Emergency Ventilator Procedures

When the ventilator sounds an alarm (1), glance at the it to determine whether it is a high or low-pressure problem.

 

High-pressure alarms!

Secretions blocking the airway cause most high-pressure ventilator alarms. Suctioning (2) will usually take care of the problem. As you suction, watch the suction hose for fluid. If not much comes out and the vent is still alarming, try once more. If the patient has a sealed, attached catheter (3) give it a gentle tug to make sure that the catheter is all the way out of the airway. If the ventilator’s alarm continues sounding, quickly switch to your backup ventilator (4). After the backup ventilator is connected to the patient, remove any ties holding the catheter or air hose connection (5) and change the inner cannula, if one is used. It could be the source of the problem. If the problem is not resolved (the ventilator is still alarming, grab your BVM (6), attach the hose to the oxygen outlet, turn on the oxygen, remove the backup vent hose and connect the BVM to the tracheotomy tube. Give the bag a squeeze. If it does not squeeze easily squeeze harder and continue to squeeze the BVM about every 6 seconds. Ideally, someone is there to call 911, if not you must call. A telephone, within reach of the patient, or a handy cell phone are particularly useful in such emergencies--you can squeeze the bag every 6 seconds and talk at the same time. Your patient might be unconscious by now but you must continue the 6 second squeezing until professional help arrives! This could prevent brain damage from lack of oxygen or even death.

 

Low-pressure alarms!

Normally, a disconnected hose is the cause of a low-pressure alarm. A quick look at the ventilator hoses and listening for escaping air can often reveal the source of the problem. Ties around the neck connection can muffle the sound of escaping air and cover visual identification so double-check there. If you cannot identify the problem immediately, give the cuff bulb (where you put the air in the cuff a gent squeeze to make sure there is air in the cuff. It may have deflated or blown out. If the cuff is holding air, hook the patient to your backup ventilator; if the cuff is not holding air, it must be changed promptly. (In case the cuff is holding air and you cannot find the problem, get the BVM; call 911, as noted above.) I have never become unconscious from a ruptured cuff but I would not want to stay like that very long. Increasing the ventilator’s title volume and breaths per minute a couple of clicks should make the patient more comfortable while you prepare to change the tracheotomy tube. This procedure is much easier and quicker with two people but it can be done by one person without stress on the patient. Knowing the procedure and remaining calm is the key. The trach changing procedure is under construction.

 

Notes

Brain cells are very sensitive to oxygen deprivation. Some brain cells start dying within 5 minutes without oxygen!

I keep as little air pressure as possible in the cuff. As the pressure drops, what I call blow-by occurs. A small amount of air escapes past the cuff but it can be quite annoying. Adding a little air eliminates this problem; however, if you suction with insufficient air in the cuff, you can draw saliva from on top of the cuff into the airway. This can result in unnecessary suctioning, and frustrate both caregiver and patient. If your certain that unusual thick mucous is the problem, 2 or 3 cc’s of sterile saline solution can be placed in the airway with a syringe, this will help loosen the mucous; however, immediate suctioning must follow this procedure. This should not be done as a suctioning routine. If your patient has thick mucous all of the time, talk to your doctor about a nebulizer.

 

Footnotes

(1)  Please keep in mind—when the alarm is sounding the patient is not getting air. This is not the time to panic--a

quick solution is needed! Know your ventilator and what it is telling you when it alarms. On my ventilators, LP-10’s, there are two separate red lights, one for high-pressure and the other for low-pressure. The high-pressure alarm stops sounding, once the obstruction is clear; however, the light remains on until you reset it. This is very important because your quick recognition of high vs. low-pressure will save you valuable time.

(2) Inserting a catheter, that is connected to a suction pump, into the trachea to remove secretions and saliva. .I have

found that suctioning removes more secretions if you suction entering and exiting the airway. A clockwise then counterclockwise/back and forth wrist rotation of the catheter also helps remove the secretions. The maximum time for this procedure should be between 10 and 15 seconds.

(3) I use a sealed, sterile, inline, attached catheter and if it is not completely withdrawn, it can block the incoming air

causing a high-pressure alarm.

(4) You must have a backup ventilator and it should be at the ready i.e., hoses connected and identical settings to the

primary ventilator. I keep mine on a rolling cart, click here for a picture.

(5) The inner cannula is a replaceable tube inside of the tracheotomy tube. Not all tracheotomy tubes have inner

cannulas!

(6) A BVM (Bag Valve Mask) is also known as an (AMBU bag). The mask detaches and the bag and valve attach directly

to the tracheotomy tube for manual respiration. Many of these devices have tubes that connect to oxygen supplies. These are the ones that you want to get. I have 3 or 4 of them. One saved my life in June of 2007.

(7) My oxygen tank is beside the head of my bed. One of my BVMs is there also. The oxygen hose is already connected

to the BVM and the oxygen tank so all that he has to be done is turn on the oxygen. My oxygen tank valve opens by turning it counterclockwise.

We do not allow smoking in the house because of the oxygen.

Smoking and oxygen are the ingredients of a disaster!