Question Answer
O2 Therapy Devices:Adult & Pediatric-Low flow – Nasal cannula 1.Delivered FIO2: 24%-45% 2.Flow: 1-6 L/M
O2 Therapy Devices:Adult & Pediatric-Low flow -Simple mask 1.Delivered FIO2: 40%-50% 2.Flow: 6-10 L/M
O2 Therapy Devices:Adult & Pediatric-Low flow -Partial Rebreather Mask 1.Delivered FIO2:60%-65% 2.Flow: 6-10 L/M 4. no one way valves.
O2 Therapy Devices:Adult & Pediatric-High flow-Venturi Mask/Air-entrainment device 1.DeliveredFIO2: 24%-55% 2. Works by mixing 100% O2 and room air. 3. Precise FIO2 delivery. 4. When FIO2 increases entraintment port is Decreased. 5. When FIO2 decreases the internal diameter of gas injector decreases.
O2 Therapy Devices:Adult & Pediatric-High flow- Non-breather Mask (NRB) 1.Delivered FIO2: 21-100% 2. It is a high flow device and keeps the reservoir bag from collapsing if the flow rate is High. 3. Used in Emergency cases. 4. it has one way valve that prevents from rebreathing CO2.
O2 Therapy Devices:Adult & Pediatric-High flow- In a non-breather Mask (NRB)-Why isa face seal important? 1. Face seal is important because reservoir should collapse slightly on each inhalation. A)If bag does not collapse – mask should be tightened and a better seal should be obtained. B)If bag collapses NBR valve may be stuck then – replace with a new mask.
O2 Therapy Devices:Adult & Pediatric-High flow- Aerosol Mask 1. Trach collar – fits loosely, easy to tolerate- used when T-pieceis inconvinient for the pt. due to pt. movement. 2. Aerosol mask-is only good for high flow system- otherwise air entrainment is too great and FIO2 will be decreased significantly.
O2 Therapy Devices:Adult & Pediatric-High flow- Brigg’s adapter (T-tube, T-piece) 1.Used to deliever aerosol. 2.requires a high flow supply/a pre-mixed gas. 3.Attaches @the end of an ET tube/trach tube. 4.Must see continues aerosol production during both inspiration&expiration, if cant see the flow the aerosol then Increase the flow.
O2 Therapy Devices: define Air-entrainment device These devices mix O2 and air to achieve an exact FIO2.
O2 Therapy Devices: Equipments of Air-entrainment device- 1. Venturi mask. 2. Large volume nebulizers (LVN). 3. Small IPPB macines. 4. Some pressure ventilators.
O2 Therapy Devices: Complications of Air-entrainment device 1. Impeded flow or back pressure- causes an increasein FIO2. 2. Occluded entraintment port – causes increase in FIO2.
O2 Therapy Devices: Air-entrainment device-What all cases does FIO2 Increases? 1. when puff of aerosol coming from the tubing of a LVB set @ FIO2 28%. 2. The very last part of the delivered breath from a Bird IPPB machine. 3. A king in the aerosol tubing coming from a LVB. –> All these cases FIO2 increases.
O2 Therapy Devices: Air-entrainment device- Air/O2 mixture Ratios 24%- 25:1 28%-10:1 30%-8:1 35%-5:1 40%-3:1 & 60%-1:1
O2 Therapy Devices: Air-entrainment device- Calculate Total Flow- if O2%=28%, O2 flow meter setting=6 L/min. ? if O2%=28%, O2 flow meter setting=6 L/min. Ratio for 28%=10:1. Now add the ratio parts (10+1)=11. Then multiply by the flow (11 x 6L) = TOTAL FLOW = 66L/min.
O2 Therapy Devices: Pediatric O2 therapy device O2 Tent. This is used for both pediatric & Neonatal. 1.Useful when humidity/Aerosol environment is desired 2.Highest FIO2=40-50%. 3.Flow Rate=12Lpm to flushout CO2. High fluid can cause fluid retention in pt.should monitor input-output pt. weight.
O2 Therapy Devices:Neonatal O2 therapy- O2 Tent 1. FIO2 is highest @ bottom 100% O2 is heavier than other gases. 2. If analyzed FIO2 near pt. face is difficult to keep consistant may need to ensure the plastic walls are tucked into the bed wall.
O2 Therapy Devices:Neonatal O2 therapy- O2 hood It is placed over infant’s head. Flow=7-14Lpm can deliver upto 100% O2, with an O2 blender. It comes w/ temp. probe. If hot infant become apneic. If cool causes increase in O2 consumption. It is loud inside hood causes hearing loss-use a blender than LVN
O2 Therapy Devices:Neonatal O2 therapy- Incubator 1. Only for neonates. 2. small, whole-body environment 3. precise control over environment including FI02. 4. Red-flag warning sign when suing FIO2 100%.
O2 Therapy Devices:Neonatal O2 therapy- hazards of Incubator 1)Skin Burns 2) Hearing damage-very loud noise 3)Electrical shock
O2 Therapy Devices:Neonatal O2 therapy- Radiant Warmer 1)it is open to room air 2)Not a good environment for O2 delivery. 3. must be combined with an O2 delivery device. 4) allows RT to have access to the infant to provide care. 5. useful in controlling temp.& helpful in decreasing insensible water loss.
