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Mechanical Ventilator

1. Definition/ Description
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assists the patients breathing, depending on the needs of the patient. For
patients who need the greatest amount of assistance, the ventilator fully
controls the volume and duration of breath throughout the respiration
cycle.

2. Indications/ Purposes

Acute respiratory failure evidenced by the lungs inability to maintain


arterial oxygenation or eliminate carbon dioxide leading to tissue
hypoxia in spite of low-flow or high-flow oxygen delivery devices.
(Impaired gas exchange, airway obstruction or ventilation-perfusion
abnormalities).

In a patient with previously normal ABGs, the ABG results will be as


follows:
PaO2 > 50 mm Hg with pH < 7.25
PaO2 < 50 mm Hg on 60% FIO2 : restlessness, dyspnea,
confusion, anxiety, tachypnea, tachycardia, and diaphoresis
PaCO2 > 50 mm Hg : hypertension, irritability, somnolence
(late), cyanosis (late), and LOC (late)

Neuromuscular or neurogenic loss of respiratory regulation. (Impaired


ventilation)

Usual reasons for intubation: Airway maintenance, Secretion control,


Oxygenation and Ventilation.

3. Preparation pre/post procedure


Prior to Procedure
Mechanical ventilation is being performed along with surgery and is planned:
The night before, eat a light meal. Do not eat or drink anything after
midnight.
Ask your doctor about any other special directions.

Anesthesia
Local anesthesia may be used to numb your throat. You may also receive a
muscle relaxant. This is to prevent gagging when the tube is inserted.
Description of the Procedure
1. First, you will wear an oxygen mask for 2-3 minutes. (This will ensure that
you have enough oxygen in your system during the procedure.)
2. Your head will be tilted back slightly. A tool called a laryngoscope will be
used. The scope has a handle, a light, and a smooth dull blade. (This tool
lifts the tongue off the back of the throat so your vocal cords can be
seen.)
3. One end of the breathing tube will be inserted through the vocal cords and
into your lower windpipe.
4. When the tube is in position, the scope will be removed and the tube will
be left in place.
5. Next, the tube will be attached to a ventilator machine.
6. The tube will then be taped to the corner of your mouth. This machine will
move air in and out of your lungs. It can adjust how quickly and how
deeply you breathe. In
some cases, the tube will be inserted through the nose instead of the
mouth.
Immediately After Procedure

Right after the procedure, your doctor will:

Listen to your lungs to make sure that the air is going into them
equally

Do a chest x-ray to make sure the tip of the tube is positioned in the
middle of your trachea

Measure the level of gases in your blood to make sure that the
ventilation is working.

4. Complications

Damage to teeth, lips, or tongue

Damage to the trachea or larynx resulting in pain, hoarseness, or difficulty


breathing after the tube is removed

Esophageal intubationwhen the tube is accidentally inserted into the


esophagus and stomach rather than the trachea

Low blood pressure

Too little or too much ventilation

Pneumonia

Lung injury/collasped lung

Infection

5. Nursing care/ responsibilities

Oral secretions can migrate down the airway and are believed to be an
important cause of nosocomial pneumonia. Therefore, it is critical to
provide regular oral care with an antibacterial solution and to suction
the pharynx.19 Patients can also develop lingual swelling and
ulceration. Applying glycerin to the tongue may be beneficial in
preventing lingual drying and damage.
Ventilated patients are also at risk of muscle atrophy, pressure sores,
and nerve damage.38 Body position should be changed every 4 hours
and passive range of motion exercises performed. Adequate bedding
and heat support should be provided. Absorbent padding for urine
collection can help keep animals dry and prevent urine scalding. A
urinary catheter may be placed in patients that require precise
monitoring of urine output. Regular palpation of the colon is advised,
and enemas should be administered as needed.3
Intravenous catheters should be rewrapped daily and veins evaluated
for signs of phlebitis or infection. Catheter placement for blood
sampling is helpful because electrolytes and venous blood gasses may
be evaluated frequently.