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Pulmonary Clearance Techniques

1. Pulmonary Clearance Techniques sanb uy gt aL aOUEIGOIH Aleuowind Pulmonary Clearance Techniques Notes Pulmonary Clearance Techniques College of Respiratory herapists of Ontario Pulmonary Clearance Techniques Patients Clients amp Caregivers Introduction A strong cough is important so you can remove mucous from your lungs If you have weak muscles you may not be able to cough out your mucous Perhaps you cannot take a deep breath in Perhaps you cannot breathe out with enough force to bring up the mucous For a strong cough you need two things vi Tobe able to completely fill your lungs and Y Tobe able to breathe out forcefully There are ways to help you if your muscles are too weak This section lists several methods and exercises to help you cough If you use these exercises daily you will be able move the mucous up from the airway into your throat or mouth where it can be suctioned out Pulmonary Clearance Techniques may improve Y The amount of air you can breathe into and out of the lungs A Coughing and speaking V The amount of oxygen getting to the body Pulmonary Clearance Techniques may prevent V The air sacs from collapsing A Lung infections Common Technigues Y Breath Stacking vV Assisted Cough Technigue Y Postive Expiratory Pressure PEP v Cough Assist Device All these techniques have one thing in common They all need someone to help you Pa
2. Upper airway anatomy and placement of a tracheostomy What is different with a tracheostomy Location and role of vocal cords Explain why an individual with a trach tube might not be able to speak 2 Describe how changing body position or eating a meal can affect breathing 3 Demonstrate safe technique for Bathing Feeding Eating Dressing 4 Explain the importance of drinking water and using a humidifier to manage secretions 5 Describe why heart rate or breathing rate may change with activity or illness Page 1 My Education Checklist and Learning Log Patients Clients amp Caregivers 10 11 12 Home Equipment Inhaled Medication 1 Describe possible signs and symptoms of a chest infection and the steps to take if there is an infection Explain the importance of proper hand hygiene and how the use of gloves and a mask can prevent the spread of infection Explain the purpose of breath stacking rr Describe what equipment is needed for breathstacking Demonstrate how to do the breathstacking technique Describe the plan for follow up care nes ae Explain the role of the family physician in the care of the individual Identify the hazards and safety implications for someone with a trach due to a loss of the protective mechanisms of the upper airway Identify home environment hazards Determine if there are sufficient number of grounded plugs Explain the function
3. LS Attempt to re insert trach tube ONCE see above CALL 911 If you cannot reinsert a trach tube of same size try inserting either a tube that is one size smaller or a cuffless tube Put a mask on the manual resuscitator bag If the patient needs oxygen remove oxygen supply from ventilator and connect to the manual resuscitation bag Place the mask over the patient s mouth and nose and give manual breaths Have a second person cover the stoma while you manually ventilate IMPORTANT Always use a manual resuscitation bag to give breaths while you are troubleshooting Page 5 Troubleshooting Guide Patients Clients amp Caregivers Problems and Solutions The Ventilator IMPORTANT When a ventilator alarms always look at the patient first not the ventilator Look to make sure that the chest is moving up and down Make eye contact with the patient and ask Are you okay Ventilators will alert you to a safety problem with a visual or an audible alarm Some situations will trigger a visual or an audible alarm Serious situations will trigger both audible and visual alarms together You need to learn what the alarms mean on your ventilator Whatever the warning signal is follow these steps On 2 Never leave the patient alone until the problem has been fixed Use a manual resuscitation bag to ventilate the patient while you are trying to fix a ventilator problem Find out which alarm went off Correct
