Ventilator use at home
Because people on ventilators with spinal cord injuries are able to live longer and healthier lives, it’s important to teach families about ventilator use in the home. With a little training and practice, most people can learn how to care for a person who is on a ventilator at home.
Here we explain important issues about the ventilator. There are many other skills related to caring for a person on a ventilator such as suctioning, tracheostomy care, assist coughing, and using an in-exsufflator, which are also covered in this section.
How a ventilator can help
A ventilator is a machine that moves air through a person’s lungs. It is attached to a trach tube in the person’s throat. It blows air or air with extra oxygen into the lung. A patient’s physician will determine how often and what settings are to be used, based on individual needs.
Because the spinal cord and its nerves help control breathing, people with a spinal cord injury in the neck area may require a ventilator. The ventilator assists with breathing by helping the diaphragm, abdominal and rib muscles move to allow air in and out of the lungs. Helping these muscles also provides the body with the ability to cough and move mucous out of the lungs and throat.
The nature of a person’s breathing problems will depend on the level of injury, the person’s general physical condition, and whether the person was a heavy smoker.
- People with a C1 or C2 injury will require a ventilator all the time because the injury is so high in the cord that it cannot send any messages to the diaphragm, rib, or abdominal muscles.
- People with C3 injuries may need a ventilator all or part of the time.
- People with C4-C8 injuries may not need a ventilator at all but are still at high risk for breathing problems.
Understanding the ventilator controls
- On/off switch: In the machine pictured here, the switch is located at far left of the bottom row. The gray square box must be pressed to turn the machine on or off. If you have two portable ventilators at home, keep one plugged into an electrical outlet at the bedside. The second portable ventilator should be hooked up to your power chair and connected to the chair battery.
- Mode of ventilation: The doctor will determine which method of ventilation will best benefit the patient’s respiratory system. The doctor will order either the assist control or the SIMV / CPAP mode.
- Breath rate: This controls how many breaths are given each minute. The number of breaths will also be ordered by your doctor. It is important to always check the rate to make sure enough breaths are being given.
- Tidal volume: This controls how much air is given in each breath. The setting is ordered by your doctor. It is important to know the tidal volume setting when doing routine ventilator checks.
- Inspiratory time: This controls how fast to deliver the set tidal volume during inhalation. The respiratory therapist will set the time.
- Pressure support: The pressure support control can only be used in the SIMV / CPAP mode. It helps wean the patient off the ventilator. This control supports each spontaneous breath the patient takes by providing extra pressure, reducing the amount of work needed by the patient to breathe. This setting is ordered by the doctor.
- Oxygen: This control will read 21% oxygen unless the patient is receiving extra oxygen in the hospital setting.
- Sensitivity: This allows the ventilator to be set according to the person’s breathing effort. The ventilator can provide 100% of the breathing work, or it can be set to assist a person who has some breathing ability. This setting will be set by the respiratory therapist.
- Lock: This will lock the settings. This control will safeguard against children changing ventilator settings in the home.
Understanding the ventilator alarms
Alarms are indicators that will let you know if something is wrong with the ventilator. When an alarm sounds, it is important that you respond to it immediately.
- Check the person to make sure they are not in distress. If they are, take them off the ventilator and use the Ambu Bag to breathe for the person. Bag the person until you find the problem. If the ventilator tubing has popped off the trach tube, simply re-attach it. If it is not something obvious, continue bagging the person and begin checking the tubing, starting where it connects to the person, and examine the tubing all the way back to the machine. If tubing has become disconnected, re-connect it.
- Check the trach cuff as you were taught. If it is low, insert a little more air and see if this stops the alarm. If you still cannot find the problem, keep bagging and call 911 for help. You will also need to call your home care company and respiratory therapist after the emergency situation is over.
- High pressure limit: This alarm tells you that there has been an increase in air pressure delivered to the lungs. It could mean that the person has too much mucous in the lungs and needs to be suctioned. It can also mean that the ventilator tubing has become kinked.
- Low pressure: This alarm tells you that there has been a drop in air pressure delivered to the lungs. It could mean that the ventilator tubing has popped off the trach tube, that there is a leak or that a piece of tubing has become disconnected. It may signal that there is a problem with the trach cuff. While this is not a ventilator problem, the alarm will still sound because there is not enough air pressure being given to the person.
- Low minute volume: This setting will be set by the respiratory therapist. When this alarm sounds, it indicates that the lung volume has dropped. Check the trach cuff pressure and examine the ventilator tubing for a leak.
- Silence/reset: Press this control to silence a ringing alarm. Press reset to return the ventilator back to patient’s usual settings.
- Set value dial: This is the large gray dial below the alarm section. When any of the settings on the control panel needs to be changed, the gray square box under the setting must be pressed, and then the set value dial is used to reduce or increase the setting. During this process, the setting number will be highlighted and the rest of the numbers on the panel will be dimmed. Once the desired number is set, press the gray square box again. To prevent unintended changes to the settings, the control lock can be pressed to lock the settings. This control will safeguard against children changing ventilator settings in the home.
The low-pressure number and low minute volume numbers will blink when there is a disconnection or leak. If this happens, check connection at the trach and all tubing connections. Check the cuff pressure of the trach tube. It might need more air. Move the vent tubing to make sure it is lying on the patient’s chest. The high-pressure alarm will beep when a patient needs to be suctioned.
An increase in the PIP level above its normal level also means that the patient needs to be suctioned.
- Airway pressure display: This is the long, rectangular window that, when select is pressed, will display several pieces of information. For example, the three most important homecare readings are PIP, for airway pressure, exhaled tidal volume and breath rate. An increase or decrease in airway pressure (PIP) can indicate that the patient needs suctioning or has an airway leak. The exhale tidal volume might need to be monitored if the patient is weaning off the ventilator.
- Power indicator: This is located in the upper right-hand corner on front of ventilator.
- During the day while the converter box is on, the external power light should be on and green.
- During the night while the ventilator is being charged, the charge status light will blink until it is fully charged, then it will become a steady amber light.
If the person is using oxygen, please note the following:
- Never smoke while oxygen is in use.
- Never place oxygen equipment near heat, electrical appliances (battery shavers are OK) or the furnace.
- Never use petroleum jelly products like Vaseline on oxygen equipment or the person.