O2 Conserving Devices:Reservoir Cannula 1. It is like a regular cannula except with a small reservoir under the nasal prongs or as a medallion reservoir inline, chest level. 2)it allows O2 be set @ a lower flow rate.
O2 Conserving Devices: Transtracheal Oxygen Catheter (TTO2) 1. It is surgically implanted thin catheter inserted thru the tracheal wall(b/w the 2nd & 3rd tracheal rings). Trachea acts a reservoir so flow may be reduce by as much as. 1/2.
O2 Conserving Devices: Transtracheal Oxygen Catheter (TTO2)-Hazards 1)Bronchospasm 2)Trauma to the trachea including bleeding 3) Risk of infection at insertion site. 4) Pneumothroax & subcutaneous emphysema upon erroneous insertion 5)Poor cleaning technique 6) Catheter may be obstructed.
O2 Conserving Devices: Transtracheal Oxygen Catheter (TTO2)- What do we do if TT02 is Obstructed? Catheter may be obstructed need to flush with saline- 1st provide O2 by nasal cannula. Then troubleshoot & find a remedy.
O2 Conserving Devices: Pulse-Dose O2 delivery It is Combined w/ specialized nasal-cannula.Humidification not required.50PSI gas source is required. System senses inhaltion,delivers pulse of O2. capable to switch to continous flow-uses continous mode when a problem is suspected. Used @homecare setting
O2 Conserving Devices: Gas Containers & Bulk Delivery Systems: Cylinders-Procedure 1)Crack Valve open before mounting regulator.2)PISS regulator is used for E Cylinder. 3)ASSS regulator is used for H Cylinder. 4)Point any glass or plastic-faced regluators away from persons while opening valve- could burst and cause harm.
O2 Conserving Devices: Gas Containers & Bulk Delivery Systems: Cylinders – Troubleshooting 1)Hissing leak sound – Tighten all connection. 2)No apparent flow-check flow using a calibrated flow sensing device
O2 Conserving Devices: Gas Containers & Bulk Delivery Systems: Cylinders- Time Factors E Cylinder = .3 H = 3.00 G= 2.41, small tanks are good care for home care patients needing mobility and as backup supply in case of concentrator failure. Do not store tanks in hot place – like trunk of car
O2 Conserving Devices: Gas Containers & Bulk Delivery Systems: Cylinders Flow Duration Formula Tank Duration(in mins.) = (Tank Pressure x Tank Factor) / Liter Flow
O2 Conserving Devices: Gas Containers & Bulk Delivery Systems: Cylinders- Bulk O2 system-1) Cylinder Manifolds it requires 2 separate banks of tanks for Primary & Reserve.(several H tanks are mounted to single manifold.)
O2 Conserving Devices: Gas Containers & Bulk Delivery Systems: Cylinders- Bulk O2 system- 2)Bulk Liquid O2 Able to store mass quantity in small space compare to tanks. Requires a backup system. Ex. H tanks. Requires a Convestion Unit. Some units are so small & easier to carry than E tanks & last longer.
O2 Conserving Devices: Gas Containers & Bulk Delivery Systems: Cylinders -O2 concentrator(molecular sieve device Requires electricity only. It produces 6L/min. Extracts O2 from room air. Must change filters & check flow regularly. Must ensure appropriate electrical load capacity of the home.Tank/a backup source of O2 is recommended. It is a device used for homecare.
O2 Conserving Devices: Gas Containers & Bulk Delivery Systems: Cylinders -Troubleshooting of O2 concentrator(molecular sieve device Check Flow & Check Circuit breaker or fuse.
O2 Conserving Devices: O2 Enhancing system: CPAP It increases surface area of the alveolar capillary membrane. Prevents soft tissues from collapsing & obstructing the airway. It facilitates use of FIO2 to accomplish the same PaO2. It can be given w/ a face mask /Nasal mask/throug an artificial airway
O2 Conserving Devices: O2 Enhancing system: Nasal CPAP Very Useful w/ infants easy & quick modality. Creates a huge leak if infant is crying. Use oral pacifier to prevent crying & keep mouth closed. It involves a nasal prongs, like a cannula.
O2 Conserving Devices: O2 Enhancing system: PEEP Works like a CPAP except used in conjunction w/ backup ventilatory rate ( mechanical ventilator)
O2 Conserving Devices: O2 Enhancing system: Mechanisms to Achieve PEEP/CPAP 1) Wate column 2) Exhalation Valve 3) Spring disk 4) Venturi
O2 Conserving Devices: O2 Enhancing system: Troubleshooting of PEEP & CPAP 1) Low Pressure = leak/insufficent flow to the sytem then increase flow. 2) High pressure = obstruction, bad CPAP/PEEP valve. Replace/Flow may be set too high
O2 Conserving Devices: O2 Blending Devices 1.Air O2 blender can accurately blend Air &O2 to exact %. Blenders will mix & deliver gas @ 50PSI 3. When using a blender & an Air-entrainment device(LVN), must set the nebulizer @100%.
Humidification & Aerosol Delivery : Passover Humidifier Gains humidity from a body of water thru evaporation as gas passes over its surface. It is not very effective. Not appropriate when using w/ mechanical vent. Or with incubated pts. Where the natural upper Airway is by passed.
Humidification & Aerosol Delivery : Bubble Humidifier The gas bubbles produce more surface area to pick up humidity. It is better than passover humidifier. Efficency depends upon water level. It involves an inlet tube w/ pop off alarm. If inlet tube is clogged pop off alarm wont funtion.
