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Oxygen Therapy

1. Periodically inspect electrical cords and cables for damage or signs of wear Discontinue use and replace if damaged To avoid electrical shock always unplug the power cord from the wall outlet before cleaning the device DO NOT immerse the device in any fluids if the device is used by multiple persons such as rental devices a low resistance main flow bacteria filter should be installed in line between the device and the circuit tubing to prevent contamination The BiPAP autoSV Advanced System One device can deliver pressures up to 25 cm H O In the unlikely event of certain fault conditions pressures of up to 35 cm H O are possible e The data obtained when using an Oximetry module accessory is not considered to be diagnostic and is not to be used in the diagnosis of a patient s condition Note Please see the Limited Warranty section of this manual for information on warranty coverage Cautions A Caution indicates the possibility of damage to the device Pins of connectors should not be touched Connections should not be made to these connectors unless ESD precautionary procedures are used Precautionary procedures include methods to prevent build up of electrostatic charge e g air conditioning humidification conductive floor coverings non synthetic clothing discharging one s body to the frame of the equipment or system or to earth or a large metal object and bonding oneself by means of a wrist strap to the e
2. New Jersey Respiratory Associates oli SNF Respiratory Managment New Jersey Respiratory Associates Inc 333B Route 46 West Suite 201 e Fairfield NJ 07004 www SeeNJRA com Tel 973 244 2190 Fax 973 244 2195 TABLE OF CONTENTS MEDICAL EQUIPMENT Stationary Concentrators Portable Concentrators Oxygen Cylinders BiPAP CPAP Medication Nebulizers THERAPY SERVICES Oxygen Therapy Pulse Oximetry Tracheostomy Care Suctioning New Jersey Respiratory Associates Nurse Competency Program NJRA Oxygen Delivery Devices Stationary Oxygen Concentrators New Jersey Respiratory Associates Nurse Competency Program Stationary Oxygen Concentrators Instruction Check Sheet Demonstrate ____ Proper placement of machine ______ Howto turn machine on ____ How to adjust flow control knob Alarm function ______ How when to clean filter __ How to care for the cabinet _____ How to attach humidifier How to analyze O2 and check liter flow Explain Indications for oxygen therapy Oxygen devices used with oxygen concentrators Safety precautions Electrical Hazards Nurse Instructor Date NJRA Stationary Oxygen Concentrators Overview 1 Oxygen concentrators are use for residents on continuous oxygen Liter flow is from 1 10 Ipm wey Concentrator should be placed 12 18 inches away from wall to insure proper ventilation of machine Rear filter should be checked daily and cleaned with soap and
3. Regularly examine the inlet filters as needed for integrity and cleanliness 1 If the device is operating stop the airflow Disconnect the device from the power source 2 Remove the filter s from the enclosure by gently squeezing the filter in the center and pulling it away from the device 3 Examine the filter s for cleanliness and integrity 4 Wash the gray foam filter in warm water with a mild detergent Rinse thoroughly to remove all detergent residue Allow the filter to air dry completely before reinstalling it If the foam filter is torn replace it Only Respironics supplied filters should be used as replacement filters 5 If the white ultra fine filter is dirty or torn replace it 6 Reinstall the filters inserting the white ultra fine filter first if applicable CAUTION Never install a wet filter into the device You must ensure sufficient drying time for the cleaned filter Cleaning the Tubing Clean the tubing before first use and daily Disconnect the flexible tubing from the device Gently wash the tubing in a solution of warm water and a mild detergent Rinse thoroughly Air dry Service The device does not require routine servicing WARNING If you notice any unexplained changes in the performance of this device if it is making unusual or harsh sounds if it has been dropped or mishandled if water is spilled into the enclosure or if the enclosure is broken disconnect the power cord and discontinue use Contac
4. Use only Invacare filters DO NOT operate unit without an air filter Part No 1148073 25 Invacare Select NJRA SECTION 5 TROUBLESHOOTING SECTION 5 TROUBLESHOOTING PROBLEM SOLUTION Device does not Make sure the plug is firmly fitted to the wall socket switch ON 2 Try plugging into another wall socket that is known to work 3 Contact your Invacare dealer Make sure that the ends of the air tubing are fitted tightly onto the main unit and onto the nebulizer 2 Check whether the nebulizer is empty of medication or has too much medication MAX 6ml 3 Check whether the nebulizer nozzle is obstructed 4 Check whether the funnel is inserted If these possible solutions DO NOT work contact your Invacare dealer Device does not nebulize or it nebulizes weakly Invacare Select 26 Part No 1148073 New Jersey Respiratory Associates Nurse Competency Program Oxygen Therapy Overview Application Devices New Jersey Respiratory Associates Nurse Competency Program NJRA Oxygen Therapy Instruction Check Sheet Demonstrate ____ FlO2 concentration delivery methods e Nasal Cannula e Venturi Mask e Simple Mask e Non Rebreather mask ___ Adequate liter flow for e Nasal Cannula e Venturi Mask e Simple Mask e Non Rebreather mask Explain _ The danger of high concentrations of oxygen with residents with known history of COPD _ Which devices can only be us
5. anatomical irregularities or coagulation problems Bedside tracheotomy can be preferable because it allows for continuity of monitoring causes less upheaval for the patient and costs less than a tracheotomy in the operating room The risks involved during each of these procedures are similar They are related to reactions to medication and anesthesia uncontrollable bleeding respiratory problems and the possibility of cardiac arrest SIMS Portex 1998 Caulfield amp Astle 2003 Generally 6 of patients have post procedural complications such as abnormal bleeding or wound infection Reasons for a Tracheotomy Inherited abnormality of larynx or trachea Blockage of airway by tumor foreign body soft tissue swelling or collapse of throat structure Severe neck mouth or throat injuries Inability to swallow or cough Ineffective expulsion of respiratory secretions Long term unconsciousness coma Need for long term Imperatore et al 2004 In one study comparing surgical tracheotomy patients with PCT patients the PCT patients show a lower incidence of these complications SIMS Portex 1998 Caulfield amp Astle 2003 mechanical ventilation Post Procedural Care The first two days following tracheotomy are especially uncomfortable for your patient Your patient is adjusting to the trauma of surgery the pain of a fresh incision the presence of a foreign object in the trachea and the inability to communicate
6. 2008 The Royal Marsden Hospital Manual of Clinical Nursing Procedures 7th edn Oxford Blackwell Publishing Higgins D 2005 Tracheal suction Nursing Times 101 8 36 37 Pryor J A Prasad S A 2001 Physiotherapy for Respiratory and Cardiac Problems Adult and paediatric Edinburgh Churchill Livingstone nn For more Practical Procedures log on to nursingtimes net and click on NT Clinical and Archive Reconnect any oxygen or nebulisers O Reassess the patient and repeat the procedure if necessary Dispose of equipment according to local policy and wash hands Document the procedure detailing the amount and type of any secretions n 17
7. Figure 2a The ratio of red to infrared light that passes through the measurement site and is received by the oximeter s detector depends on the percentage of oxygenated versus deoxygenated hemoglobin through which the light passes Figure 2b 2 The percentage of oxygen saturation thus calculated is referred to as the percent SpO 3 Figure 2 Pulse Oximeter Function Percent SpO2 7 60 50 a Red Infrared a A pulse oximeter noninvasively measures oxygen b The ratio of red to infrared light yields the saturation by shining light through a digit or earlobe oxygen saturation or SpO Table 1 Evaluation of SpO measurements o An SpO of greater than 95 is generally considered to be normal o An SpO of 92 or less at sea level suggests hypoxemia Ina patient with acute respiratory illness e g influenza or breathing difficulty e g an asthma attack an SpO of 92 or less may indicate a need for oxygen supplementation In a patient with stable chronic disease e g COPD an SpO of 92 or less should prompt referral for further investigation of the need for long term oxygen therapy 5 6 Pulse oximetry can be a useful aid to clinical decision making but is not a substitute for a clinical assessment nor sufficient for diagnosis by itself 4 Arterial blood gas measure ments obtained by arterial puncture remain the gold standard for measurement of oxygen saturation 2 Pulse oximetry is valuable
8. Indicator light A a A YELLOW Solid to 85 42 B YELLOW Flashing Sensor Failure Call a qualified technician Have a back up supply of oxygen ready SYSTEM FAILURE RED Indicator Light O Below 73 43 Continuous Audible Alarm Sieve GARD Compressor Shut down Call a qualified technician Switch to a back up supply of oxy gen immediately Part No 1118353 21 Platinum Series New Jersey Respiratory Associates Nurse Competency Program NJRA SECTION 5 OPERATING INSTRUCTIONS Front Panel Indicators Units without SensO NOTE For this procedure refer to FIGURE 5 8 Auto Shut Down Use Backup A o Call Supplier Normal 1 0 Q GREEN FIGURE 5 8 Front Panel Indicators Units without SensO2 Initial Startup of the Concentrator NOTE Concentrator may be used during the initial start warm up time approximately 30 min O purity will build to a maximum during this period LABEL STATUS INDICATOR LIGHTS SYMBOL LED SYSTEM OKAY GREEN Indicator Light SYSTEM FAILURE RED Indicator light Continuous Audible Alarm Sieve GARD Compressor Shutdown Call a qualified technician Switch to a back up supply of oxygen immediately Platinum Series 22 Part No 1118353 Oxygen Delivery Devices Portable Oxygen Concentrators New Jersey Respiratory Associates Nurse Competency Program NJRA Portable Oxygen Concentrators Training Check Sheet Demonstrate ____ Proper placement of
9. NJRA Oxygen Cylinders Instruction Check Sheet Demonstrate ____ How to set up all oxygen devices on resident ____ Proper set up of humidifier bottle with oxygen devices show common leak areas __ How to change regulator on O2 cylinders _ How to read gauges Explain _ Safe storage of 02 cylinders _ Safe handling of 02 cylinders Nurse Instructor Date Oxygen Cylinders Overview 1 Before connecting equipment to a cylinder be certain that the connections are free of foreign materials 2 Turn valve outlet away from personnel and crack cylinder valve to remove any dust or debris from cylinder valve 3 Outlets and connections must be tightened with only appropriate wrenches and must never be forced on 4 Regulators should be turned off as cylinder is turned on and the cylinder valve should be opened slowly Cylinder valves should be closed at all times except when they are in use Never lubricate valve outlets or connecting equipment oxygen and oil under pressure causes an explosive oxidation reaction 7 Cylinder valves should be closed at all times except when they are in use New Jersey Respiratory Associates Nurse Competency Program NJRA Oxygen Cylinders Operation Instructions Small Cylinder 1 Open the cylinder by turning the cylinder valve handle counter clockwise left all the way Large round handle directly on top of tank 2 The contents pressure gauge will register the amount of oxygen in the
10. WHERE THE DEVICE IS USED USE ONLY WITH A GROUNDED 3 PIN RECEPTACLE DO NOT REMOVE THE GROUNDING PIN FROM THE POWER CORD USE ONLY WITH SEQUAL SUPPLIED POWER CORDS DO NOT CONNECT THE ECLIPSE TO AN EXTENSION CORD POWER STRIP OR TO AN ELECTRICAL OUTLET CONTROLLED BY A SWITCH ALWAYS DISCONNECT AC POWER SUPPLY FROM THE WALL BEFORE DISCONNECTING THE AC POWER SUPPLY FROM THE ECLIPSE DC Power Supply A DC Power Supply allows the system to operate from DC i outlets such as those found in motor vehicles 1 Start your vehicle 2 Insert the DC cord into the recessed power receptacle on the side of the device Item 5942 3 Insert the DC Power Supply plug into the DC power 14 outlet in your motor vehicle m S eC 4 p SA 5 Personal Ambulatory Oxygen System Users Manual Mie S autoSAT Rechargeable Power Cartridge Battery item 7082 RECHARGEABLE POWER CARTRIDGE Battery The Eclipse can be powered by the recharge able Power Cartridge Battery which is supplied with the device Installing the Battery Align the Battery so that it will slide into the empty Power Compart ment Push the Battery into the empty Power Compartment until it locks clicks into position and is flush with the back of the device When the Battery is properly installed and the Eclipse is ON the Battery Status Gauge will appear on the Control Panel If you DO NOT have a Battery installed the Power Cartridge Status Gauge will not illumin
11. WIE 17 ZANDER DO NOT TAMPER WITH CRUSH DISASSEMBLE INCINERATE OR HEAT THE BATTERY ABOVE 140 F 60 C DOING SO WILL VOID THE WARRANTY THE BATTERY MAY PRESENT A RISK OF FIRE EXPLOSION OR CHEMICAL BURN IF MISTREATED SARIGI DO NOT LEAVE YOUR ECLIPSE OR YOUR BATTERY IN THE SEATING AREA OF YOUR MOTOR VEHICLE OR IN THE TRUNK OF YOUR MOTOR VEHICLE DURING A HOT DAY NOTE THE STORAGE TEMPERATURE RANGE FOR THE DEVICE IS 4 F 20 C TO 140 F 60 C AND 95 NON CONDENSING HUMIDITY ONLY USE SEQUAL PROVIDED BATTERIES Batteries are recyclable In the event of an AC or DC power interruption the Eclipse will automatically switch to Battery operation as long as the Battery is present and charged When AC power is restored the Bat tery will automatically start recharging if not fully charged If the Battery is not present or fully discharged during an AC power interruption the Eclipse will shut down and alarm The Battery is fully discharged when the Power Cartridge Status Gauge on the control panel is no longer illuminated The device will sound a low Battery alert until the device completely shuts down This audible alert may continue for up to 5 minutes until the device shuts down NOTE Press and hold the Eclipse ON OFF button for a minimum of 5 seconds to silence the Loss of Power alarm Connecting the Eclipse to an external AC power supply for 2 minutes will also eliminate this alarm TYPICAL NEW POW
12. a monthly basis even at home using a clean technique In the hospital however safety requires two people using sterile technique for inserting a new tube The initial tube change is usually done by a physician SIMS Portex 1998 Be sure that your patient has not eaten or received a tube feeding at least an hour before this procedure For cuffed tubes test the cuff by inflating and deflating before inserting it Always use the obturator for a smooth guide to insertion 10 New Jersey Respiratory Associates Nurse Competency Program NJRA Eating and Communication A tracheostomy will not prevent a patient from eating although some patients may have concurrent swallowing problems that need evaluation by an otolaryngologist or speech pathologist Patients may have poor appetite because of disease or in reaction to copious respiratory secretions Suctioning prior to meals is helpful Inability to speak is anxiety provoking for most patients and you need to devise some alternative methods of communication until long term speaking solutions are initiated Your patients require an extra measure of sensitivity in the first few days post tracheotomy while they are coping with choking sensations and pain A call button available is crucial You may try a writing pad or at least a yes no system to communicate COMPLICATIONS Complications from a tracheostomy can arise in the first few days or within several weeks Initially the most common
13. base of the mask e Venti masks can deliver FIO2s like 24 28 31 35 40 and 50 e Particularly effective in treating patients when there is a danger of respiratory depression from excessive 02 concentrations e Some disadvantages o Feeling of claustrophobia o Removal of masks by patients so they can eat or cough o Requires a high flow of oxygen and not practical for home use Note DO NOT RUN VENTIMASKS OFF OF OXYGEN CONCENTRATORS THEY MUST BE RUN OFF OF OXYGEN TANKS Simple 02 Masks e Delivers approximately 50 02 e Flow must be at least 5 8 LPM so that the patient does not accumulate CO NOTE DO NOT RUN ANY MASKS OF THE OXYGEN CONCENTRATOR THEY DO NOT PROVIDE ENOUGH PRESSURE RUN ALL MASKS OFF OF THE OXYGEN TANK Non Rebreather masks e Has a reservoir bag attached and delivers around 90 02 e Requires a high flow to keep the reservoir bag fully inflated when the patient takes a deep breath 10 12 LPM NOTE DO NOT RUN THE MASK OFF OF THE OXYGEN CONCENTRATOR THEY DO NO PROVIDE ENOUGH PRESSURE RUN ALL MASKS OFF OF THE OXYGEN TANK New Jersey Respiratory Associates Nurse Competency Program Therapy Services Pulse Oximetry New Jersey Respiratory Associates Nurse Competency Program Pulse Oximetry Instruction Check Sheet Demonstrate _____ How to turn oximeter on and off ______ How to turn oximeter on and off ____ Placement of Finger Probe _____ Proper cleaning technique of finger probe _ How to read re
14. before turning on the oxygen Turn the oxygen off before turning the device off This will prevent oxygen accumulation in the device Explanation of the Warning When the device is not in operation and the oxygen flow is left on oxygen delivered into the tubing may accumulate within the device s enclosure Oxygen accumulated in the device enclosure will create a risk of fire Oxygen supports combustion Oxygen should not be used while smoking or in the presence of an open flame When using oxygen with this system the oxygen supply must comply with local regulations for medical oxygen Do not connect the device to an unregulated or high pressure oxygen source Do not use the device near a source of toxic or harmful vapors Do not use this device if the room temperature is warmer than 35 C 95 F If the device is used at room temperatures warmer than 35 C 95 F the temperature of the airflow may exceed 43 C 109 F This could cause irritation or injury to your airway Do not operate the device in direct sunlight or near a heating appliance because these conditions can increase the temperature of the air coming out of the device If you notice any unexplained changes in the performance of this device if it is making unusual or harsh sounds if it has been dropped or mishandled if water is spilled into the enclosure or if the enclosure is broken disconnect the power cord and discontinue use Contact your home care provider
