VOLUMETRIC CUFF LEAK (PEEP 5)
Assessing for air movement past the tube to ensure no UAW edema or narrowing
”Alright, so last thing we’re gonna do here is just check to see if theres air moving past the tube. So I’m going to switch you into a diff mode on the breathing machine that’s gonna breathe for you so try to relax as best as you can, let the machine do the work for you”
1) Grab your syringe
2) Set up suction on yankuer
3) Open up to VC-AC
On THE PB980, MAKE SURE TO CHANGE TI BY CHANGING THE FLOW
4) Set Vt to whatever they’re breathing or their 6ml/kg IBW
5) On servo, ensure T-pause is zero
6) Change to decelerating flow waveform bc will be more comfortable for pt
7) “Alright, switching you over now, like I said try & relax, the machine is going to try & breathe for you”
8) Initiate ventilation & let this settle out for several breaths
9) Watch the VTi & make sure its delivering what you’ve set
SET UP ORAL SUCTION AT THIS POINT!!!
10) Once its the VT you’ve set or close enough, attach syringe to pilot line
11) Deflate cuff - “Alright so now I’m going to deflate the balloon on your tube, you’re gonna feel a gush of air in the back of your throat & if any secretions fly up, let my know by raising your hand & we can get that for you with suction”
12) Look at VTe when dropping the cuff
13) Reinflate the cuff & return to ORIGINAL SUPPORT MODE!!!
14) Re-attach sxn to the CS set-up
Looking for drop in Vt of > 25% between inspired & expired volumes
RE-INITIATE PREVIOUS SETTINGS & VENT MODE
-Let this settle out, make sure things are coming back
POST-ASSESSMENT
1) WOB
2) Vitals - If a little higher thats okay, we made them work little bit
3) Auscultate
Leave the room
”Alright so I’m going to take this information to the Dr. & we’re gonna discuss the next steps & see if we can remove your breathing tube. It was nice to meet you”