Humidification & Aerosol Delivery : How does Bubble Humidifier function can be checked? By occluding line on gasoutlet causing back pressure. If no pop-off alarm-system has a leak – tighten bottle/replace system if problem presists. If Pop-off alarm sounds w/out occlusion-check kink in the tube or for an obstruction such as H20 in the tube
Humidification & Aerosol Delivery :what happends in a Bubble Humidifier if the down tube become clogged? Pop-off will not alarm, but flow meter will read zero (compensated flow zero).
Humidification & Aerosol Delivery : Heated Cascade Humidifier Most efficient device @ creating humidity. It is commonly used w/ meachical ventilation & w/ intubated pts. It must be heated to achieve any efficiency. It can produce particles which is undesirable because it increases risk of nosocomial infection.
Humidification & Aerosol Delivery : Wick Humidifier It is efficient by expanding surface are for evaporation and humidification. It can accomplish 100% body’s humidification needs. It does not produce particles so no nosocomial infections. Some of the most common wick devices are-Concha and Fisher-paykel.
Humidification & Aerosol Delivery : Heat moisture Exchanger (HME)- other name Artifical Nose
Humidification & Aerosol Delivery : Heat moisture Exchanger (HME)- looks like what? Sponge Filter- traps heat & moisture that comes from the patient during expiration & delivers it back to the patient during inspiration.
Humidification & Aerosol Delivery : Heat moisture Exchanger (HME)- Where is it placed? placed between WYE and the patient on a mechanical ventilator circuit.
Humidification & Aerosol Delivery : Heat moisture Exchanger (HME) – Is it considered as a deadspace? Yes. It will cause the PCO2 to rise (1-2 torr)
Humidification & Aerosol Delivery : Heat moisture Exchanger (HME)- Does it cause increased ventilator pressure? Yes it will increased Ventilator Pressure.
Humidification & Aerosol Delivery : Heat moisture Exchanger (HME)- should be Remove before an in-line Aerosol or MDI therapy? Yes we must remove before a MDI therapy
Humidification & Aerosol Delivery : Heat moisture Exchanger (HME)-It is best used for ? short term humidification eg. during transport.
Humidification & Aerosol Delivery : Heat moisture Exchanger (HME)- How do you dispose? Never attempt to clean or rinse out an HME
Humidification & Aerosol Delivery : Heat moisture Exchanger (HME)- What do we do if HME is clogged on a patient? It is best to switch to a cascade/wick type humidifier. If those are not available then replace w/ a new HME.
Humidification & Aerosol Delivery : Jet Nebulizer It is a handheld or small volume neb. Reservoir sizes are different. Each devices produces different dispositions of particle sizes. It uses high pressure gases to create particle sizes 2-10microns.
Humidification & Aerosol Delivery : Reservoir Jet Nebulizer It uses the Jet Neb. Concept but combined w/ Large vol. reservoir. It is capable to deliver Aerosolized sol. w/ 1-2 Lpm flow. It is used for large doses of medications. Ability to meet humidity deficit of body is dependent upon the use of a heating source
Humidification & Aerosol Delivery :Small particle aerosol generator(SPAG) It is used to treat RSV or bronchiolitis by Ribavirin(Virazole). Produces particle size – 1.3 microns. Problems related to crysallization of the drug which can build up in circuits & clog output devices(tubing,etc)
Humidification & Aerosol Delivery :Hydrodynamic Nebulizer 1. Very effective nebulizer but not popular 2. Example nebulizer is the hydrosphere. 3. Able to meet the humidity deficit but can cause fluid overload.
Humidification & Aerosol Delivery : Ultrasonic Nebulizer Creats particles by an electrical vibrating device. Provides the most particle output but promotes fluid overload. Vibrating device is known as piezoelectric disc(clean w/ Acetic acid). Frequency of vibration cannot be set. Must have ground plug available
Humidification & Aerosol Delivery : How does Mist increase in Ultrasonic Nebulizer? 1. Increasing blower 2. Ensuring adequate fluind in reservoir. 3. Incresing amplitude of vibration .
Humidification & Aerosol Delivery : Hazards of Ultrasonic Nebulizer(Vibrating Device- Piezoelectric disc)? Cannot place a bronchodilator in the reservoir as the vibration can disrupt the molecular structure. FLUID OVERLOAD. Transient Dyspnea due to swelling of secretions(aerosol causes swelling of secretions).
Humidification & Aerosol Delivery : Centrifugal Nebulizers 1. Least effective at producing uniform particle sizes. 2. Not recommended for use . 3. Associated with high frequency of contamination.
Humidification & Aerosol Delivery : Metered Dose Inhaler’s (MDI) 1. It is portable. In mechanical ventilation -placed on inspiratory side of the circuit & b/w Y & pt. Gives uniform dosage&particle size requires pt. cooperation.Aerosol produced by pressurizing a gas or liquid in a closed canister. Spacer is recommended
Humidification & Aerosol Delivery : Why is spacer recommended for Metered Dose Inhaler’s (MDI) It minimize particles that are large by allowing them to attach to wall of chamber. Requires less time coordination w/dose, pt. can squeeze&inhale. Pt. is to take several breaths to get all the particles.High inspiratory flow rate is not optimal for pt.