4. Spinal Muscular Atrophy http www smafoundation or Page 2 Useful Web Resources Patients Clients amp Caregivers Government Listings and Publications Assistive Devices Program Ontario Ministry of Health amp Long Term Care http www health gov on ca english public program adp adp_mn html ADP Respiratory Manual http www health gov on ca english providers program adp product manuals respirator devices pdf How to Hand Wash http www health gov on ca en ms handhygiene video hand wash aspx Best Practices for Hand Hygiene in all Healthcare Settings http www health gov on ca english providers program infectious diseases best prac b hh 20080501 pdf Health Canada Health Products and Food Branch http www hc sc gc ca index eng ph Ontario s Community Care Access Centres http www health gov on ca english public contact ccac ccac mn html Page 3 Useful Web Resources Patients Clients amp Caregivers Associations Agencies Canadian Paraplegic Association Ontario http www cpaont or Canadian Sleep Society http www css to College of Physicians and Surgeons of Ontario http www cpso on ca College of Respiratory Therapists of Ontario http www crto on ca Canadian Society of Respiratory Therapists http www csrt com International Ventilator Users Network http www ventusers or Ontario Hospital Association http www oha com Respiratory Therapy Society of Ontario http ww
5. A home position for the flow valve installed in the ventilator T Set Defaults The Set Defaults option is only displayed and accessed through the VENT CHECK and VENT MTNCE menus and is used to reset user settable Controls and Extended Features settings to their factory set default values See Ventilator Checkout Tests Set Defaults for instructions on how to set default values and the LTV Series Ventilators Operator s Manual for factory set default values P N 10674 Rev H LTV Series Ventilators 53 Ventilator Operations Exit To return to the top of the VENT OP menu Er ds 1 Turn the Set Value knob until EXIT is displayed C 2 Press the Select button k XDCR ZERO This item is used to view the Transducer Autozero results and schedule the Transducer Autozero to be run please refer to the Operator s Manual P N 10674 Rev H LTV Series Ventilators 54 EXTENDED FEATURES Ventilator Operations RT XDCR DATA This menu displays the Real Time Transducer Data please see the Service Manual for more information EVENT TRACE This menu displays the Events Codes stored by the ventilator please see the Service Manual for more information P N 10674 Rev H LTV Series Ventilators 55 Ventilator Operations Exiting Extended Features To return to Monitored Parameters 1 Turn the Set Value knob until EXIT is displayed j A 2 Press the Select button a 3 Repeat Steps 1 and 2 until the Monitored Para
6. D Exh Valve Exhalation Valve drive line port E Alarm Sounder Port F Cooling Fan G DC Input DC power port pigtail connector H Patient Assist Patient Assist Call jack l Comm Port Communications port J Oy Inlet Oxygen Inlet fitting K Filter Air Inlet P N 18409 001 Rev A LTV 1200 1150 Ventilator TURNING THE VENTILATOR ON AND OFF Turning the Ventilator On 1 Push the On Standby button If the Patient Query feature is enabled on when the ventilator is powered up ventilation and alarm activation are suspended and the message SAME PATIENT is displayed e To enable the suspended alarms and begin ventilation with the settings in use during the last power cycle press the Select button while SAME PATIENT is displayed Ov Eed e To enable the suspended alarms and begin ventilation with Preset values appropriate for a new patient turn the Set Value knob until NEW PATIENT is displayed and press the Select button Then turn the Set Value knob until the desired patient type is displayed INFANT PEDIATRIC or ADULT and press the Select button see the LTV 1200 or LTV 1150 Operator s Manual Chapter 10 for detailed settings and information If the Patient Query feature is disabled off when the ventilator is powered up and passes POST it will begin ventilation appropriate alarms enabled using the settings in use during the last power cycle P N 18409 001 Rev A LTV 120
7. 1 888 335 6611 Fax 416 326 9725 WWW MCSS gOV ON ca Ontario Seniors Secretariat Tel 416 326 7076 Seniors INFOline Toll free Phone 1 888 910 1999 Toll free TTY 1 800 387 5559 Fax 416 326 7078 www ontarioseniors ca Emergency Preparedness Emergency Management Ontario Tel 416 314 3723 Toll free Phone 1 877 314 3723 Fax 416 314 3758 www ontario ca emo For Information on MedicAlert Bracelets or Identification Canadian MedicAlert Foundation Tel 416 696 0142 Toll free Phone 1 800 668 1507 Toll free Fax 1 800 392 8422 www medicalert ca For Travel Advice and Registration Service when Travelling Abroad Foreign Affairs and International Trade Canada Tel 613 944 6788 TTY 613 944 1310 In Canada and USA Toll free Phone 1 800 267 6788 Toll free TTY 1 800 394 3472 www voyage gc ca This guide is courtesy of Queen s Printer for Ontario 2007 ISBN 978 1 4249 2380 9 10M 01 07 Disponible en frangais Imprimeur de la Reine pour l Ontario 2007 ISBN 978 1 4249 2386 1 10M 01 07 Available in English College of ii Respiratory herapists of Ontario Useful Web Resources Patients Clients amp Caregivers Respiratory Related Sites West Park Healthcare Centre Includes online e learning modules example Respiratory Anatomy and Physiology Tracheal Suctioning and Manual Ventilation Tracheostomy Tubes and Stoma Care Introduction to Long Term Mechanical V
