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Care of Child Long Term Ventilation
Care of Child Long Term Ventilation
term ventilation
-
M.Sc. 24 year student
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OBJECTIVES
= Incidence of continuous ventilation
= Goals of mechanical ventilation.
= Classification of different modes of ventilation.
ljustment on the ventilator.
Guidelines recommended during mechanical ventilation
® Monitoring child with continuous ventilation
= \VWeaning from the ventilation.
= Monitoring child with non-invasive oxygen therapy.
= Complication of continuous ventilation.
=» Nursing management of ventilated patient.
Introduction:
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Larynx Position Angles posteriorly away from glottis | Straight up and down
At level of Vocal
Narrowest Point Sub-glottic region cords
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Indication for mechanical ventilation in children
= CPAP: Amount of pressure applied to the airway during all phases of the
respiratory cycle.
= Volume control
= Pressure Control
Pressure Support-CPAP
= |The ventilator uses a set flow for a set period of time to deliver the
volume.
> ns delivered volume can vary from breath-to-breath depending upon the
actors.
Comparison of ‘volume-controlled’
and ‘pressure-controlled’ breaths
VCV PCV
Tidal volume Fixed Variable
Controlled:
The machine controls the patient ventilation according to set tidal volume and
respiratory rate . spontaneous respiratory effort of Pt. is locked out, ( patient
who receives sedation and paralyzing drugs he will on controlled Mode).
ist/control:
e Pt. triggers the machine with negative inspiratory effort. If the Pt. fails to
reath the machine will deliver a controlled breath at a minimum rate and
volume already set.
Modes of Ventilation:
SIMV:
= Machine allows the Pt to breath spontaneously while providing preset
FlO2, and a number of ventilator breaths to ensure adequate
ventilation without fatigue. SIMV can be volume or pressure
ontrolled.
Spontaneous:
= The machine is not giving pressure breath.
= The Pt. breath spontaneously.
= The Pt. needs only specific FlO2 to maintain its normal blood gases.
Initial Ventilator Settings
= Rate: 20-24 for infants and preschoolers16-20 for grade school kids
12-16 for adolescents.
= TV: 10-15ml/kg
= FiO,: 100%
= |-time: 0.7 sec for higher rates, 1sec for lower rates.
= Neurologic
= Cardiovascular
Pulmonary
Neurologic
= Patient must be able to protect his airway, e.g, have cough, gag, and
swallow reflexes.
= Level of sedation should be low enough that the patient doesnt become
apneic once the ETT is removed.
“In term and near term infants and older children who are mechanically
ventilated it is acceptable to target SoO2 between 92-95 % and in
children with cyanotic CHD SpO2 between 70 -75% are acceptable if
tissue oxygenation is good.
Respiratory Disturbances
= Devices that provide adequate oxygenation and comfort for the patient
are preferred — low flow devices
Complications
Pulmonary Gastrointestinal
= Barotrauma =» |lleus
= Ventilator-induced lung injury = Hemorrhage
Nosocomial pneumonia
= Pneumoperiteneum
= Tracheal stenosis
Renal
= Tracheomalacia
= Fluid retention
= Pneumothorax
Nutritional
Cardiac
® (Vialnutrition
=» Vyocardial ischemia
= Reduced cardiac output = Overfeeding
Troubleshooting mechanical ventilation
DOPE
= D— DISPLACEMENT OF TUBE.
= O —- OBSTRUCTION OF TUBE.
= P —-PNEUMOTHORAX
= E —- EQUIPMENT FAILURE
Care of child on ventilator is a
DAILY REVIEW
HAND HYGIENE
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CHLORHEXIDINE
CATHETER CARE
SKIN ANTISEPSIS
SITE SELECTION
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Nursing Management of Ventilated Patient
3) Prevent infections.
9) Monitor GI bleeding.
1. Promote respiratory function
= Suction as needed.
Prevent
pneumonia
Reduce
hospital
stay
Suction of an Artificial Airway
1. To maintain a patent airway.
© ORAL CARE:
a) Tooth brushing twice a day
b) Chlorhexidine rinse twice a day
fo
© EYE CARE:
a) Ventilated patient is often sedated & Increase the risk
of (muscle relaxed)
1. Exposure keratitis
2,/. Corneal ulceration
3. Infection
TT. Passive closure of eyelid, use lubricants, (artificial tear.
Prevention: eye packing, lubricating ointments and artificial
tears, antibiotics eye drops)
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® SKIN CARE:
- Apply lotion to skin
- Prevent from decubitus ulcer formation
- Change position frequently
-“ Skin care to be given, massaging to be done to increase
circulation
© Moisturizers
® Skin disinfectants(cause skin necrosis, blistering, burns)
® Povidone-iodine proved better than 70% isopropyl alcohol
in pediatric patient.
. Ineffective airway clearance R/T ET obstruction
* Suctioning sos
* Auscultate chest