What is the vast majority Mechanical Ventilators used ? Positive Pressure Devices- they are classified according to how they are powered and how inpiratory and expiratory cycles are initiated and terminated
Mechanical Ventilators: Define Volume-Cycled Ventilators 1) It will continue inspiration until a preset volume of gas is delivered. 2)It ignores the amount of pressure/time it takes to deliver the volume.
Mechanical Ventilators: What limit does Volume-Cycled Ventilators incorporate? 1)Pressue limit. Excessive pressure is harmful to pt. it causes Barotrauma. 2)i.e, inpiratory phase continues until a preset vol. is given UNLESS a predetermined pressure limit is reached 1st. 3)such vents. are called Vol.-cycled,Pressure-limited devices.
Mechanical Ventilators: Volume-Cycled Ventilators-3 examples 1) Puritan-Bennett 7200 2) PB 840 3)Bear 1000
Mechanical Ventilators: Define Pressure-Cycled Ventilators It will continue inspiration until a preset pressure is reached. 2) These machines will delivered the same pressure on every breathe regardless of the volume.
Mechanical Ventilators: What is the reason when Pressure-Cycled Ventilators incorporate minimum volume alarms? The main reason for these types of ventilators is that as lung compliance & airway resistance changes, volume is sacrificed.
Mechanical Ventilators: How does Pressure-Cycled Ventilators powered? Electrically or by gas alone.
Mechanical Ventilators: In Pressure-Cycled Ventilators increased in pressure will result in what? an Increase in volume.
Mechanical Ventilators: In Pressure-Cycled Ventilators what happens at higher levels of pressure? Theres is a diminishing return of volume .
Mechanical Ventilators: Pressure-Cycled Ventilators – 2 Examples Bird Mark and Bennett PRII are examples.
Mechanical Ventilators: What treatments are given with a Pressure-Cycled Ventilator? IPPB Treatments
Mechanical Ventilators: What limit does Pressure-Cycled Ventilators gives? Pressure-Cycled Ventilators are often pressure limited.
Mechanical Ventilators: In Pressure-Cycled Ventilators what happens when flow increases? Increased flow will decrease inpiratory time(Reverse is also true).
Mechanical Ventilators: In Pressure-Cycled Ventilators what needle shows us smooth rise to Pressure? a Monometer needle. If it does not show a smooth rise then Increase the Flow Rate.
Mechanical Ventilators: In Pressure-Cycled Ventilators Air-mix on? Air mix knob is pulled out. Gas is mixed in a venturi device. FIO2 varies from 40-80%. The chamber surrounding the venturi device will retain excess O2 from 1st breath & will then entrain that O2 on the next breath which causes increase in FIO2.
Mechanical Ventilators: In Pressure-Cycled Ventilators Air-mix OFF? Air mix knob is pushed in. FIO2=100% pure source gas. Since there is no air entrainment total achievable flow rate is less. When switching from air entrainment to 100% source gas must immediately increase the flow to compensate.
Mechanical Ventilators: In Pressure-Cycled Ventilators what is Rate Control(Expiratory time control)? Device can set a time limit on the expiratory phase, thus indirectly allowing manipulation of rate.
Mechanical Ventilators: In Pressure-Cycled Ventilators what is pressure control(the part that controls the pressure – NOT the ventilatory mode? Vol. is indirectly increased by increasing pressure. If cant reach a pressure indicates a leak -check for leaks starting @pt. (mask, lip seal). Examine for connections&holes. An increase in back pressure (coughing)causes pressure limit&will reduce volume
Mechanical Ventilators: In Pressure-Cycled Ventilators what is Sensitive Control? Lower set # -easier for pt. to initiate cycled breath. Higher #s cause an increase in pt. effort. If macine is rapidly-cycling, sensitivity may be set too low(too sensitive). If machine cycles w/o pt. effort – too sensitive. If so turn dial to higher #s.
Mechanical Ventilators: In Pressure-Cycled Ventilators what is the characterestics of Bennett PRII? 1.Output Flow=15 Lpm. Neb. Has 2 controls- expriatory&inspiratory nebulization. Neb. Gas source-100% regardless of air dilution on/off 3.Terminal flow control compensates for leaks but reduce flow & works thru air entrainment.
Mechanical Ventilators: In Pressure-Cycled Ventilators-In Bennett PRII rate control & Pressure control allows what? Rate control-allows time cycle. Pressure control will allow pressures upto 50cm H2O
Mechanical Ventilators: In Pressure-Cycled Ventilators In Bennett PRII what is Air dilution ON/OFF allows/achieve? Air dilution ON-Allows FIO2 OFF 40-80%. Air dilution OFF-achieves 100% O2.
Mechanical Ventilators: In Pressure-Cycled Ventilators- In Bennett PRII what happens to the Bennett valve? Bennett Valve is flow limited device & will close if < 1 Lpm is detected.
Mechanical Ventilators: In Pressure-Cycled Ventilators what is the characterestics of AP4 & AP5 ? It is electrically powered. It only has pressure& nebulizer control. It can deliver room air. It is good for COPD Pts. It affects volume & FIO2 when different controls are manipulated.
Mechanical Ventilators: Define Time-Cycled Ventilators Inspiration continues for a specified number of seconds. And usually incorporates a specified pressure regardless of volume delivered. Thus a time-cycled vent. Will require a set inspiratory time & pressure.
