New Job, New Vent .. Need Help

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TerryH

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I have started a new job at a service that uses the Avian Bird ventilator. My last service used the Newport HT50. I liked the newport and was proficient with its use. Now, with the Bird, I have a pretty good understanding of the vent and its functions, but I am in a pickle.

My problem is that I am being sent on runs where the patient is on settings that i don't believe can be achieved with this vent. My last run was for a patient on Spontaneous, PS 15, Peep 5, FI02 40%. I didn't even think this vent could do PS. I know it does only 100% FI02.

I am new to this job and I am wondering what I should do in this situation. Are they accepting runs for patients this vent can not handle, or am I not understanding the vent?


Thanks in advance for your help,
Terry
 
Solution is quite simple...I would NOT be doing any transports with equipment I was unfamiliar with or not trained on. Your service has an obligation to train you on any equipment they carry.
 
I am familiar with it and trained on it. My problem is that I did not think this vent could do these settings and I want to make sure it is not a mistake on my part, and the mistake is with the company.
 
Some transport vents do not have the full array of settings, and there isn't much you can do about it. The vent we use has 2 adjustable settings, rate and volume. 3 if you count the ability to switch between adult and peds. PEEP is an attachment preset at 7.5, FIO2 100% only.

The best thing you can do is become as familiar with the vent as possible and learn about what adjustments need to be made to make up for the lack of features. If you transport a high number of vent patients it may be worth talking with your employer about a different vent.
 
Transporting vent patients requires more knowledge than just matching settings. You must understand the kind of breath being delivered and how the patient responds to it. You can often play around a bit to get the patient comfortable on different settings, but this requires time and knowledge.

As an aside, the HT50 is a far superior vent to the Bird Avian. You've got your work cut out for you.
 
This is a problem I have. The vent does not have the full array of settings most in house hospital vents do. If the patient breathes well on that vent, we do it. If the patient does not do so well, the patient stays.
 
With some patients I was able to go with SIMV and match their rate and volume to what the vent was reading and go without PS, but with this last patient he was fighting assisted breaths and the spontaneous breaths weren't doing much without PS.

Was there something else I could have done with the vent?
 
SIMV with a low mandatory rate and a small TV to allow the patient to take most of their breaths spontaneously while keeping some support to help oxygenation? The issue here is now you have DRASTICALLY increased the patient's work of breathing as he now has to suck air through the tube and circuit. Leading to fatigue, decreased tidal volumes, respiratory and metabolic acidosis, apnea and all other sorts of badness.

I don't know, hopefully one of the vent experts on here will chime in. Outside of adding on pain control and sedation to make the mandatory breaths comfortable (not always appropriate) I'm at a loss.

Out of curiosity, are these home care or acute care patients? In the acute care patient modifying the pain control and sedation package should be considered anyway, due to the stimulus the transport environment provides. In the home care setting I'd consider taking the patient's vent, it's more consistent anyway.
 
I used the Bird Avian several years ago at my old hospital. I don't remember too much about it. The things I remember is that it's volume cycled, and that you need to understand the relationship between tidal volume, the breaths/min (or maybe it was just the I-time), and the flow. For example, if your flow is set to high, the vent will cycle the breaths much faster than what you have it set at. Your rate may be 14, but the vent will be cycling at 30 or 40. Cut back the flow until you have your breaths where you want them to be. Your employer should have some literature on the vent, or at least give a decent inservice. If not, you can probably find some literature online to help you.

Also, it's good form to first set the pt up on your vent, for 20 mins or so before you move them, to make sure that they'll do well on the txp vent.
 
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Terry,

I'm somewhat new to the CCT game myself. I know the LTV, and can match settings and troubleshoot... but the LTV is a real vent in transport size.

This is one of my worries with doing CCT runs for another employer... my employer provides appropriate gear. I worry that I'll be asked to do stuff my vent can't do if I were to work for a provider that chooses to not spend money on equipment.

I would ask your clinical coordinator about this, and what the appropriate solution is. If you aren't happy with that answer, then I'd suggest you go to someone who cares (State? RT manager at sending/receiving? Action News?) and discuss the substandard care this service provides.
 
Jon said:
Terry,

I'm somewhat new to the CCT game myself. I know the LTV, and can match settings and troubleshoot... but the LTV is a real vent in transport size.
Click to expand...

The LTV is still a transport ventilator and has many limitations. It is no where close to an ICU ventilator. For CCT patients who require an ICU ventilator on transport, something like the Servo-i will be used with an ICU specialty team.

Unfortunately even those using the LTV don't add the graphics package which then decreases its ability to be used to its fullest.
 
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