8. During an emergency you may need to go to an emergency evacuation Shelter It is recommended that you and your family have a designated contact person that resides outside of your immediate community This way in the event of an evacuation family members can easily notify each other by calling their designated contact person Pack and store all emergency survival items including medications medical supplies and or assistive devices in an easy to access and easy to transport container should you need to evacuate Select a network of individuals at work and at home that will be able to assist you during an emergency Make sure you inform your network of where you keep your emergency survival kit Prepare a list of any food or drug allergies you might have and all the medications you are taking You may want to provide this list to your designated network and also keep a copy in your emergency survival kit on your person at home your workplace and in your car if applicable On your list of medications specify the reason for each medicine that you are taking e g medical condition being treated including the generic name dosage frequency and the name and contact information of the prescribing physician If you have children with a disability or special needs prepare a similar list for each of your children and provide it to their caregiver school emergency contact members etc If you have an allergy chronic medical cond
9. Pres Bupp ri GC a Date Formai PEER mu d PR LED v SET Fide LT L r Melee humi Bern Mosier Muted Gee Homme Freier Na CAM Cynder Duradan LTW LC Lee MA Eii EBT High I s BT Low Ge 017 Uwe a Ext P N 18409 001 Rev A LTV 1200 1150 Ventilator 19 20 EXTENDED FEATURES SBT Spontaneous Breathing Trial Using the Spontaneous Breathing Trial option you can temporarily minimize ventilatory support and perform clinical assessments of a patient s dependence on or ability to be removed from positive pressure ventilation SBT mode should be used only while attended by a Respiratory Therapist or other properly trained and qualified personnel please refer to the LTV 1200 or LTV 1150 Operator s Manual Chapter 10 for more information When the Spontaneous Breathing Trial mode is turned on SBT ON selected e The ventilator switches to CPAP mode e Pressure Support and Fio control settings on the front panel are overridden with the values preset in the SBT OP menus e The High Breath Rate alarm HIGH f in the ALARM OP menu is disabled as long as the SBT mode is on P N 18409 001 Rev A LTV 1200 1150 Ventilator 21 EXTENDED FEATURES SBT Spontaneous Breathing Trial Se SC f t To modify the Spontaneous Breathing Trial settings kW vr 1 Turn the Set Value knob until SBT START is displayed push the Select button and SBT OFF or SBT ON is displayed Turn the Set Value knob until the de
10. dose and frequency of individual specific Metered Dose Inhalers MDI puffers Demonstrate explain how to give an MDI puffer with the ventilator Caregiver Initials Caregiver Initials Page 2 My Education Checklist and Learning Log Patients Clients amp Caregivers Humidification System Tracheostomy Care 10 11 12 13 14 Explain the importance of humidification Demonstrate when and how to use an heated moister exchanger HME Demonstrate how to use and clean a passover humidifier Define tracheostomy Explain why an individual might need a tracheostomy Name the parts of the tracheostomy tube Describe stoma care Describe how to prevent and manage skin breakdown Describe how to recognize and treat skin problems around stoma e g granulomas and neck Demonstrate how to clean the stoma and describe what equipment is needed Demonstrate correct inflation and deflation of a cuffed tracheostomy tube Explain the purpose of an inner cannula Desst fe Demonstrate how to insert or remove an inner cannula Explain how a trach tube could become blocked and how to clear it Describe how to clean and take care of the trach equipment Demonstrate how to change the tracheostomy ties or holder Main role Changes outer cannula holds cannula in place until helper is finished securing the trach ties assesses and maintains airway Caregiver Initials Caregiver Initials Page 3 M