15. below 0 5 L min for Platinum 5 1 L min for Platinum 10 for more than about one minute the LOW FLOW alarm will be triggered This is a rapid beeping of the audible alarm Check your tubing or accessories for blocked or kinked tubing or a defective humidifier bottle After rated flow is restored more than 0 5 L min for Platinum 5 1 L min for Platinum 10 the LOW FLOW audible alarm will go off NOTE The use of some accessories such as the pediatric flowstand and the HomeFill compressor will deactivate the Low Flow Alarm a D SS So A Ball a FIGURE 5 6 Flowrate Platinum Series 20 Part No 1118353 SECTION 5 OPERATING INSTRUCTIONS Front Panel Indicators Units with SensO NOTE For this procedure refer to FIGURE 5 7 The SensO feature monitors the purity of oxygen generated by the oxygen concentrator If purity falls below factory preset standards indicator lights on the control panel will illuminate OXYGEN PURITY Auto Shut Down Use Backup A o RED qa Supplier Below Normal A YELLOW Normal 0 0 GREEN FIGURE 5 7 Front Panel Indicators Units with SensO2 Initial Startup of the Concentrator NOTE Concentrator may be used during the initial start warm up time approximately 30 min while waiting for the O purity to reach maximum LABEL O PURITY INDICATOR LIGHTS SYMBOL LED SYSTEM OKAY GREEN Indicator Light O over 85 2 O Between 73 3 YELLOW
16. condition An immediate response is necessary Refer to the Troubleshooting Table and contact your home care provider Flow Setting Indicator This is the main focus on your control panel Your home care provider will correctly set your prescribed flow for the Continuous Flow Mode LPM and or your Pulse Dose Mode mL settings Each time you power the device ON the previous mode and or setting has been saved and will be used at start up Power Cartridge battery Status Gauge This indicator displays the charge remaining in the battery Each of the five horizontal gray bars represents approximately 20 of the total battery charge When the battery is being charged the charge indicator bars wiil blink in a waterfall type fashion if the battery is not installed or if it is improperly installed the Power Cartridge battery Status Gauge will not be illuminated External Power Indicator When the Eclipse is properly plugged in and is using the AC or DC Power Supply this indicator will appear on the User Control Panel Buzzer An audible alarm or buzzer is used to alert you to the operating condition of 11 the device either a warning or failure and to confirm a valid key press by the user NJRA cli 10 SG ases Personal Ambulatory Oxygen system Users Manual Ns 7 autoSA PLACE THE DEVICE IN A WELL VENTILATED AREA THAT PROVIDES ADEQUATE AIR MOVEMENT PERIODICALLY CHECK IF AIR IS BEING PREVENTED FROM ENTERING OR EXITING TH
17. cord here Filter Area A reusable gray foam filter must be placed in the filter area to screen out normal household dust and pollens A white ultra fine filter can also be used for more complete filtration of very fine particles Side Cover If using a humidifier with the device this side cover can be easily removed with the release tab before attaching the humidifier Refer to the humidifier manual When not using a humidifier this cover must be in place on the device 4 User Manual New Jersey Respiratory Associates Nurse Competency Program NJRA Installing the Air Filters CAUTION A properly installed undamaged gray foam filter is required for proper operation The device uses a gray foam filter that is washable and reusable and an optional white ultra fine filter that is disposable The reusable filter screens out normal household dust and pollens while the ultra fine filter provides more complete filtration of very fine particles The reusable gray foam filter and the optional disposable ultra fine filter are supplied with the device If your filters are not already installed when you receive your device you must at least install the reusable gray foam filter before using the device To install the filter s 1 If you are using the white disposable ultra fine filter insert it into the filter area first mesh side facing in towards the device 2 Insert the required gray foam filter into the filter area after the ultra fine
18. creates a serious electrical shock hazard All disassembly and maintenance of this unit MUST be done by a qualified technician Routine Care To keep your device in the best condition and protect the unit from damage follow these directions e DO NOT subject the device or the parts to any strong shocks such as dropping the device on the floor DO NOT store the device in extreme hot or cold temperatures high humidity or under direct sunlight Storage Store the repackaged device in a dry and safe area DO NOT place other objects on top of the repackaged device Invacare Select 24 Part No 148073 New Jersey Respiratory Associates Nurse Competency Program SECTION 4 MAINTENANCE Nebulizer Change The nebulizer is designed for single patient use The nebulizer MUST be replaced after a long period of inactivity or when it is obstructed by dry medication dust etc Reusable nebulizers should last from six months to one year with general use Refer to the nebulizers owner s manual Disposable nebulizers should last 30 days For disposable nebulizers it is recommended that an extra nebulizer be kept at all times Refer to the disposable nebulizer s owner s manual Filter Change 1 The filter MUST be replaced after approximately 30 hours of use or when it turns grey 2 Open the filter holder to replace the filter with a new one CAUTION DO NOT use cotton or any other material DO NOT wash or clean the filter
19. cylinder a full cylinder registers approximately 2200 psi 3 Adjust the flow control knob until the flow indicator is at the prescribed flow rate flow control knob located directly on tank regulator This is where oxygen tubing attaches 4 Fit the cannula to your face so that it is comfortable 5 When not using the oxygen remove your cannula Close the cylinder by turning the valve handle clockwise all the way 6 The flow of gas will cease when all the oxygen pressure is released from the regulator Both gauge indicators will read 0 7 Turn the flow control knob off Large Cylinder 1 Open the cylinder by turning the cylinder valve handle counter clockwise left all the way Large round handle directly on top of tank 2 The contents pressure gauge will register the amount of oxygen in the cylinder a full cylinder registers approximately 2200 psi 3 Adjust the flow control knob until the flow indicator is at the prescribed flow rate flow control knob located directly on tank regulator This is where oxygen tubing attaches 4 Fit the cannula to your face so that it is comfortable 5 When not using the oxygen remove your cannula Close the cylinder by turning the valve handle clockwise all the way 6 The flow of gas will cease when all the oxygen pressure is released from the regulator Both gauge indicators will read 0 7 Turn the flow control knob off Oxygen Cylinders Storage and Transportation Stora
20. in triaging potentially hypoxic patients in the home office and clinic or hospital settings to determine which patients should have arte rial blood gas measurements CURRENT CLINICAL USES OF PULSE OXIMETRY A small but growing body of research detailed in Table 2 is establishing the usefulness of pulse oximetry in primary care particularly but not exclusively for the management of acute and chronic respiratory disease In patients with COPD pulse oximetry is useful in stable patients with severe disease FEV lt 50 predicted and in patients with worsening symptoms or other signs of an acute exacerbation as a tool for patients to use at home to assist with their management under physician guidance It is important to note that pulse oximetry complements rather than competes with spirometry in the assessment of COPD patients Spirometry remains the gold standard for diagnosing and staging COPD while pulse oximetry provides a method for rapid assessment especially of short term respiratory compromise In patients with asthma pulse oximetry complements peak flow meters in assessing the severity of asthma attacks exacerbations and response to a treatment In patients with acute respiratory infection pulse oximetry is useful in evaluating the severity of the illness and in conjunction with other criteria determining whether and how to refer patients for further treatment Table 2 gives further details about the recommended indi
21. machine _____ How to turn machine on ____ How to adjust flow including pulse dose settings _____ How to change and charge battery ______ How to attach to cart and wheelchair _____ Alarm function ____ How when to clean filter _ How to analyze O2 and check liter flow Explain _ Indications for oxygen therapy _ Oxygen devices used with oxygen concentrators _ Safety precautions Electrical Hazards Nurse Instructor Date Portable Oxygen Concentrators Overview 1 Portable oxygen concentrators are used for mobile residents requiring continuous or pulsed oxygen 2 Portable oxygen concentrators can operate using A C D C or battery power 3 Extra batteries are always available on the desktop charger 4 Continuous liter flow is from 1 3 LPM and Pulse Dose ranges from FIO2 settings from 25 45 5 Rear filter should be checked daily and cleaned with soap and water as needed 6 Humidifiers may be used on concentrators 7 Oxygen delivery devices and humidifiers should be changed weekly 8 There is no smoking allowed anywhere where oxygen is used Post a NO SMOKING sign 9 Oxygen therapy should be used carefully in residents with COPD due to the possibility of hypercarbia 10 Alarm will sound when electrical source is disconnected or battery is low on charge New Jersey Respiratory Associates Nurse Competency Program NJRA Portable Oxygen Concentrators Instructions 1 Make sure unit is either plugged in or b
22. maximal tidal volume a Obtain a 02 Saturation to establish the potential 02 deficit 2 Place patient on 02 up to 4lpm If patient s 02 saturation does not improve or if the patient is still having trouble breathing place the patient on a simple mask at 6 8 lpm 3 If the patient is in severe distress place the patient on a non Rebreather 4 Mask at 10 12 Ipm COPD Patients 1 Place the patient on a nasal cannula at 2 Ipm unless otherwise instructed by the physician 2 Make sure the patient is in a proper sitting position and encourage thepatient to take slow deep breaths and practice pursed lip breathing 3 Try to keep the patient s room cool too much heat can cause shortness of breath ina COPD patient NOTE THESE ARE VERY GENERAL GUIDELINES EVERY PATIENT NEEDS TO BE ASSESSED INDIVIDUALLY TO DETERMINE THERE OWN OXYGEN REQUIREMENT Oxygen Therapy Delivery Devices Nasal Cannulas e Most commonly used device e Nasal passages must be patient e Mouth breathing does not affect the 02 delivery too much because the 02 flows into the oropharynx e Humidifier bottles may be used be sure that all connections are tight to avoid leakage e Estimated Fi02 o 1L 24 o 4L 35 o 2L 28 o 5 6L 40 o 3L 32 Venti_Masks e Designed to deliver an exact prescribed dose of oxygen COPD patients with CO2 retention e By changing the valve or orifice size the FIO2 can be varied This is achieved by entraining room air through ports at the
23. messages and to confirm that certain actions have occurred for example when an SD card is inserted or removed from the device Device Inoperative When a device inoperative alarm occurs a continuous audible indicator sounds The alarm descriptions later in this manual display this indicator as EN e Power Failure When a power failure occurs a series of beeps sounds in a 1 beep pattern repeating one second on then one second off The alarm descriptions later in this manual display this indicator as High Priority When a high priority alarm is active a series of beeps sounds in the following pattern which is repeated twice 3 beeps a pause and then 2 more beeps This indicator continues until the cause of the alarm is corrected or the audible alarm is silenced The alarm descriptions later in this manual display this indicator as see eo cee so Medium Priority When a medium priority alarm is active a series of beeps sounds in a 3 beep pattern This pattern repeats until the cause of the alarm is corrected or the audible alarm is silenced The alarm descriptions later in this manual display this indicator as e e e Low Priority When a low priority alarm is active a series of beeps sounds in a 2 beep pattern This pattern repeats until the cause of the alarm is corrected or the audible alarm is silenced The alarm descriptions later in this manual display this indicator as Informational Messages and Confirmation Audi
24. off This will prevent oxygen accumulation in the device Oxygen supports combustion Oxygen should not be used while smoking or in the presence of an open flame When using oxygen with this system the oxygen supply must comply with local regulations for medical oxygen Do not connect the device to an unregulated or high pressure oxygen source Supplying DC Power to the Device The Respironics DC Power Cord can be used to operate this device in a stationary recreational vehicle boat or motor home The Respironics DC Battery Adapter Cable when used with the DC Power Cord enables the device to be operated from a 12 VDC free standing battery CAUTION When DC power is obtained from a vehicle battery the device should not be used while the vehicle s engine is running Damage to the device may occur CAUTION Only use a Respironics DC Power Cord and Battery Adapter Cable Use of any other system may cause damage to the device Refer to the instructions supplied with the DC Power Cord and adapter cable for information on how to operate the device using DC power User Manual 17 Traveling with the System When traveling the carrying case is for carry on luggage only The carrying case will not protect the system if it is put through checked baggage For your convenience at security stations there is a note on the bottom of the device stating that it is medical equipment and is suitable for airline use It may be helpful to bring t
25. oxygenate and or provide mechanical ventilation on a long term basis Mechanical ventilation is the second most frequent ICU intervention following treatment of cardiac arrhythmias Fenstermacher amp Hong 2004 About a third of ICU patients are on ventilators for up to six days Those who cannot be weaned off in a few weeks are switched from endotracheal tubes to tracheostomy tubes for airway management TRACHEOTOMY PROCEDURES Tracheotomy performed in the operating room surgical tracheotomy is done under general anesthesia Two or three tracheal cartilage rings are exposed and cut so that a trach tube can be inserted Retention sutures are often placed in the cartilage with the ends taped to the patient s skin Percutaneous dilatational tracheotomy PCT or PDT is done at the patient s bedside usually in the ICU The patient is sedated with a narcotic and or tranquilizer Under local anesthesia a large bore needle is inserted into the trachea A guide wire is placed in the opening and a series of dilators placed over the guide wire to create a stoma into which a trach tube is inserted This procedure takes approximately 15 minutes A third procedural choice is surgical tracheotomy done at the bedside Imperatore et al 2004 This is a compromise solution that reduces the number of patients having to go to the OR Percutaneous dilatational tracheotomy is contraindicated in a quarter of patients requiring tracheotomy mostly due to
26. place it ona soft surface such as a bed or couch where the air opening may be blocked Keep the openings free from lint hair and the like Keep unit at least 3 inches away from walls draperies furniture and the like You may select a room where using your oxygen concentrator would be most convenient Your concentrator can be easily rolled from room to room on its casters The air intake of the unit should be located in a well ventilated area to avoid airborne pollutants and or fumes DO NOT place in a closet Platinum Series 16 Part No 1118353 SECTION 5 OPERATING INSTRUCTIONS Set Up Plug in Power Cord Plug in power cord to an electrical outlet A POLARIZED PLUG WARNING As a safety feature this appliance may have a polarized plug one blade is wider than the other This plug will fit in a polarized outlet only one way If the plug does not fit fully in the outlet reverse the plug If it still does not fit contact a qualified electrician DO NOT attempt to defeat this safety feature Connect Humidifier If So Prescribed A WARNING DO NOT overfill humidifier DO NOT reverse the oxygen input and output connections Water from the humidifier bottle will travel through the cannula back to the patient NOTE For this procedure refer to FIGURE 5 1 FIGURE 5 2 and FIGURE 5 3 on page 18 and FIGURE 5 4 on page 19 NOTE For Platinum 5 XL recommended humidifiers are Invacare 3260 003 40 or 006 4
27. suction eye cuts the risk of trauma Suction catheters should be sterile and single use only Open the end of the catheter package to expose the catheter port Hold the catheter which is still in its packaging and attach the catheter port to the suction tubing Fig 2 Put a sterile clean glove on the dominant hand remove the catheter from the packaging avoiding contamination Fig 3 Introduce the catheter into the tracheostomy to approximately one third of the catheter length Dougherty and Lister 2008 Introduce the catheter no further than the carina the point at which the trachea divides into right and left bronchi Direct stimulation of the carina will in most cases stimulate a cough However this stimulation can cause trauma and the aim should be to remove secretions without touching the carina Fig 4 Apply suction by placing the thumb over the port control and withdraw the catheter rotating the catheter if suggested by local policy Ensure the catheter is inserted for less than 10 seconds Fig 5 Wrap the catheter around the dominant hand remove the glove over the catheter and discard Fig 6 This reduces risks of crass contamination and splash injury NJRA THIS ARTICLE HAS BEEN DOUBLE BLIND PEER REVEWED Department of Health 2001 Standard principles for preventing hospital acquired infections Journal of Hospital infection 47 supplement S2137 Dougherty L Lister S
