breathes will be delivered
PSV-each spontaneous breath is supported by the ventilator but the I-time is controlled by the infant
The start of inspiration, the start of expiration, breathing frequency and minute volume are controlled by the infant.
Pressure Control- is the pressure used to deliver the set tidal volume.
As compliance improves the ventilator will automatically decrease the pressure
Volume Guarantee- is the targeted ordered tidal volume
If Pmax is set to low and not enough pressure is generated to reach the targeted ordered tidal volume, blood gases could be effected because if the targeted tidal volume is not achieved, the infant inadvertently can become under ventilated. C02 will increase
Placing into CPAP with a backup rate:
Ordered parameters PIP, PEEP, I-time and rate
Ventilator must be placed in standby mode
Confirm the ventilator is in the standby mode
Select the Tube/NIV tab
Select the NIV tab
In the upper left and corner the NIV mode will highlight in orange
Select the start/standby tab
Select the PC-CMV
Nitric oxide therapy on the Draeger
The injector module is on the dry side of the ventilator circuit at the water chamber.
Circuit---injector module (arrow down)--one way valve
Sample line is placed by the temperature probe on the inspiratory limb of the circuit
The adapter used is found in the parts kits included with the ventilator circuits.
Extra kits are found in the RT clean room in the cabinet
Cleaning Process
Once removed from the patient, the process parts:
The exhalation block, muffler, diaphragm, drip jar are removed from the ventilator
Flow sensor and housing are removed
A blue sterile towel is placed in a red box
Spray the Draeger part with Pre Klenz
Sterile water in then poured over the parts
The red box is closed and a yellow sterile equipment tag is placed on the box with the:
Date
Number of items in the box
Location in this case as NICU
An equipment form is filled out with a list of the equipment in the box
The red box and forms are taken to sterile processing located on the first floor
Hair must be covered
The red box with the yellow tag is placed on the counter to the right after passing through the doors of sterile processing
Go to the other side of sterile processing and through the door into the breakroom. On the wall place the equipment form in the proper folder