Mechanical Ventilators: Time-Cycled Ventilators are often used for? Infants
Mechanical Ventilators: In Time-Cycled Ventilator what does it incorporates to guard against exposure to excessive pressures & consequent Barotrauma ? It incorporates a Pressure Pop-off valve
Mechanical Ventilators: In Time-Cycled Ventilators what is set indirectly to set an expiratory time? Rate maybe set indirectly by setting expiratory time.
Mechanical Ventilators: Define Bilevel Ventilators? 1. Bilevel means that positive pressure is applied during both inspiratory and expiratory phases. 2. Breaths are flow triggered and also WOB is decreased.
Mechanical Ventilators: In Bilevel Ventilators what settings does it requier? Inspiratory and expiratory pressure settings.
Mechanical Ventilators: In Bilevel Ventilators what must be higher than expiratory pressures? Inspiratory pressure must be higher than expiratory pressure.
Mechanical Ventilators: In Bilevel Ventilators what is the actual ventilatory pressure and give eg.? The actual ventilatory pressure = (Inspiratory pressure – Expiratory pressure) Eg. Inspiratory Pressure = 15 cmH2O and Expiratory pressure = 8 cm H2O therefore 15-8 = 7 cmH2O.
Mechanical Ventilators: Bilevel Ventilators can be used for what all reasons? It can be used for 1. Non-invasive ventilation 2. does not need intubation. BUT, only for those that requier some assistance ww/ ventilation and NOT for those who require full ventilator support.
Mechanical Ventilators: In Bilevel Ventilators what is an Inspiratory pressure and expiratory pressure called? Inspiratory pressure – IPAP and expiratory pressure – EPAP
Mechanical Ventilators: In Bilevel Ventilators what is the brand name and the therapy name? Brand name – BIPAP and Therapy name – Bilevel therapy
Mechanical Ventilators: Bilevel Ventilators is not a good device for what patients? It is not good for pt. requiring High levels of ventilatory pressure because most machines are only capable of 20-25 cmH2O
Mechanical Ventilators: Home-use Ventilators 1. These are electricall powered vent & maybe vol./pressured cycled. 2. If pt. requires vent. More thatn 50% then a back up ven is needed. 3. Family education on CPR & vent. Operations is required. 4. Common Home vents. Are – PLV100, L6 etc.
Mechanical Ventilators: Transport Ventilators 1. Suitable for a period of time only 2.easy to carry. 3. It is fluidically powered 4. Problems in vent. Vol. & rate occurs when gas supply gets low. Not good for weaning,long term/home vent. Needs physical assesment skills during use. Only operated by RT
Mechanical Ventilators: Negative Pressure Ventilators 1. Do not require invasive devices. 2. More natural than PPV. 3. Less negative effects compared to PPV. 4. Involves a large suction device attached to the chest wall. 5. Requires a vaccum source.
Mechanical Ventilators: what happens in Negative Pressure Ventilator work when it is applied to the chest wall? It causes the diaphragm to lower and ventilation to occur. Since diaphragm has its limits of excursion, high levels of vaccum will have diminishing return on volume.
Mechanical Ventilators: In what cycle does the Negative Pressure Ventilator ventilates and what is Rate and tidal volume controlled by? Negative pressure ventilation is Time-cycled. Rate is controlled by – time of inspiration. Tidal volume is controlled by – amout of pressure applied.
Mechanical Ventilators: In a Negative Pressure Ventilators what problems occur to get a good seal? Leak b/w the chest and the device.
Mechanical Ventilators: In Preoperational Tests what all needs to be done in a ventilator before connecting to a patient? 1) Check return Tidal Volume 2) if Tidal Volume is less than delivered look for a leak & examine connection points in the circuit. 3) also ensure alarms are working. Eg. High & Low volume or pressure.
Artificial Airways: Airway Types-ET tubes It can be inserted throught the oral/nasal route.
Artificial Airways: Airway Types- Oral ET tubes route? Oral route insertion is dacilitated by the use of a Laryngoscope an stylet.
Artificial Airways: Airway Types-Nasal ET tubes route? Nasal route is performed using a Mgill forceps.
Artificial Airways: Airway Types-what are the ET tubes graduated cm markings? 1. Oral intubation – 20-24 cm @ the lips(low 20’s) 2. Nasal intubation – 25-29 cm @ the naris (High 20’s)
Artificial Airways: Airway Types-what about ET tubes cuffs? Tubes may or may not have a cuff depends on the size. Tubes below 6 andless usually do not have cuffs.
Artificial Airways: Airway Types-what are Tracheostomytubes? Long term method of reducing airway resistance.
Artificial Airways: Airway Types-different configurations of a Tracheostomy tubes 1. Fenestrated 2. Jackson Trach tube. 3. Bivona foam cuff.
Artificial Airways: Airway Types- what is a Fenestrated Tracheostomy tubes? A hole in the outercannula.Helps in talking&weaning.Inserts innercannula for resuscitation.It caps tube closed&1st deflate cuff-remove innercannula&cap the tube.deflate while talking, remove innecannula& capping.Best for pts. partially dependent on a vent
Artificial Airways: Airway Types- what is Jackson Tracheostomy tubes? 1. Used for home care and Long term pt. 2. No cuff (cannot mech. Ventilate) 3. Tube is made of silver.