11. ee 1 Turn the Set Value knob until SET TIME is displayed 2 Press the Select button Se 3 The current time is displayed Cots los 4 Press the Control Lock button to exit or To modify the Time I 1 Press the Select button HOUR xx is displayed Denn P i 2 Turn the Set Value knob until the desired hour is displayed KZ 3 Press the Select button MIN xx is displayed 4 Turn the Set Value knob until the desired minute is displayed 5 Press the Select button to accept the new time The seconds are automatically reset to 00 P N 10674 Rev H LTV Series Ventilators 49 Ventilator Operations Date Format The Date Format option is used to select the display format for the current date After accessing Extended Features ALARM OP is displayed Turn the Set Value knob until VENT OP is displayed Press the Select button f i a 1 Turn the Set Value knob until DATE FORMAT is displayed t J S a 2 Press the Select button 3 MMI DDIYYYY or the currently selected date format is displayed 4 Turn the Set Value knob until the desired format is displayed ee Sie 5 Press the Select button P N 10674 Rev H LTV Series Ventilators 50 EXTENDED FEATURES Ventilator Operations PIP LED After accessing Extended Features ALARM OP is displayed Turn the Set Value knob until VENT OP is displayed Press the Select button ai Le 1 Turn the Set Value knob until PIP LED is displayed a e KS a 2 Press the Se
12. Contacts and Planning Patients Clients amp Caregivers Keep track of when the trach tube was changed Date of Tube Tube Tube Location Who Change Make Model Size Type changed it Keep track of medicine taken Drug Name What it does How much or how When to take many Page 3 Emergency Contacts and Planning Patients Clients amp Caregivers Special Instructions Page 4 Emergency Contacts and Planning Patients Clients amp Caregivers Your Personal Support Network Your personal support networks are people who know about your healthcare needs and can be called upon to help you in an emergency Family Doctor Name Phone Other Doctor Specialty Name Phone __ Home Healthcare Professional Specialty Name Phone Home Healthcare Professional Specialty Name Phone Equipment Supplier Name Phone Page 5 Emergency Contacts and Planning Patients Clients amp Caregivers Family Friend Name Phone Family Friend Name Phone __ Other Contact Specialty Ventilator Equipment Pool Name Phone __ Other Contact Specialty Home Care Company Name Phone _ Page 6 Emergency Contacts and Planning Patients Clients amp Caregivers Your Personal Emergency Plan Developing a personal plan can help you to cope during an emergency Comple
13. Display Test The display Test is used to verify that the ventilator displays are working correctly To run the Display Test 1 Press the Select button while DISPLAY is displayed 2 All segments of the 7 segment control displays all dots of the dot matrix window displays and all LEDs are illuminated e The External Power and Charge Status LEDs are tested and verified when the AC adapter is connected to the ventilator see page 7 e The Vent Inop LED is tested and verified during the Vent Inop Alarm Test see page 12 3 To end the display test press the Select button again and the next menu item is displayed P N 10674 Rev H LTV Series Ventilators 9 Control Test The Control Test is used to verify that the ventilator buttons and controls are working correctly To run the Control Test 1 Press the Select button while CONTROL is displayed 2 SELECT is displayed in the display windows 3 To test each control press the button The name of the button is sl displayed in the display window To test the Set Value knob turn it A clockwise and counterclockwise The direction of rotation is wg displayed in the display window 4 To exit the control test press the Select button again and the next menu item is displayed 3 P N 10674 Rev H LTV Series Ventilators 10 Ventilator Checkout Tests Leak Test The Leak Test is used to test the patient circuit for leaks The patient circuit should be tested with all ac
14. H LTV Series Ventilators 31 Alarm Operations Apnea Interval After accessing Extended Features ALARM OP is displayed Press the Select button and ALARM VOL is displayed Turn the Set Value knob until APNEA INT is displayed Press the Select button APNEA xx sec is displayed where xx is the currently set Apnea interval SET Turn the Set Value knob until the desired setting is displayed ECH uf Press the Select button wer P N 10674 Rev H LTV Series Ventilators 32 EXTENDED FEATURES Alarm Operations High Pressure Alarm Delay This menu item is used to select immediate or delayed audible notification for High Pressure alarms After accessing Extended Features ALARM OP is displayed Press the Select button and ALARM VOL is displayed Turn the Set Value knob until HP DELAY is displayed 1 Press the Select button 2 Turn the Set Value knob until the desired setting is displayed Le NO DELAY DELAY 1 BRTH or DELAY 2 BRTH or v 3 Press the Select button P N 10674 Rev H LTV Series Ventilators 33 Alarm Operations Low Peak Pressure Alarm This item is used to select the type of breaths that the Low Pressure Alarm applies to After accessing Extended Features ALARM OP is displayed Press the Select button and ALARM VOL is displayed Turn the Set Value knob until LPP ALARM is displayed 1 Press the Select button on 2 Turn the Set Value knob until the desired setting is displayed A A AL