28. through speech Patients commonly report choking sensations Robinson 2000 and generally take one to three days to adapt to breathing through a tracheostomy tube Medline Plus 2003 If your patient had a PCT a common protocol is to check vital signs every fifteen minutes for an hour every half an hour for the next hour then hourly for four hours Caulfield amp Astle 2003 Follow the monitoring protocol for patients returning from the operating room Your facility guidelines may differ follow the guidelines for your facility Respiratory secretions will temporarily increase in your patient after a tracheotomy Look for signs and symptoms of impaired gas exchange created by mucus plugs Encourage your patient to deep breathe and cough Ensure adequate humidification and fluid intake to keep secretions thinned New Jersey Respiratory Associates Nurse Competency Program Some amount of bleeding from the stoma is expected for a few days but constant oozing is abnormal and requires intervention A blood vessel may need surgical litigation or you may be directed to pack the wound around the tube to stop the bleeding Some inflammation commonly occurs at the surgical site showing redness pain swelling and drainage Lower respiratory infection requires more frequent assessment and antibiotic intervention Sometimes air escapes into the incision creating subcutaneous emphysema around the stoma that can be felt if pressed This is general
29. to insure patent airway New Jersey Respiratory Associates Nurse Competency Program NJRA Respiratory Suctioning Educational Booklet Tracheostomy Suctioning Procedures The following is an excerpt from Nursing Times Practical Procedures Manual KEYWORDS RESPIRATORY CARE 6 TRACHEOSTOMY 8 SUCTION PATIENT SAFETY Tracheostomy care Part 1 Using suction to remove respiratory secretions via a tracheostomy tube AUTHOR Dan Higgins RGN ENBi00 ENB998 is senior charge nurse critical care University Hospitals Birmingham NHS Foundation Trust INTRODUCTION One of the indications for creating a tracheostomy is to provide access to the airway to clear respiratory secretions However when a tracheostomy tube is inserted the patient s ability to remove respiratory secretions will usually be compromised This is because the normal coughing mechanism is hindered as the patient is unable to close the glottis Closure PROFESSIONAL RESPONSIBILMES This procedure should be undertaken only after approved training supervised practice and competency assessment and carried out in accordance with local policies and protocols 16 New Jersey Respiratory Associates Nurse Competency Program of the glottis allows intrathoracic pressure to increase and generate the high gas flow velocity required for coughing The consistency of respiratory secretion
30. to your airway and begin to breathe into the interface 5 Verify that the device beeps each time therapy is started If the device does not operate accordingly contact your home care provider as the alarm system may not be fully functional 6 Make sure that no air is leaking from your mask into your eyes If necessary adjust the mask and headgear until the air leak stops See the instructions provided with your mask for more information Note A small amount of mask leak is normal and acceptable Correct large mask leaks or eye irritation from an air leak as soon as possible 7 If you are using the device in a bed with a headboard try placing the tubing over the headboard This may reduce tension on the mask 8 From the Home Screen highlight Therapy then press and hold the Wheel for approximately 2 seconds to turn off therapy Or from the Monitor Pressure screen press and hold the Wheel for approximately 2 seconds to turn off therapy and return to the Home Screen Verify that the device beeps when therapy is stopped If the device does not operate accordingly contact your home care provider as the alarm system may not be fully functional w xD User Manual 7 New Jersey Respiratory Associates Nurse Competency Program NJRA Alert Audible Indicators An audible indicator sounds whenever a power failure or a high medium or low priority alarm is detected Additionally an audible indicator sounds for informational
31. 0 For Platinum 10 recommended humidifiers are high flow 7900 10 7900 25 1 Remove cap and fill humidifier bottle with distilled water to the level indicated by the manufacturer 2 Replace the humidifier cap and securely tighten Humidifier Bottle SL y FIGURE 5 1 Filling the Humidifier Part No 118353 17 Platinum Series New Jersey Respiratory Associates Nurse Competency Program NJRA SECTION 5 OPERATING INSTRUCTIONS Humidifier Bottle FIGURE 5 2 Humidifier Compartment 3 Remove the filter access door located on the side of the concentrator Insert a flathead screwdriver in the plate groove on the top edge of the filter access door and gently pry the filter access door open Refer to Detail A in FIGURE 5 3 4 The humidifier adapter is next to the inlet filter Pull up and remove the humidifier bottle adapter Refer to Detail B in FIGURE 5 3 5 Attach it to the humidifier by turning the wing nut on the humidifier bottle counterclockwise until it is securely fastened Refer to Detail C in FIGURE 5 3 6 Place the humidifier bottle in the humidifier compartment Plate Groove Insert Flat Head Screwdriver DETAIL pr Humidifier Bottle DETAIL C Filter Access Door Humidifier Bottle Adapter FIGURE 5 3 Attaching the Humidifier Bottle Adapter Platinum Series 18 Part No 118353 SECTION 5 OPERATING INSTRUCTIONS 7 Attach oxygen tubing fro
32. 0 PND Check filter weekly and replace when necessary 10 Rinse medication nebulizer after each use and change weekly New Jersey Respiratory Associates Nurse Competency Program NJRA Medication Nebulizers Operators Manual Invacare Compressor Nebulizer System The following is an excerpt from Invacare s Compressor Nebulizer System Operators Manual SECTION 2 OPERATING INSTRUCTIONS SECTION 2 OPERATING INSTRUCTIONS A WARNING DO NOT operate unit without filter Avoid operating this product in a dusty environment Otherwise premature compressor wear could occur NOTE Clean and disinfect the nebulizer and mouthpiece before using the device for the first time Refer to Cleaning and Disinfecting on page 20 Setup NOTE For this procedure refer to FIGURE 2 1 on page 17 1 Place the unit on a table or other flat stable surface Be sure you can easily reach the controls when you are seated CAUTION Make sure the power switch is in the off O position 2 Gently twist the nebulizer to separate it into two sections Invacare Select 16 Part No 1148073 New Jersey Respiratory Associates Nurse Competency Program NJRA SECTION 2 OPERATING INSTRUCTIONS 3 Besure the pick up funnel is in place in the bottom section of the nebulizer CAUTION DO NOT add over 6 ml of medication to the medication cup The maximum capacity of the nebulizer medication cup is 6 ml 4 Add the pre
33. AP Machines Operators Manual Sleepnet Phantom Nasal Mask The following is an excerpt from Sleepnet Phantom Nasal Mask User Manual Mask tubing Tubo de mascara Maskenschlauch Tubulure du masque Slang masker Tubo della maschera New Jersey Respiratory Associates Nurse Competency Program Mask plug Tap n de m scara Maskenst psel Prise du masque Maskerplug Tappo della maschera NJRA Mask tubing me CPAP tubing Tubo de mascara Tubo de CPAP Maskenschlauch CPAP Schlauch Tubulure du masque Tubulure de l appareil de Slang masker pression positive expiratoire Tubo della maschera CPAP slang Dispositivo CPAP i f a u Nose clip Clip de nariz Nasenklemme Pince nez Neusklem Clip naso lt A Squeeze Presionar Zusammendr cken Pincer Indrukken Premere 1 Mask Shell 1 Coque du masque 2 Nose Clip 2 Pince nez 3 Gel Cushion 3 Coussinet rempli de gel 4 Mask Plug 4 Prise du masque 5 Exhaust Hole 5 Orifice d vacuation d air 1 Carcasa de la m scara 1 Gelaatstuk 2 Clip de nariz 2 Neusklem 3 Acolchado de gel 3 Gelkussen 4 Tap n de m scara 4 Maskerplug 5 Orificio de ventilaci n 5 Vitlaatgat 1 Maskenau enh lle 1 Guscio della maschera 2 Nasenklemme 2 Clip naso 3 Gel Kissen 3 Cuscinetto in gel 4 Maskenst psel 4 Tappo della maschera 5 Entliftungsi cher 5 Foro di sfiato VENT HOLE PRESSURE FLOW CHARACTERISTICS Approx CARAC
34. Battery and allowing it to cool may expedite this cooling process The Battery may not recharge when operating from the DC Power Supply depending on flow setting and temperature The Battery charges when in the device or with the optional Desktop Charger OPERATING YOUR ECLIPSE FOR THE FIRST TIME Step 1 Positioning Your Eclipse for Use Place the Eclipse in a well ventilated well lit area Be sure the air inlet and exhaust vent are not obstructed Air Inlet Filter Position the Eclipse so that all audible and visual indicators or alarms can be easily seen and heard Be sure the air inlet filter is in place before operating your Eclipse If the air inlet filter is missing contact your home care provider If the air inlet filter is dirty wash with warm soapy water rinse with clear water and allow it to dry before placing the air inlet filter back in the device If necessary replace it with a new clean air inlet filter Plug the device into a grounded AC Power outlet a DC Power exhaust Vent source or be sure there is a fully charged Battery installed Step 2 Power ON the Device and Allow it to Warm Up Press and hold the ON OFF Button for two 2 seconds to power ON your Eclipse A brief audible and visual power on self test will occur Verify that all the indicators are illuminated and 18 thata buzzer sounds indicating the device is operating properly New Jersey Respiratory Associates Nurse Competency Prog
35. Check Sheet Demonstrate Proper equipment needed Removing old inner cannula and inserting new inner cannula Inspection and cleaning of stoma site Adjusting trach collar properly Explain Different types and sizes of trach tubes Hazards of performing trach care Abnormal conditions of trach to report to Physician Nurse Instructor Date Tracheostomy Care Overview 1 Each resident has a specific trach tube as ordered by a Physician Every trach resident should have a spare back up trach at the bedside for emergency reinsertion 3 Tracheostomy tubes have different sizes and styles a b c d e f Adult and pediatric Cuffed and uncuffed Fenestrated and non fenestrated Disposable inner cannulas and non disposable inner cannulas Different sizes Different brands Trach tubes and stoma sites require regular cleaning 5 Trach tubes should be changed monthly 6 Hazards of tracheostomies a If there is redness bleeding or drainage from stoma it should be reported to the resident s nurse Whenever the tube is manipulated respiratory cardiovascular and skin parameters should be assessed 7 Humidification is necessary for artificial airways 8 Suctioning is necessary to insure patent airway New Jersey Respiratory Associates Nurse Competency Program NJRA Tracheostomy Care Educational Booklet Invacare Platinum Series vocal cords larynx trachestamy tube to vent
36. E 2 2 1 Turn the unit on pressing the ON OFF switch to the I position 2 Place mouthpiece between your teeth close your mouth and tilt the nebulizer toward your FIGURE 2 2 Using the mouth Nebulizer 3 As aerosol begins to flow inhale deeply slowly and hold breath for ten seconds Then exhale slowly through the mouthpiece NOTE If you need to rest during a treatment be sure the nebulizer remains in an upright position otherwise the medication may spill 4 When treatment is complete turn the unit off by setting the switch to the O position and unplug the unit from the electrical outlet 5 Before storing supplies between treatments clean and dry the nebulizer and accessories Refer to Cleaning and Disinfecting on page 20 Part No 1148073 19 Invacare Select NJRA SECTION 3 CLEANING AND DISINFECTING SECTION 3 CLEANING AND DISINFECTING Following the cleaning instructions after each use will prevent any remaining medication in the nebulizer cup from drying and causing the device to nebulize ineffectively It is recommended that the nebulizer and the mouthpiece be thoroughly rinsed with hot tap water after each use and cleaned with a mild detergent after the last treatment of the day The same pieces MUST also be disinfected daily by soaking in a vinegar water solution or a commercially available disinfectant If your physician or respiratory therapist specifies a different cleaning procedur
37. E DEVICE BY OBSTRUCTIONS SUCH AS FURNITURE DRAPERIES BEDDING CLOTHING OR PETS OPERATING INSTRUCTIONS BEFORE OPERATING This users manual serves as your reference to help you operate and maintain the device if you have any questions or concerns please call your home care provider Important DO NOT attempt to operate the Eclipse without first reading the Safety Guidelines section of this manual Please follow all of the operating instructions Please observe all WARNINGS on the device and in the Users Manual in order to reduce the risk of fire personal injury and serious damage to the Eclipse please observe all of the safety precautions PROTECT THE ECLIPSE AND ALL POWER SUPPLIES FROM FLUID SPILLS OR FLUID DRIPS TO AVOID POSSIBLE SHOCK HAZARDS ALWAYS CHECK THAT THE AIR INLET AND THE EXHAUST VENT OF THE DEVICE ARE NOT BLOCKED AND THE AIR INLET FILTER IS CLEAN AND DRY BEFORE USING YOUR ECLIPSE POWERING ON YOUR ECLIPSE The device is capable of being operated directly from 3 different power sources e AC Power Supply with NEMA Power Cord DC Power Supply Rechargeable Power Cartridge Battery GENERAL CHARGING INFORMATION The Eclipse charges the battery while using AC power and the battery temperature is within safe charging temperature When external power is disconnected the device will automatically switch over to the battery if the battery is installed and charged When external power is restored by plugging in
38. ER CARTRIDGE OPERATING TIMES 4 4 hours 1 0 3 7 hours 2 0 hours 16mL 1 0 5 4 hours 32mL 2 0 5 1 hours 3 0 1 3 hours 48mL 3 0 4 9 hours 64mL 4 0 4 0 hours 80mL 5 0 3 7 hours 96mL 6 0 3 5 hours 128mL 2 5 hours 160mL 2 0 hours 192mL 1 7 hours NOTE Battery times will decrease with higher bolus size breath rate ambient temperature Battery age and use over time NJRA ses p SA Personal Ambulatory Oxygen System Users Manual autoSAT A ech Wika U S DEPARTMENT OF TRANSPORTATION DOT AND UNITED NATIONS UN REGULATIONS REQUIRE THE REMOVAL OF BATTERY FROM THE DEVICE FOR ALL INTERNATIONAL AIRLINE TRAVEL WHEN THE ECLIPSE IS CHECKED AS LUGGAGE WHEN SHIPPING THE ECLIPSE THE BATTERY MUST ALSO BE REMOVED FROM THE DEVICE AND PACKAGED PROPERLY DO NOT ATTEMPT TO OPEN THE BATTERY THERE ARE NO SERVICEABLE PARTS INSIDE THE BATTERY ONLY USE SEQUAL PROVIDED BATTERIES RETURN THE BATTERY TO YOUR HOME CARE PROVIDER FOR PROPER DISPOSAL KEEP THE BATTERY AWAY FROM CHILDREN TYPICAL BATTERY RECHARGE TIME The typical time to recharge your Battery in order to achieve 80 capacity from a fully discharged Battery is up to 5 0 hours depending upon the device flow setting When the battery is fully charged the battery gauge will cease cascading If the Battery becomes too warm during discharging recharging will not begin until the Battery sufficiently cools Removing the
39. R PROVIDER FOR A BACK UP SOURCE OF OXYGEN TROUBLESHOOTING TABLE po NOT IGNORE ALARMS No Battery installed Install Battery or plug into external power Battery is discharged i Plug into external power or no external power is present Y P Eclipse does not power on when AC or DC Power Supply Check plug at outlet Power Supply box and ON OFF button is not plugged in correctly at the Eclipse to ensure properly plugged in is pressed Ensure there is adequate power from the outlet Insufficient power from the outlet Outlet may be controlled by a wall switch or the circuit breaker may have engaged Other Contact your dealer provider Filter Blocked Clean Air Inlet Filter Humidifier Check humidifier attachment and tubing No Oxygen Eclipse not ON Power Eclipse ON Tubing or cannula is not properly Check tubing cannula connected or kinked and connections Other Contact your dealer provider eT a Repair or replace tubing or humidifier Restriction In tubing or humidifier Place your Eclipse so there is adequate air flow F F Clean or replace air inlet filter Place your Eclipse Low Oxygen Filter restricted so there is adequate air flow Concentration Exceeding maximum breath rate in Pulse Mode See Pulse Dose Mode Breath Rate Chart p 18 EE Restriction in humidifier or tubing Repair or replace humidifier or tubing Low Oxygen Flow Filter Blocked Clean or replace air inlet filter Switch to Continuous Flow Mo
40. TEM STATUS INDICATORS The Eclipse control panel displays important operating information This section will help you understand this operating information ON OFF Button Green Indicator This button powers the device ON or OFF The Green Indicator is illuminated when the device is ON New Jersey Respiratory Associates Nurse Competency Program Wila eclipse autos Co 1124 5 Personal Ambulatory Oxygen System Users Manual A Increase or Decrease Flow Setting Buttons Use these buttons to set the flow to your prescribed setting Delivery Mode Button and Indicator The button toggles between Continuous Flow and Pulse Dose Mode The Pulse Dose Mode activates autoSAT Technology as your breath rate changes the Eclipse servo controls the unit to provide a consistent bolus size The Pulse Dose Mode allows a significant increase in the operating time while powered by the battery When this mode is activated the green Pulse Dose Mode Indicator illuminates and a pulse of oxygen is delivered with each inspiratory effort ALERT Yellow Indicator Low and Medium Priority Alerts When iliuminated this indicates a low priority awareness condition or Caution Continue to use your system and refer to the Troubleshooting Table for the proper response A flashing yellow indicates a medium priority alert A prompt response is necessary ALARM Red Indicator High Priority Alarms Indicates a high prior ity alarm
