Page 67 - Critical Care Nursing Demystified

52 CRITICAL CARE NURSING DeMYSTIFIED

TABLE 2–8 Ventilator Alarms
Causes Nursing Actions
Low-pressure alarms
Disconnection from Find the location of the disconnect and reconnect the
patient tubing to the patient
Underinflated Determine the LWP by minimal leak technique and
balloon of ETT or recheck the LWP. If leak continues, notify the person
tracheostomy responsible for reintubating the patient and gather
supplies to assist with the procedure.
High-pressure alarms
Tubing is kinked or Release the kink. Usually this is a situation where the
caught somewhere patient is lying on the tubing or it is accidentally caught
in the bedside rail.
Patient is biting on Insert a bite block (oral airway) so the patient can not
the ETT bite on the ETT; patient may need sedation.
Patient needs Auscultate the lung fields; suction the patient and then
suctioning reassess the lung fields. If it is an emergency, suction first!
Auscultation then can be done after clearing the airway.
Patient is anxious Use therapeutic communications to help relax the
and fighting or patient. Ask yes/no questions, which give the patient a
“bucking” the ETT sense of control. Sedatives and paralytics might be 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.
and ventilator needed as a last resort.
Change in lung Perform a physical assessment. If the lungs fill with fluid
compliance (heart failure, pulmonary edema), the patient may need
a chest x-ray (CXR), diuretic, and cardiac medications
to improve cardiac functioning. If the patient has a
pneumothorax, it is best to ventilate with a BVM until
help arrives.

and reinsert another invasive airway. This should be done by a respiratory ther-
apist or trained health care provider.
A high alarm can sound when too much pressure is needed to pump air into
the lungs. Check all ventilator tubing; sometimes the tubing is kinked or caught
in something like the bedside rails. The patient maybe biting on the airway, in
which case a bite block or sedation may be tried. The peak airway pressure
gauge should be checked. When there is nothing that can be found wrong with
the tubing, the problem may be in the patient.
A high alarm usually trips because the patient needs suctioning, is fighting
the ventilator, or there has been a change in the patient’s lung status. Mucus in
the airways impedes the delivery of gas to the patient. In other words, if you
are using a pump on a bicycle tire and there is fluid in the tire, it will require
more force to inflate the tire. The MV will deliver more force to give the