Page 61 - Critical Care Nursing Demystified

46 CRITICAL CARE NURSING DeMYSTIFIED

7. Assess complications of accidental disconnection, tube obstruction, frac-
tured teeth, bleeding, vocal cord paralysis and laryngospasm.
8. Teach the patient and family that communication will need to be done
via signing or writing as the ETT goes in between the vocal cords and does
not allow speech.

H ? How to Do It—Minimal Leak Technique

i
t—Mi
n
o D
o I
o
w t
The minimal leak technique is done to ensure that air flows into the lungs and not
Th e m inima l l ea k tec h ni q u e i s done t o ensu r
around an endotracheal or tracheostomy tube. This is done to determine the lat-
a r ound an endotr acheal or tr acheost om y t
eral wall pressure (LWP) against the tracheal wall. High LWP can cause tissue
e ra l wa ll pr essur e (L WP) against t h e tr ac h
breakdown and lead to necrosis and scarring. The balloon port on the end of
breakdown and lead to necrosis and scar
either device is attached to a manometer and a pressure is read. This pressure is
either device is attached to a manometer a
us
usually kept around 25 cm/H O. If the pressure is too low, air is instilled into the ually kept around 25 cm/H OIf the pres
2
port by manipulating a three-way stopcock until a tiny leak is heard during peak
ventilator inhalation. If the pressure is too high, air is bled out of the stopcock until Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
the manometer reads 25.
Once completed, the patient should have a slight leak around the ETT cuff at
highest inhalation. The nurse confirms this by listening to the side of the tracheal
wall and observing the chest rising. The slight leak should happen at the end of
chest wall expansion.

Role of CPAP and BiPAP Prior to Mechanical Ventilation (MV)

There are actions that medical and nursing staff can take that might prevent
implementing mechanical ventilation. These assistive devices are noninvasive
and can be used when nonrebreathers do not maintain a satisfactory ventilatory
level for the patient. The nurse may already be familiar with these devices,
which are used for sleep apnea in medical-surgical patients or in home care.
CPAP is continuous positive airway pressure. It is applied to the patient in a
tight-fitting mask that covers the nose and mouth in the case of a person in
respiratory distress. When the patient breathes spontaneously, a fan delivers
pressure to the patient’s airways all the time. If you imagine the alveolus as a
balloon that expands on inspiration and gets smaller on expiration, CPAP give
a positive pressure to alveoli, which keeps them expanded longer. This does two
things. First, it increases the surface area of the alveolus, thus allowing more