41. TERISTICAS DE PRESION FLUJO DEL ORIFICIO DE VENTILACI N APROX ENTL FTUNGSLOCHDRUCK FLIESSVERHALTEN ungef hr CARACTERISTIQUES DE PRESSION DEBIT DES ORIFICES D EVACUATION approx VENTILATIEOPENINGEN DRUK STROMINGSEIGENSCHAPPEN bij benadering CARATTERISTICHE PRESSIONE FLUSSO FORO DI SFOGO Appross 3 20 Vent Flow L min Mask Pressure cm H20 Vent Flow L min Mask Pressure cm H20 Flujo de ventilaci n Presi n de la m scara Entl ftungsrate Maskendruck Debit d vacuation Pression du masque Ventilatiestroming Maskerdruk Flusso foro di sfogo Pressione maschera New Jersey Respiratory Associates Nurse Competency Program NJRA BiPAP CPAP Machines Operators Manual Philips Respironics BiPAP CPAP System The following is an excerpt from Respironics System One User Manual CAUTION U S federal law restricts this device to sale by or on the order of a physician Intended Use The BiPAP autoSV Advanced System One is intended to provide non invasive ventilatory support to treat adult patients gt 30 kg 66 Ibs with Obstructive Sleep Apnea and Respiratory Insufficiency caused by central and or mixed apneas and periodic breathing This device may be used in the hospital or home Warnings A warning indicates the possibility of injury to the user or the operator This manual serves as a reference The instructions in this manual are not intended to supersede the health care professional s instructions re
42. V Advanced System One comes with an SD card inserted in the SD card slot on the back of the device to record information for the home care provider Your home care provider may ask you to periodically remove the SD card and send it to them for evaluation Note If the SD card is inserted in the device the SD card icon f will display next to Info on the Home screen and it will also display in the lower left corner of the Therapy screen Note The SD card does not need to be installed for the device to work properly The SD card records device usage information for your home care provider You can refer to the Device Alerts section in this manual for more information on the SD card Contact your provider if you have any questions about the SD card Adding Supplemental Oxygen Oxygen may be added at the mask connection Please note the warnings listed below when using oxygen with the device WARNINGS When using oxygen with this system a Respironics Pressure Valve must be placed in line with the patient circuit between the device and the oxygen source The pressure valve helps prevent the backflow of oxygen from the patient circuit into the device when the unit is off Failure to use the pressure valve could result in a fire hazard Note Refer to the pressure valve s instructions for complete setup information When using oxygen with this system turn the device on before turning on the oxygen Turn the oxygen off before turning the device
43. acheostomy Care Respiratory Suctioning New Jersey Respiratory Associates Nurse Competency Program Respiratory Suctioning Instruction Check Sheet Demonstrate Sterile technique for suctioning Resident assessment during suctioning Proper placement of machine How to turn machine on How to adjust suction pressure Proper assembly of suction circuitry How to clean equipment How to change filters Explain Different types of suction catheters Indications for suction machine Safety precautions Electrical Hazards Infection Control Nurse Instructor Date NJRA Respiratory Suctioning Overview 1 Each resident has a specific trach tube as ordered by a Physician Every trach resident should have a spare back up trach at the bedside for emergency reinsertion 3 Tracheostomy tubes have different sizes and styles a Adult and pediatric b Cuffed and un cuffed c Fenestrated and non fenestrated d Disposable inner cannulas and non disposable inner cannulas e Different sizes f Different brands Trach tubes and stoma sites require regular cleaning 5 Trach tubes should be changed monthly 6 Hazards of tracheostomies a If there is redness bleeding or drainage from stoma it should be reported to the resident s nurse b Whenever the tube is manipulated respiratory cardiovascular and skin parameters should be assessed 7 Humidification is necessary for artificial airways 8 Suctioning is necessary
44. anually palpate the patient s pulse to verify the pulse rate displayed on the oximeter Things that may affect readings e Motion artifact e Abnormal hemoglobin e Low perfusion states e Nail polish e Exposure of probe to ambient light NOTE The pulse oximeter is only a tool to assist you in the total clinical evaluation of a patient New Jersey Respiratory Associates Nurse Competency Program NJRA Pulse Oximetry Operators Manual Nonin GO The following is an excerpt from Global Primary Care and Patient Education Handbook THE PURPOSE OF THIS GUIDE Chronic respiratory diseases such as COPD and asthma are among the most common health conditions seen in primary care practices affecting more than 1 billion patients worldwide Primary care clinicians are also often the first point of contact for patients suffering from acute respiratory infections such as influenza and pneumonia These health care professionals need tools to help them evaluate monitor and decide when to refer patients with respiratory conditions Pulse oximetry is a technology that enables the noninvasive measurement of oxygen saturation contributing to this measure s rapid acceptance as a fifth vital sign in addition to temperature blood pressure pulse and respiratory rate in clinical assessment Although the technology has been available since the 1970s recent advances have reduced the size and cost of pulse oximeters and as a result these
45. at a water fill level less than 25 cm Lewis Heitkemper amp Dirksen 2000 Bissell 2004 Record the pressure reading and report if you notice it takes increasing volumes to inflate the cuff Increasing volumes may indicate that the valve may be faulty or tracheal changes may be responsible Deflating and inflating the cuff is a way to e Assess how the cuff is working e Periodically relieve pressure on the trachea Let secretions above the cuff to drain down so you can suction them The frequency of this procedure will most likely line up with suctioning and the routine care schedule There are two ways to determine the best cuff pressure The occlusive technique is used when the cuff has a pressure relief valve for self adjustment The minimal leak technique is used to provide some pressure slack by releasing a small amount of pressure after inflating the cuff to a point indicating a tight seal With a stethoscope placed on the neck inflate the cuff until you no longer hear hissing Then deflate in tiny increments until a slight hiss returns Changing the Trach Tube Trach tubes both the single cannula type and the outer cannula of a universal type are changed every one to four weeks Metal tubes can eventually develop cracks at the soldered joints Silicon types can crack or tear Soft PVC tubes stiffen with age When a patient has had a tracheostomy for several months the stoma is well formed and tube changes can be safely done on
46. ate To remove the Battery pull DOWN on the black release lever While holding DOWN the release lever pull the Battery away from the Eclipse Battery Operating Times The duration of use of the Battery is displayed at the top of the Control Panel A variety of factors such as flow setting Pulse or Continuous Flow Mode and breath rate will impact the operating time The table on page 15 provides operating time ESTIMATES for the Eclipse using a new fully charged Battery based on flow settings and operat ing conditions as indicated ON STORE IN A COOL AND DRY LOCATION TO HELP ENSURE THE LONGEVITY OF YOUR BATTERY INITIAL BATTERY CHARGING The new Battery supplied with your Eclipse is not fully charged when it is shipped from the fac tory Before using your Eclipse for the first time you must first fully charge the Battery With the AC Power Supply plugged in and the Battery correctly installed in the Power Compart ment of the device allow the Battery to completely charge The Battery is fully charged when the Power Cartridge Status Gauge on the Control Panel is no longer cascading The Eclipse can be used while either discharging or recharging the Battery It may take up to 5 0 hours dependent upon the flow setting to achieve 80 capacity from a fully 16 discharged Battery New Jersey Respiratory Associates Nurse Competency Program autoSAT IM eC 4 p SP 5 Personal Ambulatory Oxygen System Users Manual
47. attery has sufficient charge 2 Attach the nasal cannula to the outlet You are now ready to use the oxygen concentrator 3 Turn the machine on You will hear an alarm which is normal and will stop in several seconds 4 Make sure the flow is set at the prescribed amount 5 Place the nasal cannula in your nose This is most easily done by inserting the prongs first into each nostril and then placing the tubing over each ear Tighten the Lariat under your chin until the cannula is comfortable NOTE The prongs should be pointing downwards when inserting TROUBLE SHOOTING ALARMS Your oxygen concentrator has alarms which will tell you if the machine is not functioning properly or is low on battery If you hear or see one of the alarms or there is a power outage or machine malfunction turn machine off Use your back up oxygen cylinder Portable Oxygen Concentrators Operators Manual SeQual Eclipse 3 with autosar p The following is an excerpt from SeQual s Eclipse 3 Operators Manual New Jersey Respiratory Associates Nurse Competency Program NJRA Claes pa e Personal Ambulatory Oxygen System Users Manual Wiis au _ INTRODUCTION TO YOUR ECLIPSE 3 This Users Manual will inform you of the use and care of the Eclipse and its standard components Please read all of the information in this manual before operating your Eclipse Contact your home care provider for proper training on the use and ca
48. ausa org New Jersey Respiratory Associates Nurse Competency Program Suctioning Suctioning is necessary for all trach patients to remove secretions and assess airway patency Acute care patients need to be assessed every two hours for the need for suctioning Suctioning is routinely done twice a day but more often if needed particularly following tracheotomy or when there is an infection present Suctioning activates psychological and physiological reflexes that make the experience both uncomfortable and frightening for your patient SIMS Portex 1998 They may have severe hypoxia cardiac arrhythmias and even cardiac arrest when the airway is occluded by the catheter and air is simultaneously sucked out of the lungs This risk can be minimized by following technical parameters arrived at by consensus among clinicians and researchers American Thoracic Society 2004 Lewis Heitkemper amp Dirksen 2000 Robinson 2000 Bissell 2004 NJRA Indications for Suctioning Dyspnea flared nostrils chest retractions prolonged wheezing Noisy breathing Cyanosis clammy skin Restlessness agitation Copious secretions moist cough Low oxygen saturations Increased peak inspiratory pressure on mechanical ventilator Lewis Heitkemper amp Dirksen 2000 Robinson 2000 McConnell 2002 Bissell 2004 e Position patient in semi Fowler s Time suctioning for prior to eating e Choose a catheter not exceeding half
49. ble Indicators When an informational message appears on screen a brief 1 beep audible indicator sounds Additionally when the device detects that a certain action has been completed for example when an SD card is inserted or removed from the device a brief 1 beep audible indicator sounds The descriptions later in this manual display this indicator as Silencing an Alarm You can silence an alarm by pressing the Alarm Silence lndicator button This will silence the alarm for one minute If another alarm occurs while the silence period is active the audible alarm portion of the new alarm will not sound until the silence period expires When the silence period expires the alarm s audible alarm is reactivated Touching the Alarm Silence Indicator button while the silence period is active will restart the silence period Alarm Message Screens When an alarm message is activated an alarm screen is displayed showing the text or icon specific to the most recent highest priority alarm Pressing the Control Wheel will reset the alarm and remove the alarm screen from the display Resetting the alarm allows you to return to the previous screen If multiple alarms occur during the same period of time the alarm screen will display the higher priority alarm higher priority alarms take precedence over lower priority alarms Alert Summary Table The following table summarizes all of the high medium and low priority alarms and informational mes
50. cations for use of pulse oximetry in various primary care situations Recommendations about the use of pulse oximetry in specific primary care situations have also been incorporated into some guideline documents for respiratory care For a summary of recommendations from several such documents see Ref 7 also sce 6 8 9 10 LL Although pulse oximeters may also have additional applications in certain health care settings the most common and best evidenced primary care uses of pulse oximeters are covered here LIMITATIONS OF PULSE OXIMETRY Despite recent technological improvements pulse oximeters have some limitations that can affect the accuracy of the measurement Clinicians should be aware of certain situations where the oximeter reading may not be accurate Table 3 In addition some patients with severe chronic lung disease experience hypoxic drive in which respiration is driven by low oxygen levels rather than elevated carbon dioxide levels These patients often have severe disease and may already be on long term oxygen therapy This condition does not affect the accuracy of pulse oximetry readings but it does affect the goals of monitoring and treatment Specifically to avoid hypercapnia for some of these patients the goal should be to maintain SpO at a somewhat lower target e g between 88 92 3 New Jersey Respiratory Associates Nurse Competency Program NJRA Table 2 Current Clinical Uses of Pulse Oximetry in Pri
51. ch ear Tighten the Lariat under your chin until the cannula is comfortable The prongs should be pointing downwards when inserting TROUBLE SHOOTING ALARMS Your oxygen concentrator has alarms which will tell you if the machine is not functioning properly If you hear or see one of the alarms of if there is a power outage or machine malfunction turn machine off Use your back up oxygen cylinder Stationary Oxygen Concentrators Operators Manual Invacare Platinum Series The following is an excerpt from Invacare s Platinum Series Operators Manual New Jersey Respiratory Associates Nurse Competency Program NJRA SECTION 5 OPERATING INSTRUCTIONS SECTION 5 OPERATING INSTRUCTIONS Introduction Your oxygen concentrator is intended for individual use indoors It is an electronically operated device that separates oxygen from room air It provides high concentration of oxygen directly to you through a nasal cannula Clinical studies have documented that oxygen concentrators are therapeutically equivalent to other types of oxygen delivery systems Your provider will show you how to use your oxygen concentrator He She should be contacted with any questions or problems regarding your oxygen concentrator This owner s manual will tell you about your concentrator and will serve as a reference as you use your concentrator Select a Location A WARNING NEVER block the air openings of the product or
52. changes should long term tracheal be done by two people or with new ties secured before old ties are removed stomas have McConnell 2002 Bissell 2004 Twill tapes Velcro tapes metal chains and chronic bacterial plastic IV tubing are some options You should be able to easily slip one or infections two fingers between the ties and the neck for a proper fit Do not use Velero if Robinson 2000 there is a possibility the patient will try to pull them apart The skin around the stoma is often cleaned with swabs soaked in half strength hydrogen peroxide rinsed with normal saline solution and patted dry Some occasional redness and purulent drainage may be expected Topical treatment can be used for minor infections Dressings around the stoma are only changed for excessive exudate If necessary they should be uncut gauze or sponges and changed frequently enough to keep the area dry The majority of trach tubes have inner cannulas that require cleaning one to three times daily unless they are disposable Use sterile technique to clean the reusable cannula with half strength hydrogen peroxide and normal saline solution Reinsert and lock in place within a fifteen minute timeframe Cuff Pressure If your patient has a cuffed trach check cuff pressure every four to eight hours Complications can arise quickly from excessive pressure that inhibits capillary perfusion Ideally pressure should be less than 20 mmHg as measured with a manometer or
53. de until respiratory fate resumes to an acceptable rate Other Contact your dealer provider Tubing cannula longer than 7 feet 2 1m Attach 7 foot 2 1m tubing cannula No Oxygen Delves in Humidifier attached Remove humidifier Pulse Flow Mode No inspiration detected Contact your dealer provider Unit in Continuous Mode Switch to Pulse Mode Nasal cannula not in the Place nasal cannula in nostrils nose or mouth breathing and breath through your nose Power Cartridge Status Contact i ate A wae your dealer provider Gauge never indicates Power Cartridge Battery is aging 22 fully charged to replace Power Cartridge Battery New Jersey Respiratory Associates Nurse Competency Program NJRA eC 4 n se ases Personal Ambulatory Oxygen System Users Manual ATA PUEA CLEANING CARE AND ROUTINE MAINTENANCE Routine Maintenance Servicing of the internal components inside the cabinet of the Eclipse must be conducted by a SeQual trained and qualified service technician as needed Preventative Maintenance PM should be completed on a regular basis Consult your provider to arrange PM schedule Your home care provider or qualified technician will perform inspections and maintenance of the compressor alarms internal 9 volt battery battery and other internal parts only as needed User Care and Cleaning of the Device Cannula Replacement Replace your supply tubing and cannula on a regular basis as recom mended by y
