Ventilator ‘triage’: What to do when you hear the alarm
January 1, 1998 4 minutes read
Ventilator triage’: What to do when you hear the alarm
Six major dos and don’ts when troubleshooting ventilators
When you hear the alarm of a patient’s ventilator, a sense of anxiety frequently follows.
ED nurses need to "triage" the alarm, according to Richard Branson, RRT, assistant professor of surgery at the University of Cincinnati Medical Center (OH). Some alarms can be life-threatening and some can be nuisances, and that is where the importance of clinical assessment comes in," Branson says. With more patients being boarded in the ED while waiting for an available bed, nurses need to feel comfortable troubleshooting ventilators.
If we don’t have a bed ready for a patient, the therapist isn’t going to stay with them until they find that bed," says Robert Campbell, RRT, senior research associate at the University of Cincinnati Medical Center (OH). If there is a problem, the nurse will need to intervene until we can get there."
Here are some dos and don’ts to keep in mind when responding to ventilator alarms:
DO silence the alarm. The alarm should be silenced as quickly as you can get to the bedside, but you should never turn your back on the patient, stresses Campbell. "Some ventilators now incorporate a two-minute silencer that allows time to look for potential problems, while a flashing light indicates the probable cause," he adds.
If alarms are allowed to sound incessantly, the staff can become numb to hearing them go off, says Tom Malinowski, RCP, RRT, clinical director of respiratory care services at Loma Linda. "Hearing the alarm can also make the patient extremely anxious, which is not a good thing, " Malinowski adds.
DON’T silence the alarm by altering the controls on the ventilator. A lot of the ventilators we use now have dual function, so if you make a change in the rate, you may significantly adjust the mean airway pressure as a result and have a negative outcome," says Campbell.
DO determine what set off the alarm. ED nurses should quickly assess what’s causing the alarm to sound before calling the therapist. "Approach the problem in a systematic fashion, starting with the patient and moving backward toward the machine," Branson advises.
One of the most common alarms is low pressure, caused by airway pressure disconnect, says Malinowski. "Look to see if a tube is dislodged, or if a ventilator is disconnected from the endotracheal tube," he suggests.
High-pressure alarms usually mean one of two things, says Campbell. "Either a patient is coughing, or they’re bucking the ventilator, in which case they either need to be suctioned or sedated," he says. "High pressure alarms usually tell you to do something, and once you do it, it doesn’t alarm anymore."
DO talk to the patient. Patients who hear an alarm going off on their ventilator may become anxious, says Malinowski. "The patient may think the alarm means they are going to die, so it helps to explain what’s going on," he suggests.
Anxious patients can become "out of phase," meaning they are fighting the ventilator and breathing out of sequence, causing the alarm to sound. Speaking to these patients calmly can help, says Malinowski. "Most patients have never had the unfortunate experience of being on a ventilator, and they now have a machine breathing for them, which is very frightening," says Malinowski. "It can be very helpful to say, `I know this may feel very uncomfortable, but try to relax and let the machine breathe for you."
Often, patients assume something is wrong with their voice because they can’t talk. "You need to explain to the patient that they cannot speak at this time because a tube is in their throat, and when we take the tube out it will go away," says Malinowski.
DO consider manually ventilating a patient in immediate danger. If the patient is in trouble, you can’t wait until the respiratory therapist shows up. "Any time you see bradycardia or hypotension that is nonresponsive, disconnect the patient from ventilatory support and hand ventilate them with 100% oxygen, then trouble shoot the ventilator," says Campbell.
Although procedures vary from department to department, in some facilities nurses are allowed to increase the oxygen level if necessary. "Any time the saturation drops below 90 percent, I think it’s acceptable to turn up the oxygen as a short-term solution until the therapist arrives," says Campbell. "The patient shouldn’t be hypoxemic for an extended period until the therapist is paged and makes it down to the ED."
DON’T hesitate to call the respiratory therapist. If you’re not sure whether it’s necessary to call the therapist, err on the side of caution. "If you don’t call, the lack of communication can get everybody in trouble. Sometimes it may just be a courtesy call to give them a heads up," says Campbell. "They may say, You did the right thing, so I don’t need to come down,’ but it’s good to let them know what’s going on with the patient."
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