Specific ventilator orders must be ordered by the physician as well as any oxygen / treatment orders
An order of “resume home settings” is not a valid home ventilator order
If home equipment is not available, the therapist will place patient on a Servo-I until the parents / home care company can provide the needed equipment
All equipment must be plugged into red plugs
For ventilator-dependent patients, always have alternate ventilation equipment available, such as a back-up ventilator, manual resuscitator or similar device
Trouble Shooting
If ventilator is alarming, the first thing to do is look at your patient. Assess:
Chest rise
Color
Respiratory Rate
If unstable check airway patency and placement, take them off of the vent and manually ventilate patient
High-pressure alarm
Causes:
Coughing
Increased secretions
Bronchospasm
Obstructed airway
Water in the tubing
Blocked pressure line
Partially occluded ventilator circuit
To Troubleshoot
Assess patient
Suction
Reposition
For trach patients, if cannot pass catheter, verify the trach is in place. If not in place or if there’s an obvious obstruction, replace trach. (Bag the pt. and call RT), Empty water from tubing, check tubing for obstruction
Low Pressure or Low Minute Ventilation alarm
Causes:
Leaks in circuit
Leak around trach
Loose trach ties
Disconnected circuit
Change in patient overall condition
Positional leaks
Trach decannulation
Cuff leak
Large mask leak
Suction catheter is pulled back too far
Troubleshoot:
Reposition ventilator circuit and trach ties
Reposition mask
Verify cuff pressure
Check trach position
Check suction catheter
Check all fittings along the vent circuit to make sure circuit is intact
Astral Vent
General
For the Therapy on/off indicator light a constant green display means the device is turned on but not ventilating
The therapy on/off indicator light Flashes blue when the device is ventilating, and the Ventilation LED setting is ON. Otherwise is OFF
The Astral device max levels of supplemental oxygen up to 30 L/min
The internal battery operates for approximately eight hours under typical conditions
Turning off the device must be done manually and must be performed before leaving the device disconnected from AC power for any extended period of time. Failure to do so may result in battery depletion and activation of alarms. To power off the device, press the green on/off button at the back of the device and follow the on-screen prompts. To ensure the device is fully powered down, touch the screen
Contraindications
Pneumothorax or pneumomediastinum
Pathologically low blood pressure, particularly if associated with intravascular volume depletion
Cerebrospinal fluid leak, recent cranial surgery or trauma
Unlock the low flow oxygen inlet at the rear of the device by pushing up on the locking clip
Insert one end of the oxygen supply tubing into the oxygen port connector. The tubing will automatically lock into place
Attach the other end of the oxygen supply tubing to the oxygen supply
Start ventilation
Turn on oxygen and adjust (at the oxygen supply) to the prescribed flow rate or FiO2 level
LTV
To do a Pre-use check hold down the “Select” and the “On” button simultaneously, scroll through and follow on screen instructions
Leak test
Once in the pre use menu, select leak
Occlude circuit
The screen will say set turbine as the machine readies itself, apressure will be given and a pass or fail will then read on the screen
If the LTV being used is not a 1150 or higher than the ventilator is NOT peep compensated
If the patient needs more or less flow
Go to the rise profile under the additional menu
Hold down the select button for 5 sec and an alarm / vent menu will appear
Use the wheel to turn the choice to vent options
Once in vent options press select until the option of rise profile shows up
1= fast, 9= slow
This will help you to achieve the desired pip if measured is off from desired
I-time can be affected, even when patient is in PC if the Tidal Volume setting is set too low
Even if not in Volume Ventilation you will adjust flow rates if you press the tidal volume key and adjust the tidal volume
Trilogy Vent
This is a PEEP compensated ventilator in PS setting only. Therefore, if you have an order for a PIP of 25, then the pip dialed in setting needs to be set to 25 regardless of the peep setting. Look at the pts. manometer to verify dial setting needs.
To get into the Set-up menu
Hold down silence and down arrow buttons at the same time to allow access to circuit type, and dual prescription orders. This is the same process used to “unlock” the settings when the patient comes in from home
Auto Trak
Auto trak is a feature on the Trilogy that takes the place of the flow trigger, patients should be placed on this setting as it compensates for leaks and changes flow with patient demand
AVAPS
AVAPS is a pressure support function that can be activated within S, ST, PC and T pressure modes. It automatically adapts pressure support to patient needs to guarantee an average tidal volume, based on the Auto-TRAK algorithm performance
Low-circuit Leak alarm
Causes:
Whisper valve restricted from a build-up of condensation or crystallized medication
The whisper swivel cannot be wrapped, covered up, or blocked at all