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Nursing aspects: general

Nursing aspects: general. Early information relatives / visitors Monitoring tcPCO2, SPO2 Observation thorax vibrations (Intensity, difference L/R ) Patient disconnection as less as possible Adjustment alarmlimits Push RESET button long enough when starting ventilator.

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Nursing aspects: general

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  1. Nursing aspects:general • Early information relatives / visitors • Monitoring tcPCO2, SPO2 • Observation thoraxvibrations (Intensity, difference L/R ) • Patient disconnection as less as possible • Adjustment alarmlimits • Push RESET button long enough when starting ventilator

  2. Humidification • Standard system Fisher & Paykel • Waterlevel chamber control • Initial Setting: Patient temperature: 37 0C - 0 • Goal 1: No condensation in inspiration limb • If so: Setting to 38-1, 39-2, 40-3 • (also when too much condensation in expiration limb) • Goal 2: Slight condensation in expiration limb • Tip: Do not empty watertrap completely

  3. Nursing aspects:ET Tube suctioning • Thorough ET Suction before starting HFOV • Decrease of thoraxvibrations, increase tcPCO2 • and/or decrease SPO2: possible Mucus Accumulation • Closed ET Suction, with inline suctioning system • TIP: Oscillation stop during suctioning if mucus distal • In weaningphase HFOV: often increased need of suctioning

  4. Nursing aspects:positioning • Every position possible (Swiffel) • At least 2 nurses (risc of disconnection) • After change of position observation of thoraxvibration, SpO2 • and tcPCO2 • Re-adjustment of ventilator parameters if needed • Check ET tube position

  5. Nursing aspects:recognize complications • Partial ET Tube obstruction: decrease of thoraxvibration, increase • tcCO2 and/or decrease SPO2 • Overdistension: increase tcCO2 and/or decrease SPO2, • increase CVP and/or decrease BP possible • Pneumothorax: decrease SPO2 and/or BP, difference in thorax • vibration L/R, dissimilarity thoraxheight L/R

  6. Inhaled Nitric Oxide Therapy During HFOV

  7. Nitric Oxide: • NO is formed throughout all vascular beds ( endothelial cells ) • and in the upper airways • NO is also made by other cells( platelets, macrophages , neurons) • NO maintain normal blood vessel tone • iNO decreasing pulmonary blood flow resistance • iNO improves oxygenation

  8. Nitric Oxide: • iNO after passing the alveolar membrane and getting • in contact with red blood cells (Hb), NO is deactivated • Inhaled NO (iNO) is a selective pulmonary vasodilator • iNO has no effects on systemic blood pressure

  9. iNO Indications: Pulmonary Hypertension in : • ARDS • PPH • Cardiac surgery ( Typical clinical range of iNO < 30 ppm )

  10. 3100 A/B HFOV and iNO : • Maximized alveolar contact surface of iNO • Easy to handle (continues flow system) • (iNO concentration depends on NO flow + Bias flow) • Excellent mixing by oscillating membrane • Short contact time of iNO + O2 f.e. 20 l/min: 0.5 sec • 40 l/min: 0.25 sec

  11. NO2 formation Foubert et. Al. The Lancet vol. 339 June 27 1992

  12. iNO concentrationdepends on: • BIAS Flow • iNO Flow

  13. SensorMedics 3100A/B Gas Scavenger : - Designed to remove expiratory gas during iNO therapy -Scavenger fits around the green expiratory valve - A 15 mm external connector can be connected (via a T piece) to a vacuum system - If desired, a NO & NO2 absorber can be placed in line between scavenger and vacuum system

  14. Inlet iNO Measurement iNO

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