3Precautions that would reduce troubles I. Power:Plug into a grounded AC power with correct voltage receptacle.Secure the power cord properly.Battery Back up:Check the battery level before connecting.Charging should be carried out regularly.Remember it is for short term use.
4II. Gas Source Preferable to have centralised supply. If cylinders used, should be fullSpare cylinders should be available.Gas hoses should be in good condition.Hoses – not contaminated with grease or oil (combustible)Availability of compressors should be ensured.Gases should remain dry and clean.
5III. Personnel Properly trained personnel should only use. Familiarising staff with operator’s manuel before using on a patient.(One manufacturer’s manual may not exactly match with other brands).Appropriate monitoring the functioning state of the ventilator while in use.
6Contd… Familiarizing staff with alarm system. Do not place ventilators in a combustible or explosive environment.Do not use with flammable anaesthetic agents such as nitrous oxide and ether.
7IV Servicing and Testing Qualified personnel should undertake servicing.Ventilator housing should not be opened while it is still connected with power.Follow the specifications mentioned in the service manual.Use replacement parts supplied by the manufacturer only.
8Contd…. General servicing at regular intervals should be done. Run the prescribed tests and calibrations before using the ventilator on a patient.Ensure that the ventilators pass all the tests before putting them in to clinical use.
9ALARMSAll ventilators are equipped with visual and audible alarms which notify the user problems.
10Points to remember Never ignore an alarm. Never mute the alarm on regular basis.Find out for yourself what alarm is on.Check the patient.Silence the alarm.
11Act SwiftlyDepending upon the patient’s status and nature of the alarm, act appropriately.This includes disconnecting the ventilator and connecting another means of ventilation to patient – Bain’s/ Ambu.
12Do not forgetThe use of an alarm monitoring system does not give absolute assurance of warning for every form of trouble that may occur with the ventilator.
13Do not be like this !But hear the alarm and respond See the problem and Ask if you do not know what to do
14Common Troubles and Shooting Ensure Alarm knobs / switches are turned on and functional.AlarmCauseShootingApnoeaNo breath was delivered for the operator set apnoea time in spont, SIMV, AC, CMV & NIV modesBecause spontaneous Ventilation is too high or patient effort is too minimalTrigger level set improperly.Check the patient- Arouse if neededActivate back up facility if it was not done already.Consider switching over to any mandatory modeOr go up on rateSet trigger level appropriately
15Low SpO2Air / O2 Blender continuousalarmDelivery of O2 : FiO2, PEEPHigh resistancedue to variousclinical reasonsSupply pressuresare inadequate.Disconnect patientfrom ventilatorManually bag withBain’s and Ambu.Insert the gas hosefittings (air & O2)correctly into the walloutlets.Ensure wall outletshas adequatepressure
16The measured PIP is lesser than the set minimum level because of Low pressure orLow min.VentOrLow exhaled volume orDisconnectionThe measured PIP is lesser than the set minimum level because ofcuff leak.Leak in thecircuitConnectionsmay be looseET tubedisplacementInadequateflowEvaluate cuff pressureat regular intervals.Reinflate if leak /ruptured is noticed –change ET tube.Check circuits, junctions-tighten or replace.Check water trapsCheck ET tubeplacement. Position itproperly.Reconnect ventilator.Patient may requirehigher flow.
17High Pressure AlarmThe measured peak inspiratory pressure is great than set level because ofSecretions in airwayPartial block – (ETt)Kinking of tubeBiting the tubeWater in the tubeCuff herniationDeep Rt. sidedintubationFighting theventilatorSuctioning, IrrigationRelease tubingsBite block insertionEmpty the tubings andwater trapsDeflate & reinflate cuff3-4 timesReposition the ET tubeReposition the patientRe assuranceSedation &medication (pain)
18High pressure alarmCoughIncreased airwayresistance ordecreasedcompliancebecause ofBronchospasmAtelectasisFluid overloadPneumothoraxMedicationBronchodilatorsAdjust the settingsVT & RateVT Rate, PEEP(Peak pressure to be monitored)Immediate intervention
19Auto CyclingHigh Tidal VolumeLeak & Improper trigger settingPatient trying to take more volume of airSecure alltubings tightSet propertrigger levelIncrease flowrate orIncrease tidalvolume
20Trouble shooting!THANK YOU FOR YOUR PATIENT HEARING