Handling Ventilator Alarms for Respiratory Clients

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?

  1. An anxious client who is incessantly moving around the bed and is not restrained
  2. 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.

Daily Hygiene

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.

For discussions about the other nursing-related topics, you can check our SimpleNursing website and YouTube channel.

How to Regulate Ventilator Settings (AC, SIMV, RR, FiO2)

Scenario:

Your client is on a ventilator.

Questions:

  1. How are you going to regulate that?
  2. What does that even mean?
  3. How do you make sure that the ventilator installed appropriately?
  4. What are the different modes of ventilation?

Don’t panic!

Breathe.

With Mike’s ventilator setting memorization tips, you can easily answer those questions without second-guessing yourself.

Now, to address your predicament, think of the ventilator as an air conditioning system. You want to make sure that your client’s lungs are getting sufficient air.

Things to consider

As a medical professional assigned to safeguard the condition of your client, assessing introduced air into the lungs is one of your top priorities. You don’t your client’s lung to burst by putting in more than what the lungs can handle. However, if this happens, it could lead to over inflation.

Another factor that you have to consider as a medical provider is, you have to make sure that your client is getting adequate respirations and oxygen every minute. This is what we refer to as FiO2.

Ventilator settings

Ventilator settings have two ventilator modes – the AC mode and the SIMV mode. To differentiate, AC stands for Assist-Control while SIMV is for Synchronized Intermittent-Mandatory Ventilation. The AC mode breathes for your client, pushing air down to the respiratory tracts. The SIMV mode is the “weaning mode”.

Assist-Control Ventilator Mode

As what was previously mentioned, the AC setting is a full-pledged breathing mode that aids in breathing by pushing oxygen down your client’s lungs. Equipped with an endotracheal tube (ET) or a vent, air is pushed by shoving down the tubes inside the respiratory tract and then a balloon is inflated to keep the airway open. Another route that the tube is inserted is through an opening created directly at your throat. This mode is usually seen in clients who are technically brain dead and can no longer breathe for themselves.

Synchronized Intermittent-Mandatory Ventilation Mode (SIMV)

On the other hand, if a client underwent an operation and anesthesia was required, the client will first be placed on AC mode then, as the client’s condition improves, the ventilator will be switched to SIMV mode. It has been referred to as the “weaning mode” for the reason that you would want to gradually taper ventilation until it reaches the point when the client will resume normal breathing.

Tidal Volume/Respiratory Rate

Another ventilator setting is your tidal volume which is the one responsible for pushing a given number of milliliters into the client’s respiratory system. The tidal volume is directly proportional to your client’s weight. One of the complications of the increased tidal volume is pneumothorax which is too much volume introduced down the lungs.

Remember, your respiratory rate should be between 16 to 20 breaths per minute.

Fraction of Inspired Oxygen (FiO2)

FiO2 is the amount of oxygen invested in the ventilator itself to pump your client’s lungs up with air. Normal FiO2 is between 35% to 50%. However, in the events that your client is not compensating and is not receiving the desired amount of oxygen, the FiO2 can be increased to 75% and as much as 100%.

Variables of an open airway

Aside from what was already discussed, there are other things that influence a person’s airway and of which is the Positive End-Expiratory Pressure (PEEP). PEEP maintains the alveoli open at the end of respiration. When pushing down air into the distal portions of the respiratory tracts, sometimes, the alveoli collapse; thus, increasing the oxygen supply during the exchange.

The main goal is to decrease your CO2 and increase the pH levels, making sure that the client is not acidic and not lead to respiratory acidosis. Increasing the oxygenation in the pulmonary artery oxygen (PAO2) is another goal.

Remember, anything between 80% and 100% is desirable. If that goes down to 60%, it can be criteria for acute respiratory distress.