For nurses who are unfamiliar or are relatively new to handling mechanical ventilators for clients with respiratory problems, the alarm going off can be quite stressful and can cause panic. Therefore, it is important to be appropriately oriented when handling clients who have ventilators.
Determining the Problem
There are two primary reasons why ventilator alarms go off – too little or too much pressure. So, as the nurse in charge of a respiratory client, it is essential to determine which of the two reasons is causing the alarm.
Too Little Pressure
There are a couple of scenarios that might cause decreased pressure in the mechanical ventilator. What are some examples?
- An anxious client who is incessantly moving around the bed and is not restrained
- Waking up from sedation, clients tend to pull out their tubes. There are instances wherein clients are not properly sedated, they wake up from their sedative state and pull out their tubes, extubating themselves in the process.
When there is too much movement from the client, or when the tube is purposely pulled out, the ventilator alarm will immediately start beeping, indicating that there is low pressure. The ventilator would also advise that the client should be reconnected; otherwise, the client is unable to breathe due to low pressure.
Too Much Pressure
Obstruction in the ventilator line is one of the main reasons why there is increased pressure. Coughing can also cause too much pressure inside the ventilator; this act will instantly trigger an alarm that tells you there’s increased pressure. Although coughing is not considered a blockage, it still contributes to too much pressure.
An NCLEX® Favorite
Take note that an NCLEX® question that is frequently asked regarding ventilator has something to do with a mucus plug, which is just mucus build-up, blocking the endotracheal tube. If a mucus plug gets stuck, that will cause the alarm to go off.
Therefore, if there is mucus blocking the tube, the nursing management would be to suction the client to get rid of all the secretions and maintain a patent airway, allowing the client to breathe properly. Suctioning will decrease the pressure, thereby shutting down the ventilator alarm.
When a client has an endotracheal tube attached to a mechanical ventilator, it is critical that good oral hygiene is observed. Daily cleaning of the endotracheal tube will prevent ventilator pneumonia. Ventilator pneumonia occurs when healthcare providers fail to proper ET hygiene, resulting in the introduction of bacteria into the lungs which can lead to infection.
Inside the ICU
Clients with ventilators are usually admitted to the intensive care unit (ICU). Round-the-clock oral hygiene and suctioning are forms of preventive measure that are necessary so that clients won’t develop systemic conditions like ventilator pneumonia. Oral hygiene kits like toothbrushes with an attached suction device are usually provided to keep the client’s mouth clean and at the same time, suction all the crud and mucus out.
So, don’t forget the two main reasons why ventilator alarms get triggered – too much and too little pressure. While decreased pressure is caused by dislodging of the tube, increased pressure is caused by coughing or mucus plug.
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