54. del BIPAP Explain Indication of CPAP BIPAP Need for Humidification Nurse Instructor Date BiPAP CPAP Machines Overview CPAP Continuous Positive Airway Pressure BIPAP Bilevel Positive Airway Pressure 3 CPAP and BIPAP machines are both used to provide positive pressure to the patient s airways There are generally two indications for CPAP BIPAP therapy a Patients with Obstructive Sleep Apnea use CPAP BIPAP to force air through their obstructed upper airways While they sleep their throat closes in and prevents air from getting into their lungs This causes their oxygen saturation to drop and their carbon dioxide to rise Their body will instinctively cause them to gasp and open their airways Without proper ventilation the body does not get the right REM sleep and this can result in sleeplessness during the day and other medical problems While using the CPAP BIPAP machine the positive pressure prevents the airway from collapsing and the patient is able to breathe properly A patient gets an overnight sleep study done to determine the proper CPAP BIPAP pressure needed to prevent airway collapse These patients do not have problems with their lungs only their upper airways b Some patients require BIPAP to boost air into their lungs and assist them to breathe more deeply and more easily In this way the BIPAP is used as a non invasive ventilator BIPAP is used instead of CPAP because the inspiratory pressure needed t
55. devices Figure 1 are becoming increasingly used in respiratory patient monitoring in specialty and primary care practice In most countries oximeters are only sold to patients under the guidance of a licensed health care professional and use by patients should be supervised by their physicians or other qualified health care provider Incorrect or inappropriate use of oximeters will not provide useful information and they should be used as part of a broader clinical assessment and not in isolation Figure 1 Pulse Oximeter Primary care clinicians have varying levels of awareness of pulse oximetry and knowledge of its proper uses Therefore this World Organization of Family Doctors Wonca and International COPD Coalition ICC f Oxygen guide offers advice for those who wish to use pulse on ae oximeters in patient care It presents the clinical situations in which the devices are being used and the Pulse Rate scientific evidence for such uses and it points out the limitations of the devices and inappropriate uses In addition to scientific articles we are guided in our recommendations by the expert opinions of the faculty who have overseen the development of this pocket guide It will be important for clinicians and their patients to monitor the appearance of new published peer reviewed clinical research concerning the clinical and home uses of pulse oximetry This document was prepared by the Wonca expert panel including A
56. e follow their instructions Cleaning the Outer Case A WARNING Unplug unit before cleaning DO NOT submerge in water to clean Clean outer case with damp cloth Invacare Select 20 Part No 1148073 New Jersey Respiratory Associates Nurse Competency Program NJRA SECTION 3 CLEANING AND DISINFECTING A DANGER DO NOT attempt to separate the outer case of this unit Removing the case creates a serious electrical shock hazard All disassembly and maintenance of this unit MUST be done by a qualified technician Cleaning the Nebulizer A WARNING To prevent possible risk of infection due to contamination follow these instructions Clean the nebulizer before initial operations e Clean the nebulizer after each aerosol treatment e ALWAYS use fresh cleaning solution e DO NOT towel dry the nebulizer components after cleaning NOTE Your physician and or an Invacare dealer may specify certain cleaning procedures If so follow their recommendations If not clean according to the following instructions 1 Remove the nebulizer and mouthpiece from the tubing Part No 148073 21 Invacare Select SECTION 3 CLEANING AND DISINFECTING 2 6 7 Disassemble nebulizer chamber by turning counterclockwise and separating Fill two plastic containers or bowls A Washing Hot water detergent solution B Soaking Hot water vinegar solution one part vinegar to three parts water Thorough
57. e usually used Bissell 2004 These are generally without cuffs but still adaptable for mechanical ventilation equipment Disposable and reusable trach tubes are both available and tubes can be custom made Some trach tubes are designed to allow patients to speak Patients being weaned off trach tubes may have either a cuffless fenestrated tube with an opening that allows air to flow across the larynx or a tracheostomy button that does not extend into the trachea enough to restrict airflow past the larynx For long term tracheostomy patients speaking is possible with these options e A fenestrated inner cannula inside a cuffed outer cannula allows speech when the cuff is deflated Some tubes have cuffs that expand on inspiration and deflate on expiration allowing speech as you expire Others have cuffs that have to be manually deflated e A speaking trach valve is a diaphragm attached to the trach tube It opens on inspiration and closes on expiration so that air is forced up over the vocal cords when there is no inflated cuff blocking the flow A speaking trach tube forces air or oxygen from an outside source to flow across the vocal cords independent of the airflow within a closed system created by a cuffed trach tube The patient has control over this air line with a thumb port NJRA NURSING CARE OF YOUR TRACHEOSTOMY PATIENT Don t let the equipment distract you from your first priority assessing the patient Look for signs of h
58. ed with oxygen tanks _ Emergency Application of Oxygen Nurse Instructor Date Oxygen Therapy Overview Purpose To treat hypoxemia decrease work of breathing and decrease myocardial work Scope Patient s requiring supplemental 02 therapy due to respiratory or cardiac insufficiency Procedure e Follow Universal Precautions e Verify Medical Doctor order should include liter flow type of 02 delivery device if possible e Wash hands and explain procedure to the patient e Confirm the patient s identification from the wristband e Gather equipment o 0 source o Oxygen delivery device o Humidifier with sterile water if indicated e Connect the humidifier bottle filled with sterile water to the 02 source making sure all connections are tight e Turn on the 0 source and adjust the flowmeter to the prescribed flow e Verify the flow of 02 at the patient end of the delivery device e Connect the 02 delivery device to the patient e Simple masks should be run at 5 10 lpm e Non Rebreather masks should be run at an adequate flow so that the bag doesn t deflate on the maximal inspiration at least 6lpm e Venturi mask flow should be advised as per Venturi device indicating desired F103 New Jersey Respiratory Associates Nurse Competency Program NJRA Oxygen Therapy Emergency Application of Oxygen General Patients 1 Any patient having trouble breathing should be sitting straight up to obtain maximal diaphragm movement and
59. er When using the bacteria filter the device performance may be affected However the device will remain functional and deliver therapy When DC power is obtained from a vehicle battery the device should not be used while the vehicle s engine is running Damage to the device may occur Only use a Respironics DC Power Cord and Battery Adapter Cable Use of any other system may cause damage to the device Repairs and adjustments must be performed by Respironics authorized service personnel only Unauthorized service could cause injury invalidate the warranty or result in costly damage Contraindications The device should not be used if you have severe respiratory failure without a spontaneous respiratory drive If any of the following conditions apply to you consult your physician before using the device Inability to maintain an open airway or adequately clear secretions At risk for aspiration of gastric contents e Diagnosed with acute sinusitis or otitis media Allergy or hypersensitivity to the mask materials where the risk from allergic reaction outweighs the benefit of ventilatory assistance Epistaxis causing pulmonary aspiration of blood Hypotension Patient Precautions e Immediately report any unusual chest discomfort shortness of breath or severe headache If skin irritation or breakdown develops from the use of the mask refer to the mask instructions for appropriate action The following are potential side ef
60. essure known as IPAP Inspiratory Positive Airway Pressure when you inhale and a lower pressure known as EPAP Expiratory Positive Airway Pressure when you exhale The higher pressure makes it easier for you to inhale and the lower pressure makes it easier for you to exhale When prescribed the device can also provide features to help make your therapy more comfortable The ramp function allows you to lower the pressure when trying to fall asleep The air pressure will gradually increase until the prescription pressure is reached Additionally the Bi Flex comfort feature provides increased pressure relief during the expiratory phase of breathing Several accessories are also available for use with the device Contact your home care provider to purchase any accessories not included with your system SD Card Accessory Slot SD Card Cover Air Outlet Pore Power Inlet Filter Area Side Cover This figure illustrates some of the device features described in the following table Device FEATURE DESCRIPTION Air Outlet Port conical 22 mm Connect the flexible tubing here SD Card Accessory Slot If applicable insert the optional accessory SD card here SD Card Cover lf applicable the optional accessories such as a Link Module or Modem can be installed here Refer to the instructions supplied with the accessory When not using an accessory this cover must be in place on the device Power Inlet Connect the power
61. fects of noninvasive positive pressure therapy Ear discomfort Conjunctivitis Skin abrasions due to noninvasive interfaces Gastric distention aerophagia Contact your health care professional if symptoms of sleep apnea recur Symbol Key The following symbols may appear on the device and power supply DEFINITION SYMBOL DEFINITION Do not disassemble For Airline Use Complies with RTCA DO 160F Separate collection for electrical and electronic section 21 category M O equipment per EC Directive 2002 96 EC DC Power Class Il Double Insulated Type BF Applied Part For Indoor Use Only Drip Proof Equipment User Manual 3 System Contents Your BiPAP autoSV Advanced System One includes the following items Device Flexible tubing 22 mm optional 15 mm tubing is also available User manual Power cord and power supply Part 1058190 Carrying case Side cover panel e Reusable gray foam filter SD card Disposable ultra fine filter Humidifier optional Note If any of these items are missing contact your home care provider System Overview The BiPAP autoSV Advanced System One device is intended to augment your breathing by supplying pressurized air through a circuit It senses the your breathing effort by monitoring airflow in the circuit and adjusts its output to assist in inhalation and exhalation This therapy is known as Bi level ventilation Bi level ventilation provides a higher pr
62. filter Note If you are not using the white disposable filter simply insert the gray foam filter into the filter area Connecting the Breathing Circuit To use the system you will need the following accessories in order to assemble the recommended circuit Respironics interface nasal mask or full face mask with integrated exhalation port or entrainment valve or Respironics interface with a separate exhalation device such as the Whisper Swivel 11 Respironics 22 mm flexible tubing 1 83 m 6 ft or optional Respironics 15 mm tubing Respironics headgear for the mask WARNING If the device is used by multiple persons such as rental devices a low resistance main flow bacteria filter should be installed in line between the device and the circuit tubing to prevent contamination To connect your breathing circuit to the device complete the following steps 1 Connect the flexible tubing to the air outlet on the side of the device If you are using the optional Respironics 15 mm tubing the device tubing type setting must be set to 15 If your device does not have the tubing type setting you must use the Respironics 22 mm tubing Note If required connect a bacteria filter to the device air outlet and then connect the flexible tubing to the outlet of the bacteria filter CAUTION When using the bacteria filter the device performance may be affected However the device will remain functional and deliver therapy 2 Connect the
63. g should be prescribed for you by your physician CONTINUOUS FLOW MODE OPERATION When operating in the Continuous Flow Mode a continuous supply of oxygen measured in liters per minute LPM will flow through your tubing and nasal cannula PULSE DOSE MODE OPERATION When operating in Pulse Mode a bolus of oxygen measured in milliliters mL is delivered upon inspiration DO NOT use a humidifier in the Pulse Dose Mode Secure a prescription for pulse dose from your physician with consideration to your needs at rest during exercise and when traveling at altitude When operating in pulse dose mode the Eclipse 3 supplies a continuous flow of oxygen when a breath is not detected The device will continually check for an inspiratory effort every 15 seconds Once an inspiration is detected the device reverts to measured bolus delivery To exit Pulse Dose Mode and engage Continuous Flow Mode push the flow mode button NJRA 2 c 4 p S E pages Personal Ambulatory Oxygen System Users Manual autoSA PULSE DOSE MODE AND autoSAT FEATURES Your Eclipse has a feature called autoSAT that delivers a consistent sized bolus of oxygen up to 40 breaths per minute see max breath rate chart below As your breath rate increases ie during ambulation the autoSAT feature servo controls the device delivering the set bolus size autoSAT Technology is proprietary to SeQual and is utilized during Pulse Mode only AC Power Supply Pulse a
64. garding the use of the device The operator should read and understand this entire manual before using the device This device is not intended for life support The device should be used only with masks and connectors recommended by Respironics or with those recommended by the health care professional or respiratory therapist A mask should not be used unless the device is turned on and operating properly The exhalation port s or entrainment valve associated with the mask should never be blocked Explanation of the Warning The device is intended to be used with special masks or connectors that have exhalation ports to allow continuous flow of air out of the mask When the device is turned on and functioning properly new air from the device flushes the exhaled air out through the mask exhalation port or entrainment valve However when the device is not operating enough fresh air will not be provided through the mask and exhaled air may be rebreathed Rebreathing of exhaled air for longer than several minutes can in some circumstances lead to suffocation When using oxygen with this system a Respironics Pressure Valve must be placed in line with the patient circuit between the device and the oxygen source The pressure valve helps prevent the backflow of oxygen from the patient circuit into the device when the unit is off Failure to use the pressure valve could result in a fire hazard When using oxygen with this system turn the device on
65. ge e The temperature of the room must not exceed 125 degrees Fahrenheit e Storage rooms must be dry cool and well ventilated e Cylinders must not be stored near flammable substances e Large cylinders must be stored in an upright position e Valves should be kept closed on empty cylinders at all times e Cylinders must be stored with their protective caps in place Transportation e Protective caps should be used whenever cylinders are in transport until they are ready for use e Cylinders must not be dragged slid dropped or allowed to strike each other violently e Cylinders must be transported on an appropriate cart secured by a chain or strap e ANO SMOKING sign must be posted where the oxygen is administered It must be legible from a distance of five feet and must be displayed in a conspicuous location e Cylinders must not be handled with oily or greasy hands gloves or clothing e Inform all occupants of the area of the hazards of smoking and of the regulations New Jersey Respiratory Associates Nurse Competency Program BiPAP CPAP Devices BiPAP CPAP Machines New Jersey Respiratory Associates Nurse Competency Program NJRA BiPAP CPAP Machines Instruction Check Sheet Demonstrate ______ Howto set up BIPAP CPAP on resident ____ Proper set up with Humidification ____ Proper set up with oxygen __ Circuit changes Proper cleaning of mask assembly head gear and nasal pillows Setting changes IPAP EPAP Mo
66. his manual along with you to help security personnel understand the BiPAP autoSV Advanced System One device If you are traveling to a country with a line voltage different than the one you are currently using a different power cord or an international plug adaptor may be required to make your power cord compatible with the power outlets of the country to which you are traveling Contact your home care provider for additional information Airline Travel The device is suitable for use on airlines when the device is operating from an AC or DC power source Home Cleaning e Cleaning the Device WARNING To avoid electrical shock always unplug the power cord from the wall outlet before cleaning the device DO NOT immerse the device in any fluids 1 Unplug the device and wipe the outside of the device with a cloth slightly dampened with water and a mild detergent Let the device dry completely before plugging in the power cord 2 Inspect the device and all circuit parts for damage after cleaning Replace any damaged parts Cleaning or Replacing the Filters Under normal usage you should clean the gray foam filter at least once every two weeks and replace it with a new one every six months The white ultra fine filter is disposable and should be replaced after 30 nights of use or sooner if it appears dirty DO NOT clean the ultra fine filter CAUTION Dirty inlet filters may cause high operating temperatures that may affect device performance