15. If Pressure ventilation is selected set the Pressure Control Not available on the LTV 900 Set the Inspiratory Time The calculated peak flow Vealc is displayed in the window while Inspiratory Time is being changed Vcalc only applies to volume ventilation Set the Pressure Support if desired Set 02 LTV 1000 only Set the Sensitivity to a setting from 1 to 9 Set the High Pressure Limit alarm Set the Low Pressure alarm Set the Low Minute Volume alarm Set the PEEP control on the exhalation valve P N 10674 Rev H LTV Series Ventilators 22 SETTING UP MODES OF VENTILATION Setting Up CPAP Mode P N 10674 Rev H LTV Series Ventilators 23 To set the ventilator up in CPAP mode 1 2 3 4 5 6 7 8 9 10 11 12 13 Press the Select button twice to toggle the modes between Assist Control and SIMV CPAP Select the SIMV CPAP mode Press the Select button twice to toggle between Volume and Pressure ventilation for Apnea backup Select Volume or Pressure for Apnea backup Not available on the LTV 900 Set the Breath Rate to Off dashes If Volume ventilation is selected set the Tidal Volume for Apnea backup The calculated peak flow Vcalc is displayed in the window while Tidal Volume is being changed If Pressure ventilation is selected set the Pressure Control for Apnea backup Not available on the LTV 900 Set the Inspiratory Time for Apnea backup The calculat
16. Regular breath stacking is good to do even if it is not used with an assisted cough You may find that breath stacking with an assisted cough is only needed once a day Page 2 Pulmonary Clearance Techniques Patients Clients amp Caregivers When breath stacking is done right it should not result in v dizziness Y chest discomfort vi chest pain IMPORTANT If you encounter dizziness chest discomfort or chest pain stop the breath stacking exercise and rest How often should breath stacking be done Each time you do this exercise do it 3 to 5 times Breath stacking should not be done more than every ten minutes Breath stacking should be done 3 to 5 times a day Page 3 Pulmonary Clearance Techniques Patients Clients amp Caregivers Assisted Cough Method Having someone push on your abdomen belly just when you are trying to cough out is called the Assisted Cough method If you are not able to have someone push on your abdomen then they could push on your rib cage as you try to cough IMPORTANT If you are sitting when this is done be sure that the chair will not tip over When should assisted cough be done Doing breath stacking and assisted cough method on a full stomach may cause you to vomit To prevent this from happening do it vV Before eating a meal v 2hrsafter eating a meal V Bedtime Helpful Hints for Children Children 2 to 6 years of age are often not able to take a deep breath in while
17. after an emergency if you cannot check them yourself Check with your local municipal office to find out if emergency evacuation shelters in your area are wheelchair accessible Dos Ay Don ts Assisting People with Disabilities V Use latex free gloves when providing personal care whenever possible People with spinal cord injury have a greater risk of developing an infectious disease during an emergency Gloves help control secondary medical conditions that can easily arise if personal care is disrupted during an emergency V Ensure that the person s wheelchair goes with the person X Do not push or pull a person s wheelchair without their permission Vision eee Vision loss can include a broad range of conditions ranging from complete blindness to partial or low vision that cannot be corrected with lenses or surgery A person s ability to read signs or move through unfamiliar environments during an emergency may be challenged creating a feeling of being lost and or being dependent on others for guidance Your Emergency Plan e Have a long cane available to readily manoeuvre around debris on the floor or furniture that may have shifted after an emergency e Mark all emergency supplies in advance with fluorescent tape large print or in braille Mark gas water and electric shutoff valves in advance with fluorescent tape large print or in braille Familiarize yourself in adva