Artificial Airways: Airway Types- what is a bivona foam Tracheostomy tube cuff? 1. Also called Kamen-wilkinson. 2. The cuff is oassively full means leave pilot open to amnient air to keep cuff expanded. 3. To deflate/inflate or insertion/ removal of a cuff use a syringe.
Artificial Airways: Airway Types-what is the complications with a Tracheostomy tubes? Subcutaneous Emphysema-occurs when tracheostomy tube is dislodged&adding air to subcutaneous layers of skin. It feels like crackling when palpating air. Remedy by adjusting tube back to the trachea. This happens while pt. is being moved for a bath or so.
Artificial Airways: Airway Types- Double-lumen ET tube 1. Tube has 2 cuffs w/the opening of one lumen @ the end of the tube and another opening b/w the 2 cuffs. 2. One lumen(distal) will ventilate the lung side in which it is inserted. The other lumen (proximal) will ventilate the other lung side.
Artificial Airways: Airway Types- what is Double-lumen ET tube good for and with? Good for Independent lung ventilation with 1. Bronchopleural fistulas. 2. During surger to areas of the lung (lobectomy, esophageal resection.)
Artificial Airways: Airway Types-Laryngeal Mask Airway 1. short ET w/an inflatable mask(cuff)@the end.Cuff part is inserted in the deflated mode in the hypopharnx above the trachea&then inflated. It facilitates good breathing.Not to use w/PPV causes gastric innsufflation.Pt. cooperation needed for LMA removal
Artificial Airways: Airway Types- Combitube 1. Dual lumen tube w/ 2 cuffs. 2.Used for quick intubation 3. Tube is intended to insert in Esophagus, Proximal opening in the tube gives access to the lungs. 4. It can be inserted blindly. 5.Larges cuff serves as an anchor against hard palate.
Artificial Airways: Airway Types-Oral airway 1. Usually plastic do not enter the trachea keeps airway open even if pt. is biting. 2. Proper size is distance b/w angle of jaw &tip of chin. 3. Inserted 180 Degrees from it final position then twisted into place. 4. Should not secure w/ a tape.
Artificial Airways: Airway Types- Nasal airway 1. Also called Nasal trumphet. 2.Sizes – a. Outer diameter of the airway should match inside diameter of outer naris. B.lenth should be equal todistance b/w the earlobe & the nasal septum. When too long pt. coughs – change to short tube after insertion
Artificial Airways: Airway Types- Define cuffs? Airways may or may not come w/inflatable cuffs. This varies according the tube’s size, application and function.
Artificial Airways: Airway Types- 2 Types of cuffs? 1.Large volume,Low pressure-minimizes pressure on the wall of trachea&avoids impedance of capillary blood flow& reduces the incidence of tracheal tissue damage.2. Low volume,High pressure-used on tubes that incorporate 2cuffs. (combitubes & lumenn tubes)
Artificial Airways: Airway Types- What is a cuff pressure? 1.Cuff Normal is 20 mmHg. Higher than 20 mmHg could impede blood-flow&promote tissue death. It can be monitored using a pressure manometer. If NO pressure-check connections then add air&observe a pressure rise. If NO pressure rise – then replace the tube
Artificial Airways: Airway Types- What is Minimum Occluding Technique ? MOV – adding & removing air from the cuff while ausculting over the neck. Enough air is added to stop the sound of air passing around the cuff.
Artificial Airways: Airway Types- What is Minimum leak Technique ? MLT – It is performed like the MOV. Enough air is subtracted from the cuff to allow a very small leak at the top of inspiration.
Artificial Airways: Airway Types- Insertion equipment – Larngoscope? It attaches to varies blade sizes, usually contains batteries to power a light on the blade.
Artificial Airways: Airway Types- Insertion equpiment- 2 types of Larngoscope Blades 1. Miller blade(straight blade)- a. Fits under epiglottis. B. only used for infants. 2. Macintosh blade (curved blade)- fits into the vallecula.
Artificial Airways: Airway Types- Insertion equpiment- what are the Larngoscope lights? 1. Light should turn on when blade is snapped into place. 2. If it does not turn on then a. First tighten the bulb b. try a different blade. C. change handle/handle batteries.
Artificial Airways: Airway Types- Insertion equpiment- what are the Blade sizes of a larngoscope? 1. Adult- size 3. 2. Pediatric- size 2 3. Full-term infant- size 1. 4. Pre-term infant- size 0
Artificial Airways: Airway Types- Insertion equpiment- What are other intubation assisting tools?- Stylet? 1. ONLY fot Oral intubation. 2. Insert it into the ET tube to help shape it and ease insertion.
Artificial Airways: Airway Types- Insertion equpiment- What are other intubation assisting tools?- Magill forceps 1.ONLY for nasal intubation. 2. Insert into the mouth to direct tip of a nasally inserted ET tube into the trachea 3.If asked to gather equipment for an ORAL intubation – DO NOT include magill forceps. If performing nasal intubation do not include stylet
Artificial Airways: Airway Types- What are the ET tubes sizes? 1. Adult- use the 1st number of the pts. Wght. In kg. eg. Pt weighs 72 kg then use – 7 ET tube. If 84 kg then use 8 ET tube. 2.Pre-term infant- size 2 3.Full term infant – size 3.
Pulmonary Assessment Equipments: Define Blood gas analyzers Used to make direct measurement of PCO2, PO2 an pH.