67. hite cap directly to the patient s mask The other end of the circuit attaches to the CPAP BIPAP machine There is also a small hole at this end of the circuit This is the exhalation port this is where the patient exhales this should never be covered up It is normal to feel a constant flow of air escaping from the exhalation port while the patient is using the CPAP BIPAP Try to face this hole away from the patient so that it does not blow on the patient 5 When setting the patient up on nasal pillows or mask make sure that there are no leaks Adjust the headgear so that the mask or nasal pillows fit snugly on the patient s face 6 Wash the mask or nasal pillows every morning 7 Change the circuit once a week HELPFUL HINTS e When you use Nasal CPAP for the first time you will note an unusual sense of pressure when breathing You will need to consciously push out when you breathe out This is normal and will occur automatically when you are asleep At first you may feel that the pressure is impeding your breathing It is not Take your time and learn to adapt to this new sensation A few deep breaths at the start of use may help to minimize the sensation e If you open your mouth air will leak out This is an unpleasant sensation While wearing your mask when you are awake you should keep your mouth closed When you are asleep this usually happens automatically However if you awake at night and open your mouth the sensation of air ru
68. hose with darkly pigmented skin 19 Poor perfusion cold digits due to hypotension hypovolemic shock cold environment or cardiac failure Anemia Oxygen delivery to tissues is inadequate but SpO is normal Carbon monoxide poisoning Carbon monoxide binds to hemoglobin resulting in inadequate oxygen transport despite normal pulse oximeter readings 3 Certain antiretroviral medications Affect oxygen s affinity for hemoglobin 20 Movement shivering patient heart arrhythmias Oximeter may not be able to identify an adequate pulse signal 3 Nail polish dirt artificial nails Can cause false low readings or no readings 3 Bright artificial light as in an operating room Can cause false low readings 3 May result in the machine not providing a reading 3 Older patients Normal oxygen saturation levels may be slightly lower than in younger people 13 Sickle cell disease Does not confound SpO results in adults 21 but may in children 22 Consult manufacturers recommendations regarding the effects of low perfusion and performance in darkly pigmented skin New Jersey Respiratory Associates Nurse Competency Program Tracheostomy Care Respiratory Care amp Tracheostomy Tubes airway esophagus vocal cords larynx trachestamy tube to ventilator New Jersey Respiratory Associates Nurse Competency Program NJRA Tracheostomy Care Instruction
69. ilator The following is an excerpt from RN com s Update on Tracheostomy Care course booklet INTRODUCTION Taking care of a patient with a tracheostomy trach requires you to know about natural and artificial airway anatomy signs and symptoms of hypoxia sterile vs clean technique and appropriate nursing actions if the trach tube accidentally comes out Putting your patient s medical condition aside for the moment this course will focus on how to adapt your care to the presence of a tracheostomy i Nasal Cavity N ra Palate Oral Cavity Pharynx Epiglottis Larynx opening Into pharynx Esophagus Courtesy of the National Cancer Institute 2004 www nci gov New Jersey Respiratory Associates Nurse Competency Program NJRA TRACHEOSTOMY FACTS In the span of your nursing career you may be responsible for the following patients who have tracheostomies A comatose patient A patient with cancer of the larynx A burn patient with inhalation damage A COPD patient on mechanical ventilation A pediatric patient with a congenital airway obstruction Tracheotomy is the surgical procedure that creates a tracheostomy It is rarely done as an emergency because oral or nasal intubation or cricothyrotomy is much faster and less complicated when managing respiratory arrest Tracheotomy is performed for the following reasons To bypass an obstruction To maintain an open airway To remove secretions more easily To
70. ll contribute to tissue necrosis A fistula can develop between trachea and esophagus or grow into the wall containing a major artery Aspiration of gastric contents is the consequence for one path of erosion hemorrhage results from the other If your patient is coughing and choking during meals you suspect food particles are in the trach secretions and trach cuff inflation requires increasing amounts of air your patient may have a tracheal esophageal fistula Schreiber 2001 Dixon 2003 Suctioning grape juice or blue dyed liquid from the trach after your patient drinks it is one way to test this A patient with a fistula should be NPO and evaluated for surgery Complications Common Long term Infection abscesses Webbing granulomas Mucosal bleeding Fistulas New Jersey Respiratory Associates Nurse Competency Program WEANING Tracheostomy tubes are discontinued either surgically or through a transition process of intermittent trials The trach tube is capped or plugged for periods of time until the patient can tolerate it for 24 hours Assess your patient s risk of aspiration before taking the tube out There may be some residual swallowing impairment caused by cuff pressure on swallowing muscles Lewis Heitkemper amp Dirksen 2000 Systematic downsizing of the tube may also be used in weaning Once the tube is taken out the stoma usually closes by itself gradually If not minor surgery will close it NJRA Tr
71. ly clean the nebulizer and mouthpiece in hot water detergent solution Remove from the water detergent solution and rinse with clear hot tap water Soak in hot water vinegar solution for 30 minutes Rinse with hot tap water again and air dry thoroughly NOTE If using medical disinfectant cleaners follow manufacturer s instructions carefully 8 Keep the outer surface of the tubing dust free by wiping regularly NOTE The nebulizer air tubing does not have to be washed internally because only filtered air passes through the tubing Invacare Select 22 Part No 1148073 New Jersey Respiratory Associates Nurse Competency Program NJRA SECTION 3 CLEANING AND DISINFECTING Cleaning the Compressor CAUTION Unplug unit before cleaning DO NOT submerge in water to clean DO NOT clean using abrasive cleaners 1 Clean the casing of the main unit daily by using a soft cloth moistened with water or a mild detergent 2 Wipe the casing and immediately dry using a soft clean cloth Cleaning the Mouthpiece 1 Boil the mouthpiece in water for a maximum of five minutes or autoclave at a maximum of 121 C for ten minutes D Allow the mouthpiece to air dry gt Once dry the mouthpiece may be stored inside the nebulizer top Part No 1148073 23 Invacare Select SECTION 4 MAINTENANCE SECTION 4 MAINTENANCE A DANGER DO NOT attempt to separate the outer case of this unit Removing the case
72. ly of no clinical consequence Excessive manipulation of the trach tube during coughing and suctioning can break insecure ties and dislodge the tube Within the first 48 hours the freshly created stoma may close shut constituting a medical emergency To minimize this risk trach ties are not changed for 24 hours and the first tube change is generally done by a physician after a week has passed Lewis Heitkemper amp Dirksen 2000 Your facility will have emergency policies and procedures to follow in the case of a dislodged fresh tracheostomy Types of Tracheostomy Tubes You will encounter different kinds of trach tubes selected for individual patient needs The most common type is the three part universal tube It has an outer cannula with an inflatable cuff an inner cannula with an adaptor for connecting to a ventilator or other equipment and an obturator with a rounded tip for smoothly inserting the outer tube and avoiding trauma to the tracheal wall A cuffless model is used for fong term trach patients whose gag and cough reflexes are intact For the acute care patient a pilot tube allows the cuff to be inflated with air foam or water providing a closed airway for mechanical ventilation and preventing aspiration of gastric or oral secretions Tubes may be made of metal PVC material or silicone and will differ accordingly in the degree of flexibility they provide For infants and small children single cannula soft plastic trach tubes ar
73. m the humidifier bottle to oxygen outlet connector on the oxygen concentrator FIGURE 5 4 8 Attach the cannula patient supply tubing to the humidifier bottle outlet FIGURE 5 4 9 After assembly ensure that oxygen is flowing through the cannula Oxygen Outlet Oxygen Connector Tubing Humidifier Outlet FIGURE 5 4 Attaching the Oxygen Tubing Power Switch NOTE For this procedure refer to FIGURE 5 5 on page 19 1 Press power switch to on position All the panel lights and the audible alarm will come on for one second indicating that the unit is functioning properly On Off VO Power Switch FIGURE 5 5 Power Switch Part No 1118353 19 Platinum Series New Jersey Respiratory Associates Nurse Competency Program NJRA SECTION 5 OPERATING INSTRUCTIONS Flowrate NOTE For this procedure refer to FIGURE 5 6 on page 20 1 Turn the flowrate knob to the setting prescribed by your physician or therapist CAUTION Never set the flow greater than 5 L min on the IRC5 Never set the flow greater than 10L min on the IRC10 A WARNING DO NOT change the L min setting on the flowmeter unless a change has been prescribed by your physician or therapist NOTE To properly read the flowmeter locate the prescribed flowrate line on the flowmeter Next turn the flow knob until the ball rises to the line Now center the ball on the L min line prescribed 2 Ifthe flowrate on the flowmeter ever falls
74. mary Care Stable disease Establishing a baseline value in patients with stable disease 4 Monitoring of patients with exercise related dyspnea 4 In patients with moderate to severe COPD a screening tool to identify patients i e those with SpO lt 92 who should be referred for comprehensive oxygen assessment 3 In patients with stable COPD or those recovering from an exacerbation at home an SpO 88 or less is a strong indication to initiate long term oxygen therapy 12 However ideally the decision to initiate oxygen therapy should be made based on arterial oxygen tension PaO lt 7 3 kPa 55 mm Hg Titrating oxygen flow setting in patients on long term oxygen therapy provided their disease is stable and they have good circulation In general the goal should be to maintain SpO gt 90 during all activi ties 7 Evaluation of patients with severe disease FEV lt 50 predicted cyanosis or cor pulmonale for pos sible respiratory insufficiency failure 4 7 Exacerbations Assessment of patients with acutely worsening symptoms especially dyspnea and determination of the severity of the exacerbation 4 7 Triage for arterial blood gas measurement referral to emergency department and or determination of whether to initiate oxygen therapy or other treatment for exacerbation 4 Monitoring patients after the initiation of oxygen therapy Measure SpO regularly every 5 to 30 min utes 13 especiall
75. nd Power B S Dose olus Size Cartridge Battery 7 15 mL Setting 15 Max Breath Max Breath DC Power DO NOT USE SUPPLY TUBING OR CANNULA EXTENSIONS THAT ARE MORE THAN 50 15 2 IN LENGTH IN THE CONTINUOUS FLOW MODE PULSE DOSE MODE SETTINGS MUST BE DETERMINED FOR EACH PATIENT INDIVIDUALLY FOR THEIR NEEDS AT REST DURING EXERCISE AND WHEN TRAVELING DO NOT EXCEED 7 FEET 2 1M IN LENGTH OF SUPPLY TUBING OR CANNULA TUBING WHEN OPERATING IN PULSE DOSE MODE IN ORDER TO ADEQUATELY DETECT ADEQUATE INSPIRATORY EFFORT AS WITH ALL OXYGEN CONSERVING TYPE DEVICES THE ECLIPSE MAY NOT BE ABLE TO DETECT ALL INSPIRATORY EFFORTS IN PULSE MODE IF THE ECLIPSE DOES NOT RESPOND TO YOUR INSPIRATION EFFORTS ASK YOUR HOME CARE PROVIDER TO CHECK THE SENSITIVITY SETTING Step 5 ADJUST THE FLOW SETTING TO THE PRESCRIBED LEVEL Using the Flow Setting Buttons adjust the flow setting to the prescribed setting supplied by your physician DO NOT CHANGE FROM PRESCRIBED FLOW SETTING WITHOUT CONSULTING WITH A QUALIFIED 20 _ CLINICIAN OR PHYSICIAN New Jersey Respiratory Associates Nurse Competency Program NJRA HA CC 4 p sa 5 Personal Ambulatory Oxygen System Users Manual autoSsAT Step 6 Begin Using Your Eclipse Breathe normally through the nasal cannula NOTE You will achieve longer operating time on the Battery if you operate your Eclipse in the Pulse Mode Step 7 Universal Ca
76. nds that gloves should be worn as single use items and not be powdered Local policies should be consulted Patients having suction should be observed closely for any signs of cardiovascular instability during and after the procedure NT 3 February 2009 Vo 105 No 4 waww nursingtimes net Nikki Tadd Carrying out suction via a tracheostomy puts staff at risk from splashfinoculation injury Local infection contro procedures must be followed THE PROCEDURE Prepare the patient obtain informed consent and discuss any anxieties Wash hands and put on an apron non sterile gloves and eye protection as required Encourage deep breathing and if the patient is receiving oxygen and there are no contraindications increase Inspired oxygen concentration Any change in concentration must be prescribed These measures may help to reduce the risk of hypoxia and alveolar collapse Higgins 2005 Select vacuum pressure Fig 1 This should be at a low level The general recommended pressure range is 8 20kPa Pryor and Prasad 2001 Select a suction catheter This should be no more than half the internal diameter of the tracheostomy tube a useful rule of thumb is to use the smallest catheter possible NEXT WEEK Tracheostomy care 2 How to change an inner tube NT 3 February 2009 Vol 105 No 4 www nursingtimes net that is effective at aspirating the secretions Using catheters with more than one
77. nect the power supply cord from the electrical outlet WARNING Periodically inspect electrical cords and cables for damage or signs of wear Discontinue use and replace if damaged CAUTION Do not use extension cords with this device 6 User Manual Navigating the Device Screens Turn the wheel to toggle between options and settings on the screen Press the wheel to choose an option or setting that is highlighted If you choose Back on any screen it will take you back to the previous screen Note The screens shown throughout this manual are examples only Actual screens may vary slightly Examples are for reference only Starting the Device 1 Supply power to the device 2 The Home screen will appear shown below Home Screen Note Bi Flex shown above will either display a blank screen or it will show Bi Flex or Rise time depending on how the provider set up the device Note The SD card icon will display next to Info if the SD card is inserted Put on your mask assembly Note If you are having trouble with your mask refer to the instructions supplied with the mask 4 Turn the wheel to toggle between the options Highlight Therapy Press the wheel to turn on the airflow and begin therapy The Monitor Pressure screen will appear described in detail in the next section Note If the Auto on feature is enabled the device will automatically turn the airflow on whenever you apply the interface mask
78. ntonio Anzueto Richard Casaburi Stephen Holmes and Tjard Schermer with Yousser Mohammad Chair It was developed in collaboration with the International Primary Care Respiratory Group IPCRG and the European Federation of Allergy and Airways Diseases Patients Associations EFA The panel members have also solicited input from various experts working in developing countries in order to produce a document that will be relevant to a variety of health care systems and socioeconomic conditions New Jersey Respiratory Associates Nurse Competency Program NJRA BACKGROUND AND PRINCIPLES OF PULSE OXIMETRY Pulse oximetry is a noninvasive method that enables rapid measurement of the oxygen saturation of hemoglobin in arterial blood 1 It can rapidly detect changes in oxygen saturation thus providing an early warning of dangerous hypoxemia 2 3 The use of pulse oximetry for patient assessment and monitoring is well established in critical care anesthesiology and emergency departments 2 In recent years the availability of small user friendly portable and affordable pulse oximeters including those worn on the fingertip has opened up the potential for use of this technique in an expanded variety of clinical settings including primary care 4 A pulse oximeter shines light at two wavelengths red and infrared through a part of the body that is relatively translucent and has good arterial pulsed blood flow e g finger toe earlobe
79. o wear there is significant air leakage around the mask or you experience other mask related issues You have a runny nose Contact your home care provider 16 User Manual New Jersey Respiratory Associates Nurse Competency Program NJRA Accessories There are several accessories available for your BiPAP autoSV Advanced System One device such as a humidifier Oximetry module or a modem Contact your home care provider for additional information on the available accessories When using optional accessories always follow the instructions enclosed with the accessories CAUTION Pins of connectors should not be touched Connections should not be made to these connectors unless ESD precautionary procedures are used Precautionary procedures include methods to prevent build up of electrostatic charge e g air conditioning humidification conductive floor coverings non synthetic clothing discharging one s body to the frame of the equipment or system or to earth or a large metal object and bonding oneself by means of a wrist strap to the equipment or system or to earth Adding a Humidifier You can use the System One Heated humidifier or the Passover humidifier with your device They are available from your home care provider A humidifier may reduce nasal dryness and irritation by adding moisture to the airflow Note Refer to the humidifier s instructions for complete setup information Using the SD Card The BiPAP autoS
