Patient-Ventilator System Checks CHSB Cardiopulmonary Department Patient-Ventilator System Checks

Objective Upon completion of this course, the participant will be able to: State the objectives for checking a mechanical ventilator Describe circumstances in which a ventilator check is indicated Verbalize contraindications and hazards associated with conducting a ventilator check Understand the importance of assessing the outcome of a ventilator check

Patient-Ventilator System Check AARC Definition: A patient-ventilator system check is a documented evaluation of a mechanical ventilator and of the patient’s response to mechanical ventilatory support (RCJournal, 1992).

Ventilator Check Objectives To evaluate and document the patient ‘s response to mechanical ventilation at the time of the check To assure and document the proper operation of the mechanical ventilator To verify and document that the ventilator is functioning and is properly connected to the patient

Ventilator Check Objectives To verify and document that appropriate alarms are activated To verify and document that inspired gas is properly heated and humidified To verify and document that inspired oxygen concentration is measured with every change in FIO2 or, at least, every 24 hours To verify and document that the ventilator settings comply with physician orders

Ventilator check: Indications A patient-ventilator system check must be performed Q2 hours in the adult and neonatal critical care units and Q4 hours on medical floors and sub-acute areas. In addition, a check should be performed: Prior to obtaining blood samples for analysis of blood gases and pH Prior to obtaining hemodynamic or bedside pulmonary function data Following any change in ventilator settings As soon as possible following an acute deterioration of the patient’s condition Any time that ventilator performance is questionable Following a patient transport

Contraindications There are no absolute contraindications to performance of a patient- ventilator system check. If disruption of PEEP results in hypoxemia, bradycardia, or hypotension, portions of the check requiring disconnection of the patient from the ventilator may be contraindicated

Hazards Disconnecting the patient from the ventilator during a patient-ventilator system check may result in hypoventilation, hypoxemia, bradycardia, and /or hypotension Prior to disconnection, preoxygenation and hyperventilation may minimize these complications When disconnected from the patient, some ventilators generate a high flow through the patient circuit that my aerosolize contaminated condensate, putting both the patient and clinician at risk for nosocomial infection

Assessment of Outcome Routine patient-ventilator system checks should prevent untoward incidents, warn of impending events, and assure that proper ventilator settings, according to physician’s order, are maintained

References RCJournal. (1992). AARC Clinical Practice Guideline: Patient-Ventilator System Checks. Retrieved from http://www.rcjournal.com/cpgs/mvsccpg.html Community Hospital of San Bernardino. (2012). Assessment and Documentation of Ventilator Care: Policy 7720.0610. Retrieved from \\chsb-nas-002a\usergroups\edu-pol\CHSB - Policies and Procedures\Clinical Services Manual\Cardiopulmonary\7720.0610 Assessment and Documentation of Ventilator Care.pdf