Pulmonary Assessment Equipments: Electrode Types of Blood gas analyzers 1. pH – sanz electrode. 2. PCO2 – Servinghaus electrode. 3. PO2 – Clark electrode.
Pulmonary Assessment Equipments: Calibrations of Blood gas analyzers 1. Low pH solution- 6.84 High pH solution – 7.38 2. PCO2 calibration – 5% CO2 gas. 3. Low PO2 calibration – 0% O2. High PO2 calibration – 12%/20% O2.
Pulmonary Assessment Equipments: How many hours does a QC material should be run? 8 hrs.
Pulmonary Assessment Equipments: Blood gas quality control – 3 solutions introduced for a QC material? 1. acidodic. 2. Normal and 3. Alkalotic materials.
Pulmonary Assessment Equipments: Types of graphical information on a QC device? 1. In control 2. Also in control 3. Trend 4. Shift 5. Random error. 6. Not in control.
Pulmonary Assessment Equipments: what is a CO-Oximeter? 1. It determines the amount of CO in the blood. 2. Acceptable range – 1-3% (smokers b/w – 5-15%) 3. Above 20% – CO poisoning requires treatment. 100% O2, Hyperbaric therapy etc. 4. Since analyzed in the machine, data is a spot check value.
Pulmonary Assessment Equipments: What is a Pulse-Oximeter? 1. It is a non-invasive way to measure O2 saturation. 2. It determines saturation by examining light wave lengths transmitted through the finger/ ear lobe etc.
Pulmonary Assessment Equipments: When is a Pulse-Oximeter show low accuracy or poor function? 1. High ambient light. 2. Finger nail polish. 3. Very low BP&perfusion (shock) 5.Erythema. -If suden fall is indicated SaO2 is noted-then suspect a problem w/ the probe 1 st – DO NOT increase the flow/ other intervention decision based on that data alone
Pulmonary Assessment Equipments: What is a Capnography (PECO2/PetCO2)? Measures CO2 from expired gas.It is not invasive. Uses infra-red technology. Varies about 10mmHg w/ arterial CO2(reads lower).If reading low/0 pt. needs vent. support. If capnography has no plateau on the waveform, then think about Airway resistance-COPD
Pulmonary Assessment Equipments: What is Inflection points in a Capnography (PECO2/PetCO2)? Any part of graph that changes direction is called an inflection point. 1.Normal capnograph. 2. capnograph w/ a dead space – pulmonary embolism. 3. capnograph w/ poor ventilatoion/ventilatory failure.
Pulmonary Assessment Equipments: What is Pulmonary Function Testing (PFT)? Collins water-sealed spirometer is the most effective w/meausrements of flow and volume.
Pulmonary Assessment Equipments: What is an O2 analyzer? 1. Used to measure FIO2. 2. requires calibration. 3. Should be used any time a change in FIO2 is made.
Pulmonary Assessment Equipments: What are the types of electrodes? 1. Polargraphic 2. galvanic fuel cell
Pulmonary Assessment Equipments: what is a polargraphic? 1. It requires battery and a n electrolyte solution. 2. If analyzer don’t read 100% – then change battery. 3. If analyzer don’t read and battries are good – then change electrolyte solution. ex: clark electrode.
Pulmonary Assessment Equipments: What is a galvanic fuel cell? Its a cell batery & is good & common.If not working-it could be fuel cell is consumed so change cell.DON’T change solution/battery bcoz CELL is the battery.It is affected by high pressures changes in altitude, H20 on the electrode. PAP causes high reading
Pulmonary Resuscitation Equipments: Desired characterstics? 1. self-inflating. 2. NBR valve. 3. Adjustable relief valve on pediatric models, fixed 25cmH2O on adult models. 4. Internal diameter connector of 15mm,outer diameter22mm. 5.Reservoir to maximize FIO2. 6.Shapeable, transparent& inflatable mask.
Pulmonary Resuscitation Equipments: Troubleshooting If bag collapses easily when squeezed & no chest rise replace bag & If bag is difficult to squeeze, ensure pt. valve isnt stuck, check if the problem is low pulmonary compliance. If bag is suspected faulty replace bag dont fix the problem unless no option
Pulmonary Resuscitation Equipments: Mouth-to-valve mask 1. serves as a barrier b/w pt. and provider. 2. Cross contamination from pt.s expelled air is prevented through a one-way valve. 3. Superior to mouth-to-mouth ventilation.
Pulmonary Resuscitation Equipments: Demand valve (Pneumatically powered) 1. Deliever 100% FIO2. 2. Triggers by manual button & negative inspiratory pressure produced by the pt. 3. Not sensitive to changes in lung compliance-risks a pneumothorax. 4. Too powerful for infants. 5. Associated w/ gastric insufflation.
Suctioning Equipment: Suctioning Catheter- Closed system suction catheter 1. Ballard is an eg. For closed suction device. 2. allows repeated used of the catheter-bags keep catheter sterile. 2. No discontinuance of FIO2/mechanical ventilations. 3. Useful when pt. is on high PEEP levels (no break in PEEP).
Suctioning Equipment: Suctioning Catheter- Standard Catheter 1. Must maintain sterile technique when using. 2. one-time use only. (no cleaning)
Suctioning Equipment: Suctioning Catheter- Coude Tip Catheter 1. Tip of catheter is bent slightly to facilitate entrance and suction of the left mainstem bronchous. 2. Can be twisted to direct into either bronchus. 3. requires sterile technique.