80. o assist them to breathe is fairly high and it would be difficult to exhale against that pressure The inspiratory pressure is set high and the expiratory pressure is generally very low Some BIPAP machines have respiratory rate that can be dialed in to trigger a breath a number of times per minute The types of patients who use BIPAP in this way are COPD patients or patients with musculoskeletal problems like quadriplegics and patients with Muscular Dystrophy 4 There are several different types masks and headgears to administer the CPAP BIPAP therapy Each patient is different so different mask sizes and types are available to suit the patient s needs The masks used either only cover the nose or cover both the nose and mouth There is also an item called nasal pillows that fit directly into the nose instead of the mask is the patient is unable to tolerate the mask Masks come in small medium and large New Jersey Respiratory Associates Nurse Competency Program NJRA BiPAP CPAP Machines Instructions 1 Pull the thin clear tubing off of the main tubing you won t be using it 2 Atthe top of the circuit is a port with a white cap If the patient is not using oxygen close the port with the cap 3 If the patient requires oxygen to be bled into the circuit bleed it in here Cut off one end of the oxygen tubing and place it here Attach the other end of the tubing to the oxygen source 4 Attach the end of the CPAP BIPAP circuit with the w
81. occurs contact your home care provider The airflow does not turn on There may be a problem Make sure the device is powered correctly Make sure Therapy or the with the blower C icon is highlighted when pressing the control wheel to start airflow If the airflow does not turn on there may be a problem with your device Contact your home care provider for assistance The device s display is erratic The device has been Unplug the device Reapply power to the device If the problem dropped or mishandled continues relocate the device to an area with lower EMI emissions away or the device is in an area from electronic equipment such as cellular phones cordless phones with high Electromagnetic computers TVs electronic games hair dryers etc ff the problem still Interference EMI emissions occurs contact your home care provider for assistance The Ramp feature does not work Your home care provider If Ramp has not been prescribed for you discuss this feature with your when you press the Ramp button did not prescribe Ramp for home care provider to see if they will change your prescription you or your prescription pressure is already set to the minimum setting ff your provider has enabled Ramp but the feature still does not work check the pressure setting on the Monitor Pressure screen If itis set to the minimum setting 4 0 cm H O or the starting pressure i
82. of the diameter of the trach tube e Hyperoxygenate before each pass with the catheter although some initial suctioning should be done if using bag ventilation so as not to drive secretions deeper toward the lungs Exceptions to hyperoxygenation are children and those with long term trachs e Insert catheter to a pre measured depth matching the length of the tube and only to a point of resistance if deeper suctioning is necessary e Use saline only as needed to loosen plugs e Supply suction intermittently while rotating unless the catheter has side holes Controversy exists on whether to apply suction on withdrawal only or on both insertion and withdrawal e Limit suctioning to 5 seconds for pre measured depth and 15 seconds for deep suctioning e Use suction pressure between 120 and 150 mmHg Limit suctioning to 3 passes and discontinue if heart rate drops by 20 increases by 40 produces arrhythmias or decreases oxygen saturation to less than 90 Suction mouth after trach suctioning to remove secretions above a cuffed tube but do not contaminate the trach by going from mouth back to trach Copyright protected material used with permission of the authors and the University of Iowa s Virtual Hospital www vh org Routine Tracheostomy Care Factoid Trach ties are generally changed daily after the first 24 hours To lower the risk 60 to 100 of of accidental decannulation the trach tube coming out the tie
83. ones are Inflammation and edema of the trachea Infection and abscess of the stoma and or pulmonary tree e Bleeding associated with suctioning Bissell 2004 SIMS Portex 1998 If humidity is insufficient the mucous membranes dry out and the irritation of an inserted catheter will cause small amounts of bleeding during routine suctioning Long term complications from the presence of a trach tube are due to tracheal scarring and erosion Stenosis the narrowing of the trachea from scar tissue occurs in 5 to 15 of patients Fenstermacher amp Hong 2004 This development escalates with a history of endotracheal intubation and or excessive trach tube cuff pressure Scarring can occur at the stoma the tube cuff site or at the point where the distal end of the tube presses on the tracheal wall It may cover a large area extending beyond the trachea in weblike fashion or appear as a localized granuloma Your patient most likely will not be scoped to assess tracheal stenosis until after the trach tube is taken out Stenosis is not significant enough for surgical intervention unless it narrows the airway more than 50 Fenstermacher amp Hong 2004 Treatments for scarring are Serial dilation e Endoscopic excision e Anterior cricoid split or laryngotracheoplasty Bissell 2004 Fistulas take months to develop The constant pressure from a poorly fitted trach tube excessive cuff volume and or a nasogastric feeding tube a
84. or until the user acknowledges it No action needed Operates SD card removed Operates This message occurs when the SD card is removed from the device lt is present for 30 seconds or until the user acknowledges it No action is needed User Manual 15 Troubleshooting The table below lists some of the problems you may experience with your device and possible solutions to those problems Why It HAPPENED WHAT To Do PROBLEM Nothing happens when you apply There is no power at the power to the device The backlights on outlet or the device is the buttons do not light unplugged If you are using AC power check the outlet and verify that the device is properly plugged in Make sure there is power available at the outlet Make sure the AC power cord is connected correctly to the power supply and the power supply cord is securely connected to the device s power inlet If the problem continues to occur contact your home care provider Return both the device and power supply to your provider so they can determine if the problem is with the device or power supply If you are using DC power make sure your DC power cord and battery adaptor cable connections are secure Check your battery ft may need recharged or replaced If the problem persists check the DC cord s fuse following the instructions supplied with your DC cord The fuse may need to be replaced If the problem still
85. our home care provider Your physician or home care provider will provide you with cleaning disinfection and replacement information Air Inlet Filter Ambient air is drawn into the device through the air inlet located on the top rear of the device Cleaning the air inlet filter is the most important maintenance activity you will perform as a user cleaning the air inlet filter will keep your Eclipse performing properly Check this air inlet filter daily and clean it at least once a week using the following procedure 1 Remove the air inlet filter 2 Wash the filter in warm tap water using a mild soap detergent solution 3 Rinse the filter thoroughly with clear tap water and squeeze out the excess water 4 Allow the filter to air dry 5 Reinsert the filter in the cabinet Cleaning tip keep a clean second filter as a replacement for use when one filter is drying THE AIR INLET FILTER SHOULD BE FREE OF LIQUID WATER AND DRY TO THE TOUCH BEFORE REINSTALLATION MOISTURE IN THE FILTER MAY IMPAIR PROPER OPERATION OF THE ECLIPSE NOTE THAT THE SERVICE PORT IS EXPOSED WHEN THE AIR INLET FILTER IS REMOVED DO NOT ATTACH ANY CABLES TO THIS SERVICE PORT THE PART IS TO BE USED BY A QUALIFIED SERVICE TECHNICIAN ONLY DO NOT PLACE FOREIGN OBJECTS INTO OR THROUGH THE VENT HOLES OF THE AIR INLET OR 23 EXHAUST VENT Oxygen Delivery Devices Oxygen Cylinders New Jersey Respiratory Associates Nurse Competency Program
86. quipment or system or to earth 2 User Manual New Jersey Respiratory Associates Nurse Competency Program NJRA Before operating the device ensure that the SD card cover is replaced whenever any of the accessories such as the Link Module or Modem are not installed Refer to the instructions that came with your accessory Condensation may damage the device If this device has been exposed to either very hot or very cold temperatures allow it to adjust to room temperature operating temperature before starting therapy Do not operate the device outside of the operating temperature range shown in the Specifications Do not use the device in the presence ofa flammable anaesthetic mixture in combination with oxygen or air or in the presence of nitrous oxide Do not use extension cords with this device Do not place the device directly onto carpet fabric or other flammable materials Do not place the device in or on any container that can collect or hold water A properly installed undamaged reusable foam inlet filter is required for proper operation Tobacco smoke may cause tar build up within the device which may result in the device malfunctioning Dirty inlet filters may cause high operating temperatures that may affect device performance Regularly examine the inlet filters as needed for integrity and cleanliness Never install a wet filter into the device You must ensure sufficient drying time for the cleaned filt
87. r the user 3 Service Port 4 External Power The Eclipse AC or DC Power Supply cords may be connected to this Receptacle receptacle 5 Exhaust Vent Exhaust air from the Eclipse exits the device from this vent 9 6 Power Cord Retainer Retainer to secure the Power Cord eclipses autoSAl Personal Ambulatory Oxygen System Users Manual HOW YOUR ECLIPSE 3 WORKS The Eclipse 3 Personal Ambulatory Oxygen System with autoSAT Technology is a portable concentrator used to extract oxygen from the atmosphere concentrate it to greater than 90 and present it to the patient The device will operate in Continuous Flow or Pulse Dose Mades In Continuous Flow Mode the oxygen is provided at a constant flow rate between 0 5 and 3 0 LPM in Pulse Dose Mode oxygen is supplied in a bolus at the beginning of each inspiration providing a selectable range setting of 16mL to 192ml The Eclipse 3 operates from either external power or from an internal rechargeable battery The system includes a Smart Battery charger that recharges the internal battery whenever the Eclipse is connected to external power The system monitors and controls the power source and the battery charger The Eclipse 3 separates oxygen from ambiant air The air is filtered and then separated into oxygen and nitrogen the nitrogen is then purged This cycle concentrates the oxygen UNDERSTANDING THE CONTROLS ON THE CONTROL PANEL USER CONTROLS AND SYS
88. ram 19 Nps ses Personal Ambulatory Oxygen System Users Manual Wild au NOTE If there are three beeps this indicates a low battery condition for the 9 volt battery inside the cabinet of the Eclipse Please contact your home care provider and request that the 9 volt battery be replaced NOTE Please allow longer warm up times for cold weather start ups The Eclipse has an oxygen concentration status indicator OCSI built in to the device The OCSI continually monitors the oxygen output of the device and incorporates a green light normal yellow light alert red light alarm and a buzzer These indicators will all illuminate during the power on self test at start up After initially powering ON the device please allow up to five 5 minutes for the device to reach its performance specifications When only the green indicator light is illuminated the device has reached its performance specifications eclipses utos A Step 3 Connect the Oxygen Supply Tubing or Nasal Cannula to the Oxygen Outlet Replace the cannula and oxygen supply tubing regularly as recommended by your home care provider Consult your home care provider for cannula and supply tubing cleaning and replace ment information Step 4 Select the Flow Mode Press the Flow Mode button to select the desired mode Pressing this button repeatedly will toggle you back and forth between Pulse Dose Mode and Continuous Flow Mode The proper mode and proper settin
89. rd Low Corrupted Solid yellow button SD card corrupted Reformat card Operates This alarm occurs when a problem exists with the SD card The data may be corrupted Press the Alarm Silence Indicator button to silence the alarm Choose yes to reformat the card If you choose no the card will not be reformatted Note Any information on the card will be lost when reformatted Contact your home care provider with any questions Solid yellow button Operates This alarm occurs when the SD card is SD card full full Press the Alarm Silence indicator button to silence the alarm Remove the SD card and replace it SD Card Remove and Reinsert This alarm occurs when the device cannot read the SD card The card may be inserted incorrectly Remove the SD card and reinsert If the alert continues to occur replace the SD card or contact your home care provider Solid yellow button Reinsert SD Card Operates SD Card Prescription Rejected Solid yellow button SD card inserted prescription rejected This message occurs when the prescription is missing or incorrect Contact your home care provider for the correct prescription Operates SD card inserted prescription accepted SD Card Prescription Accepted SD Card Removed This info message will be present for 30 seconds
90. re of this device Your physician has prescribed supplemental oxygen as part of a treatment plan Long Term Oxygen Therapy LTOT is now widely accepted as the standard treatment for chronic hypoxia caused by Chronic Obstructive Pulmonary Disease COPD The Eclipse may be used in the home an institution a motor vehicle or in a commercial airplane Your physician has prescribed specific oxygen flow settings to meet your individual clinical needs e at rest e during activities or exercise e at night for travel at altitude e Become familiar with the key features of the Eclipse and the user control panel Control ranet FRONT Handle BACK 6 Service Port Not for Patient Use Q Air Inlet 2 Filter 4 External Power a Oxygen Receptacle Outlet Port FAA Approval Icon Location FAA Approval Icon A Power 6 a Cord Cartridge Retainer Battery 5 Exhaust Vent T Rating Label amp S Power Cartridge Latch Serial Number 7 Location 1 Oxygen Outlet Port Oxygen supply tubing or a cannula is attached to this port ESS Ts A Ambient air is drawn into the device through the air inlet This air inlet 2 Air Inlet Filter filter prevents dust and debris from entering the Eclipse and should be top rear cleaned regularly This connection located behind the air inlet filter allows qualified service personnel to diagnose and monitor the Eclipse performance This port is not intended fo
91. re power If the alarm continues contact your home care provider for service Low Speed Operates High Pressure Red flashing button High Pressure Operates if the alarm continues for 10 seconds the alarm escalates to a Device Inoperative alarm This may be caused by a malfunctioning device Press the Alarm Silence Indicator button to silence the alarm Remove your mask Remove power from the device Restore power If the alarm continues contact your home care provider for service Low Red flashing button Operates This could be caused by an excessive Pressure Low Pressure leak or blockage or a device malfunction Support Support Press the Alarm Silence Indicator button to silence the alarm Remove your mask Check for the following dirty inlet filters blocked air intake excessive leak in the patient circuit If the alarm continues contact your home care provider Red flashing button Apnea Operates This alarm is generated when an apnea event occurs during therapy Press the Alarm Silence Indicator button to silence the alarm Report the alarm to your home care provider Continue using your device This alarm occurs when the calculated minute ventilation is less than or equal to the alarm setting Press the Alarm Silence lndicator button to silence the ala
92. rm Report the alarm to your home care provider Continue using your device Low Minute Ventilation High Red flashing button Low Minute Vent Operates Patient High soa es Disconnect Red flashing button Patient Disconnect Operates This alarm occurs when the patient circuit is disconnected or has a large leak Press the Alarm Silence Indicator button to silence the alarm Reconnect the patient circuit or fix the leak If the alarm continues contact your home care provider for service 14 User Manual New Jersey Respiratory Associates Nurse Competency Program NJRA AUDIBLE VISUAL INDICATORS Device Action User ACTON INDICATOR PRIORITY Low Input Voltage Yellow flashing button Low Voltage Device Operates Humidifier shuts down The alarm is caused when input power at the device either from an AC outlet or battery falls below the acceptable limit for 10 seconds Press the Alarm Silence Indicator button to silence the alarm If the device is plugged into a wall outlet unplug the device and then plug it back in If the alarm continues to occur contact your home care provider for service If you are using a battery replace the battery or plug the device into an AC outlet If the alarm continues contact your home care provider for service SD Ca
