Today our topic of discussion is Procedure of Ventilation.
Procedure of Ventilation
Procedure
Care of ETT/Tracheostomy
- Secure positioning of ETT/tracheostomy tube with tape or adhesive plaster
- Inflate cuff once correct positioning has been confirmed
- Cuff is inflated with air using a syringe until a “hiss” is heard on auscultation (minimal air leak technique).
Maintaining Ventilation
- Effects of ventilation are assessed by observing patient’s color, chest movement, blood pressure, pulse rate/ oxygen saturation and ventilatory measurements such as expired minute and tidal volume, airway pressure and rate of ventilation
- Ventilators make characteristics sounds during inspiration and expiration which nurse must be capable of identifying
- Ensure patient has adequate fluid and calorie intake
- Administer sedation as prescribed to ensure adequate artificial ventilation and promotion of rest.
Signs of Adequate Ventilation
- Improvement in skin color and oxygen saturation more than 90%
- Rhythmic expansion of chest with expiratory phase longer than inspiratory phase
- Normal pulse, change in pulse rate may indicate decreased cardiac output due to increase in intra- thoracic pressure
- Steady blood pressure.
- A drop in blood pressure may reflect decreased cardiac output
- Audible respiratory rhythm
- Absence of any abnormal neurological signs
- Absence of hyperventilation or hypoventilation.
Signs of Inadequate Ventilation
- Breathing occurs out of sequence with ventilation and patient is restless, perhaps diaphoretic, flushed or cyanosed
- First signs of ventilatory inadequacy and hypoxia may be tachycardia and hypertension
- If change in recordings of ventilatory volume occurs check airway pressure and rate of ventilation
- If increase in minute volume, check for leaks in cuff seal, connections and tubing If decrease in airway pressure occur check for leak in circuit
- If increase in peak airway pressure occur check for obstruction such as secretions, kinking, pooling of water, patient biting tube slipped into a main stem of bronchus, pneumothorax.
Suctioning
- Explain procedure to patient/family
- Frequency of suction to be carried out depending on patient’s pulmonary state
- Tracheal suction is an aseptic procedure.
- Sterile catheter and one sterile glove to be used for each suctioning episode/session
- Suction is applied while catheter is being withdrawn using intermittent technique, not more than 10 to 15 seconds
- When secretions are tenacious, instill 1 to 3 mL.
- Sterile normal saline 0.9 percent into endotracheal/ tracheostomy tube to liquefy and make removal easier.
Weaning
- Inform patient that this is a progressive step in treatment
- Repeatedly encourage and reassure patient to avoid fear or exhaustion
- Withhold sedation and muscle relaxant as ordered by doctor
- Watch for respiratory distress, hypoxia, tachycardia, Tachypnea, cyanosis, and hypotension and drop in oxygen saturation.
Routine Nursing Care
- Give daily bed bath and change bed linen, if soiled
- Provide 2 hourly attentions to pressure sites by turning and repositioning of patient
- Four hourly oral hygiene and whenever needed
- Four hourly eye care.
- Instill artificial tears and cover with Jaconet gauze/plastic foil, to prevent corneal abrasions
- Check and record vital signs every hour
- Measure blood, intravenous transfusion and fluid intake every hour
- Measure blood loss, urine, nasogastric, aspirate, etc. every hour
- Change drainage bags, chest drainage bottles and tubing’s as required e Maintain intake/output chart every shift
- Eight hourly aseptic urinary catheter toilet
- Assess bowel action every third-day
- Eight hourly wound dressings
- Change the tape anchoring ETT and Ryles tube
- Change intravenous administration sets and dressing of puncture sites every day
- Change suction bottle and connecting tubing everyday
- Change ventilator circuit tubing, connections and adapters everyday
- Record patient’s condition and events that have occurred during each shift in nurse’s progress sheet Give detailed hand over to nurse on following shift.
Psychological Aspects of Patient’s Care
- Endeavor to allay patient’s and relatives anxiety fears and clear doubts as necessary
- Motivate patient and relatives to participate in daily care activities
- Promote good relationship with patient/family and encourage them to express fears, stress factors/feelings.
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