Suctioning Equipment: Catheter Size- Length 1. Nasal/Oral suctioning- 20 inches. 2. Tracheostomy suctioning- 15 inches.
Suctioning Equipment: Catheter Size- Diameter 1. should not exceed 1/2 of the internal diameter of the ET/Trach tube.
Suctioning Equipment: Catheter Size- Diameter in French Units 1. 1mm/ID of ET/Trach tube = 3 French. Ex. If Id = 6.0 mm, catheter shouldnt exceed 3.0mm i.e. 3.0mm*3 = 9 French catheter. 2.If catheter comes in 8-10 french & catheter needs to be 9 (choose smaller of 2 (8 fr.) 3. 10 & 12 Fr. Most common for adults.
Suctioning Equipment: Suction Pressure- 1. Adults: 100-120 mmHg. 2. Pediatrics: 80-100 mmHg 3. Infant: 60-80 mmHg.
Suctioning Equipment: If suction not adequate what do we do? 1. check connections 2. check collection bottle – change if full.
Suctioning Equipment: Other suction Devices 1. In-line specimen trap (luken’s trap) 2. Tonsil suction devices- a. Know as a yankauer(brand) b. also know as oral suction device. C. Useful in suctioning mouth and throat.
Equipment Cleaning- Define Disinfection? Kills pathogenic organisms.
Equipment Cleaning: Disinfection- Steam autoclave 1. No plastics. 2. Involves placement in packages prior to prodcedure.
Equipment Cleaning: Disinfection- Pasteurization 1. Done with pre-washing and hot-water soak. 2. Best to use with equipment used on patients with infectious disease such as hepatitis.
Equipment Cleaning: Disinfection- Alcohol 1. ethyl and isopropyl are effective. 2. 70-90% concentrations.
Equipment Cleaning:Define Sterilization? Kill all living organisims
Equipment Cleaning: Sterilization- Irradiation 1. Uses radioactive gamma rays. 2. DO NOT follow irradiation with ethylene oxide (ETO).
Equipment Cleaning: Sterilization- Incineration 1. Destroys equipment. 2. Useful for disposable items.
Equipment Cleaning: Sterilization- Ethylene Oxide (ETO) 1. Gas sterilization 2. Good for devices that have electrical components.
Equipment Cleaning: Sterilization- Cidex (Alkaline Gluteraldehyde) 1. Liquid. 2. Not good for electrical components. 3. Will kill all bacteri in 10 mins. 4. Will kill everything in 10 hrs. 5. Tuberculocidal in 20 mins. 6. Works by using a caustic (alkaline) pH (7.5-8.5)
Equipment Cleaning: Sterilization- Sonacide (Acid Gluteraldehyde) 1. Kills bacteria in 10 minutes. 2. Kills everything in 1 hr. 3. Uses acidic pH (2.5-3.5)
Special equipment consideration: 1.Bronchoscope – Cidex ( Alkaline gluteraldehyde) 2. IPPB machine – ETO
Biological control: 1.disposable method of determining pathogens survived a sterilization/disinfection procedure such as pasteurization. 2. If viable (able to live) spores are found, then equipments requires re-sterilized.
Infeection Control: a therapist have to use what precautions? Always use at least Universal precautions.
Infeection Control: How do we dispose an equipment? In a plastic bio-hazard waste bag. 


Question Answer
NON rebreather mask up to 70% 8 lpm or greater. The highest you can go without intubabting someone DOES NOT GO WITH HUMIDIFIER
Oxygen tent 12-15 lpm 40-50% FiO2
Factors that effect FIO2 by low flow device RR, peak insp flow, proper fit, flow going to device, size of reservoir mask
When to use CPAP patient has decrease FRC
factors determining perfromance on a O2 mask flow to mask, fit, size of reservoir
What would you use if you want 60% O2 partial rebreather
Device to add moisture humidifer
Device to particulate matter suspended in gas stream nebulizer
Highest O2? non rebreather mask
What would you use if you want 75% O2 Non rebreather (it’s the highest) it goes 70% and greater
If the sheets are covering the air entrainment device what will O2 % do? O2 will increase
IF air is completely inspired on an Ttube flow when its on maximum what do you do? use 2 nebulizers in tandem
What’s a baffle an impacting surface designed to break up large aerosol particles
What do you do to increase the humidity output of a large reservoir jet neb heat the nebulizer system
If anaylzer reads 21% when exposed to room air but only reads 64$ when exposed to 100% what do you do? change the battery
Function of a baffle in a nebulizer providing aerosol particles that are consistently small
How to calculate total flow TIC TAC TOE 100% Oxygen on left upper; 20% Air……Add 2 numbers together then x by lpm given
Oxyhood 7 or greater lpm
PRB and NRB adjust flow to where bag does not completely deflate
T-tube flowby adjust flow so you still see aerosol coming out
cannula 1-6 lpm
simple mask 5-10 lpm
Patient with tachypnea and COPD you want a FiO2 of 40%; what do you use venturi mask (because of the precise amount
Heated nebs are used to increase the H2O content of gas being delivered to airways
correct inspissated correction 100% humidity
Pulse oximeter measures saturation of 80% or greater
If pulse spirometer is troubleshooting what do you do match with HR