93. rt Operation The Universal Cart is designed for use on pedestrian type surfaces Align the locator holes on the bottom of the device to the tabs on the Universal Cart Align the large threaded screw to the insert at the back of the Eclipse Then hand tighten the knob on the cart until the Universal Cart is tightly secured to the device Depress the push button E on the Universal Cart handle to adjust the height of the handle Step 8 Power Off the Device Press and hold the ON OFF Button for two 2 seconds to power OFF your Eclipse Store the Eclipse in a cool and dry location NOTE DO NOT operate your Eclipse and ambulate while a humidifier is attached Remove the humidifier bottle before walking DO NOT lay the Eclipse down while attached to a humidifier bottle Eclipse Standard Components supplied with each Eclipse AWARNIN ONLY USE SEQUAL RECOMMENDED ACCESSORIES OTHERS MAY IMPAIR PERFORMANCE AC POWER POWER CARTRIDGE SUPPLY WITH BATTERY NEMA POWER _ CORD UNIVERSAL CART Universal Cart Your Eclipse can be easily transported while attached to the Universal Cart The Universal Cart features wheels and a telescoping handle to 21 aid mobility LL mi eclipses Personal Ambulatory Oxygen System Users Manual autoSAT AYAN ASAHIN A BACK UP SOURCE OF SUPPLEMENTAL OXYGEN IS RECOMMENDED IN CASE OF A POWER OUTAGE OR A MECHANICAL FAILURE OF THE DEVICE CONSULT YOU
94. s is also affected by the tracheostomy as the mechanism of warming and humiditying air through the upper airway is lost Secretions become thick and dry which inhibits mucociliary transport They can build up and may block the tracheostomy tube Endotracheal suctioning is performed to maintain a clear airway and optimise respiratory function Dougherty and Lister 2008 It can be performed via a tracheostomy tube A number of risks are associated with it These include Hypoxia as oxygen flow is interrupted and the airway partially obstructed Alveolar collapse as gas is aspirated out of the bronchial tree Tracheo bronchial trauma Infection Haemodynamic instability resulting from stimulation of the vagus nerve which supplies the larynx trachea lungs and heart When to perform suction The decision to perform suction must be based on a comprehensive patient assessment rather than using set times This assessment will include a review of characteristics such as respiratory rate and pattern chest excursion and palpation and auscultation of the chest Higgins 2005 The equipment needed Is as follows Vacuum generator collection device tubing Selection of appropriate sized catheters Gloves Apron Eye protection 0 Gallipot smail bowl 6 Saline water solution There appears to be some controversy over the use of sterile or non sterile gloves The Department of Health 2001 recomme
95. s the same as the prescribed pressure the Ramp feature will not work The airflow is much warmer than The air filters may be dirty Clean or replace the air filters usual The device may be operating in direct sunlight or near a heater The temperature of the air may vary somewhat based on your room temperature Make sure that the device is properly ventilated Keep the device away from bedding or curtains that could block the flow of air around the device Make sure the device is away from direct sunlight and heating equipment If using the humidifier with the device check the humidifier settings Refer to the humidifier instructions to make sure the humidifier is working properly If the problem continues contact your home care provider Make sure the Tubing type setting 22 or 15 matches the tubing that you are using Respironics 22 mm tubing or the optional Respironics 15 mm tubing If the problem continues contact your home care provider The airflow pressure feels too high or too low The Tubing type setting may be incorrect This could be due to improper headgear adjustment or improper mask fitting This may be caused by a nasal reaction to the airflow Make sure you are properly fitted with the correct size mask If the problem continues contact your home care provider to be fitted with a different mask The mask feels uncomfortable t
96. sages PRIORITY AUDIBLE VISUAL INDICATORS Device ACTION User AcTION INDICATOR Shuts down Remove your mask Press the Alarm Silence Indicator button to silence the alarm Check your power connections Make sure there is power at the outlet or power source Restore power to the device If the alarm continues contact your home care provider for service Red flashing button Blank screen Red solid button Shuts down Device Inoperative Remove your mask Press the Alarm Silence lndicator button to silence the alarm Contact your home care provider for service Device inoperative User Manual 13 Priority Aupiste VISUAL INDICATORS Device ACTION User ACTION INDICATOR Low Red flashing button Operates This could be caused by an excessive Pressure Low Pressure leak or blockage or a device malfunction Alarm Press the Alarm Silence lndicator button to silence the alarm Remove your mask Check for the following dirty intet filters blocked air intake excessive leak in the patient circuit If the alarm continues contact your home care provider is High High is High oe Red flashing button Low Blower Speed This may be caused by a malfunctioning device Press the Alarm Silence Indicator button to silence the alarm Remove your mask Remove power from the device Resto
97. scribed amount of medication to the cup of the nebulizer using an eyedropper pre measured dose or ampoule Eyedropper Nebulizer Cup FIGURE 2 1 Adding Medication 5 Gently twist the top and bottom sections together to assemble the nebulizer Be sure the two sections fit securely 6 Attach one end of the air tubing to the air tubing connector located on the front of the compressor Part No 1148073 17 Invacare Select SECTION 2 OPERATING INSTRUCTIONS 7 Attach the other end of the air tubing to the base of the nebulizer NOTE Ensure nebulizer tubing is firmly attached to compressor before use A WARNING In the case of high humidity condensation may form inside the internal tubing Run the unit for two minutes before connecting the nebulizer to the tubing 8 Attach the mouthpiece to the top section of the nebulizer Refer to the nebulizer manual for additional instructions NOTE Before starting a cold unit let the unit reach room temperature in a heated area 9 With the power switch off plug the power cord into an appropriate electrical outlet CAUTION This device is for intermittent use 30 min ON 30 min OFF Failure to operate within these limits could damage the device beyond repair Invacare Select 18 Part No 1148073 New Jersey Respiratory Associates Nurse Competency Program SECTION 2 OPERATING INSTRUCTIONS Treatment Instructions NOTE For this procedure refer to FIGUR
98. shing from your mouth might alarm you at first You should close your mouth and try to go back to sleep e Some people experience a continuing dryness of the nose mouth or throat when on nasal CPAP particularly during the winter months This may be relieved by the use of an in line humidifier such as a hygroscopic condenser humidifier HCH or a heated humidifier both of which are available Contact your physician or equipment supplier for specific advice on whether these are suitable for you Also note that your set pressure may need to be adjusted if a humidifier is used Note In line humidifiers should never be used at the same time as nebulized drugs or when nose sprays are used e Washing your face to remove excess facial oils prior to fitting the mask will help prolong the useful life of the cushion e Atight fit of the mask is not necessary A well balanced comfortable fit without undue tightness can usually be obtained to provide an efficient air seal Pulling the straps too tight can lead to sensitivity of the bridge of the nose or the upper lip and occasionally skin irritation Setting the final tension is best done while lying down Note A minor leak around the lower part o the face is sometimes preferable to over tightening the mask but you should eliminate any air leaks blowing in the direction of the eyes as this may cause eye irritation New Jersey Respiratory Associates Nurse Competency Program NJRA BiPAP CP
99. sults Explain _ Things that affect readings _ Normal ranges for Pulse Oximetry _ Infection Control Nurse Instructor Date NJRA Pulse Oximetry Overview Pulse oximetry works by photospectometry A light on the inside of the patient probe shines a light through the tissue and receives a signal on the other side If the patient s blood is well saturated with oxygen a certain kind of wavelength of light is transmitted If the hemoglobin is not well saturated with oxygen another type of wavelength is transmitted The only way to get a direct measurement of arterial oxygenation is an arterial blood gas The pulse oximeter provides a painless noninvasive cost effective manner of estimating the patient s oxyhemoglobin When using the pulse oximeter e Clean the inside of the probe and the patient s finger with alcohol This removes any residue on the light source and finger that may interfere with the reading e Place the lighted side of the probe on the nail bed e DONOT squeeze the probe on the patient s finger as tissue injury or a poor reading will occur e Watch the strength of the wavelength on the pulse oximeter if available to verify the stability of the reading e Watch the patient s SpO reading for several minutes until it is stabilized If an inadequate or questionable reading is obtained select another finger e If you cannot believe the heart rate displayed you cannot trust the SpO gt reading e M
100. t your home care provider 18 User Manual New Jersey Respiratory Associates Nurse Competency Program Medication Nebulizers Compressor Nebulizer System New Jersey Respiratory Associates Nurse Competency Program Medication Nebulizers Instruction Check Sheet Demonstrate Assembling medication nebulizer Administration of treatment to resident Assessment of resident during treatment Changing filter in small air compressor Explain Indications of aerosolized medications How bronchodilators work Hazards of administrating medications Trouble shooting compressor Infection control for equipment Nurse Instructor Date NJRA Medication Nebulizers Overview 1 Aerosolized medications are delivered to the airways to decrease bronchoconstriction in the airways and improve air exchange 2 Residents with diagnosis benefiting from bronchodilators include a Pneumonia b Emphysema c Asthma d Chronic Bronchitis e Bronchiectasis 3 Medication dosage and frequency should be included in the MD order 4 Assess resident before during and after treatment heart rate respiratory rate sounds and work of breathing 5 Instruct the resident to breathe deeply during the treatment and cough strongly for the treatment Hazards include tachycardia palpitations increased tremor and hyperventilation Document medication assessment and sputum production Place small air compressor on sturdy surface while using
101. to an AC outlet the device will accept power from the external power source and replen ish the battery Proper connection of the AC or DC Power Supply requires aligning the power plug with the recessed external power receptacle of the device The recessed external power receptacle is located on the right side of the device when 13 facing the Control Panel Push the power plug into the recessed receptacle New Jersey Respiratory Associates Nurse Competency Program NJRA Wt sa 3 Personal Ambulatory Oxygen System Users Manual autoSAT CORD MAY RESULT IN A FIRE HAZARD DO NOT TOUCH THE METAL CONNECTORS INSIDE THE POWER COMPARTMENT CABINET WITH THE DEVICE CONNECTED TO AN EXTERNAL AC OR DC POWER SOURCE THIS MAY RESULT IN AN ELECTRICAL SHOCK AC Power Supply with NEMA Power Cord Item 5941 AC POWER SUPPLY The Eclipse includes a universal AC Power Supply for use at home or wherever standard AC power is available To connect to an AC power source be sure the AC Power Supply cord is securely inserted into the recessed power receptacle on the side of the device and that the cord from the AC Power Supply is plugged into a grounded AC outlet When the Eclipse is plugged in properly a green indicator on the AC Power Supply will light and the External Power Indicator a will appear on the user contro panel Step 1 ION THE AC POWER CORDS USED WITH THE ECLIPSE MUST MEET THE ELECTRICAL REQUIREMENTS OF THE COUNTRY
102. tubing to the mask Refer to the instructions that came with your mask 3 Attach the headgear to the mask if necessary Refer to the instructions that came with your headgear Where to Place the Device Place the device on a firm flat surface somewhere within easy reach of where you will use it at a level lower than your sleeping position Make sure the filter area on the back of the device is not blocked by bedding curtains or other items Air must flow freely around the device for the system to work properly Make sure the device is away from any heating or cooling equipment e g forced air vents radiators air conditioners CAUTION Do not place the device directly onto carpet fabric or other flammable materials CAUTION Do not place the device in or on any container that can collect or hold water Supplying AC Power to the Device IMPORTANT If you are using your device with a humidifier refer to the instructions included with your humidifier for details on how to power the device and humidifier Complete the following steps to operate the device using AC power 1 Plug the socket end of the AC power cord included into the power supply also included 2 Plug the pronged end of the AC power cord into an electrical outlet that is not controlled by a wall switch 3 Plug the power supply cord s connector into the power inlet on the back of the device 4 Ensure that all connections are secure IMPORTANT To remove AC power discon
103. water as needed Humidifiers may be used on concentrators Oxygen delivery devices and humidifiers should be changed weekly Oxygen concentrators should analyzed as per manufacturer s recommendations There is no smoking allowed anywhere where oxygen is used Post a NO SMOKING sign O Oy OT a Oxygen therapy should be used carefully in residents with COPD due to the possibility of hypercarbia 10 Alarm will sound when electrical source is disconnected New Jersey Respiratory Associates Nurse Competency Program NS NOTE NJRA Stationary Oxygen Concentrators Instructions Plug the electrical cord into an outlet DO NOT use an extension cord Keep back from sides of unit at least six inches from drapes or walls Attach the humidifier jar of sterile water to the outlet of the machine This adds humidity to the oxygen to keep your nose from becoming too dry If ordered by physician If the bottle is on properly bubbles will appear in the humidifier bottle when the machine is turned on 4 NOTE Attach the nasal cannula to the outlet on the top of the humidifier You are now ready to use the oxygen concentrator Turn the machine on You will hear an alarm which is normal and will stop in several seconds Make sure the flow is set at the prescribed amount Place the nasal cannula in patients nose This is most easily done by inserting the prongs first into each nostril and then placing the tubing over ea
104. y if the patient s clinical condition deteriorates For patients at risk of hypercapnic respiratory failure aim to maintain SpO 88 92 for all other patients aim for Spo 94 98 14 Evaluating patients for initiation of hospital at home intermediate care and monitoring them once they are enrolled in this form of care 7 During an asthma attack Evaluation and assessment of severity complementing peak flow meter data 3 4 Triage for arterial blood gas measurement referral to emergency department and or determining when to initiate acute oxygen therapy 7 Monitoring patients after the initiation of oxygen therapy or response to other therapy see COPD Exacerbations above Particularly important in children with severe acute wheezing 7 Follow up of patients after a severe or complicated exacerbation 4 Assessing the severity of a lower respiratory tract infection 4 Triage for arterial blood gas measurement referral to emergency department specialist and or deter mining when to initiate acute oxygen therapy 4 7 Monitoring patients after the initiation of oxygen therapy see COPD Exacerbations above Part of clinical assessment for children with suspected significant respiratory tract infection Part of clinical assessment in children with acute asthma 15 16 17 8 Table 3 Limitations of Pulse Oximetry SpO values lt 80 Pulse oximeters can overestimate oxygen saturation particularly in t
105. ypoxia infection and pain while establishing rapport Then check out the trach tube any tubing and equipment connected to it and the stoma site Observe for redness purulent drainage and abnormal bleeding at the stoma site Note the amount color consistency and odor of secretions Listen to breath sounds with a stethoscope Before beginning any care ensure that the appropriate emergency trach replacement tubes and CPR equipment is at the bedside Trach patients need assistance to mobilize secretions Their artificial airway bypasses natural humidification and imposes a foreign object that the body reacts to In addition many patients have acute and or chronic diseases that predispose to stagnation of secretions Frequent repositioning deep breathing and coughing chest physiotherapy postural drainage oral and parenteral hydration and supplemental humidification all help to thin and mobilize secretions Humidifiers and nebulizers may be used with or independent of mechanical ventilation Tubing from an external moisture source accumulates moisture and needs frequent draining Ensure the tubing is positioned lower than the patient to avoid aspiration A moisture conservation device called a heat moisture exchanger can also be attached to the outside of a trach tube for long term trach patients isseli 2004 airway vocal cords larynx trachestomy tube lo ventilator Graphic courtesy of the Muscular Dystrophy Association www md

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