18. and order supplies EN Change bacterial filter in breathing circuit AEK EES Clean or replace inlet filters see manual EE EN Discharge and recharge ventilator internal battery LO Ne Discharge and recharge the D C External battery Change suction filter Every 2nd month NIN IRN Ventilator preventative maintenance by VEP or other As required by equipment equipment provider provider Update the ventilator equipment pool with any changes As changes occur Page 1 Routine Tasks Patients Clients amp Caregivers Notes Page 2 College of Respiratory Therapists of Ontario My Education Checklist and Learning Log Patients Clients amp Caregivers Introduction to Checklist Below is a list of learning goals It is important that all caregivers take part in learning how to care for someone who is ventilated You will learn from many different healthcare professionals This checklist is a guide to make sure that everything you need to know is covered At any time if you feel you need to redo something or are unsure of something just ask Your healthcare professionals are eager to help you Individual s Name _ Learning Objectives At the completion of the training the participant will be able to Individual Care Caregiver Initials 1 Describe in general terms normal anatomy and physiology of the respiratory system How we breathe Humidification
19. any problems if you find any Replace any broken equipment Change the ventilator circuit if needed You should always have a spare ventilator circuit set up ready for use Any equipment that failed is called defective Do not use defective equipment If your ventilator is defective manually ventilate the patient If there is no other ventilator available then call for an ambulance to take the patient to the nearest hospital Once the patient is stable and taken care of call the VEP to report the problem The telephone number for VEP is 1 800 633 8977 A respiratory therapist is on hand 24 hours a day to help with ventilator issues and problems Follow the prompts on the message for service after business hours For other replacement disposable supplies contact the home care company The following table lists specific problems and what you can do to solve them Please see manufacturer s instructions for a complete list of alarms for your ventilator Page 6 Troubleshooting Guide Patients Clients amp Caregivers vi Mucous plugs or mucous High Pressure Suction to remove mucous Low Pressure Apnea Setting Power Switch Over Low Power Coughing swallowing or hiccupping Bronchospasm Changes in patient s breathing pattern Patient is not responding to medicine or suctioning Alarm set incorrectly Leaks in the ventilator circuit Water in pressure line Patient is disconnected from ventilator
20. cool and dry to avoid making their symptoms worse Avoid shouting or speaking quickly Instead speak clearly but not so slowly as to offend the person Do not restrain a person having a convulsion Instead roll them on their side to keep their airway clear and place something soft e g your jacket under their head to protect it from injury Once the convulsion passes and they become conscious help them into a resting position Seniors with Special Needs ee e Since an emergency situation or an evacuation can be a frightening and confusing time it is important that seniors especially those with special needs know the steps to take in an emergency This includes seniors contacting their local municipal office to find out about programs and services available in their community that will help them during an emergency and assist them to return to their regular routine Your Emergency Plan e Create an emergency contact list with names and telephone numbers of your physicians case worker contact for your seniors group neighbours building zeug mr superintendent etc Keep a copy of this list in your survival kit and on your person e Write down the names and phone numbers of on site doctors nurses social workers etc at your place of residence if applicable including the hours they keep Familiarize yourself with all escape routes and location of emergency doors exits in your home Know the
21. how change the trach tube Call 911 if airway is still blocked The trach tube has fallen out and the patient is not having any trouble breathing Try to put the trach tube back in Only try this once If this does not work get a new trach tube to insert 1 Completely deflate the cuff of the new trach tube Lubricate the trach tube with water soluble lubricant Insert obturator into the new trach tube Slide new trach tube into stoma but do not force Remove the obturator Insert the inner cannula if there is one Reinflate cuff if there is one Try to ventilate with a manual resuscitation bag Check that the chest is rising and falling with each breath 10 Place patient back on the ventilator 11 Check patient to make sure they are okay COON 9 41 ew m v If you are not able to re insert the trach tube 1 Use a manual resuscitation bag with mask and ventilate the patient 2 CALL 911 Contact your doctor and your respiratory therapist Page 4 Troubleshooting Guide Patients Clients amp Caregivers Problem What to do The patient is in pain v ANSA Determine the type and location of the pain For example is the pain with coughing swallowing or only on breathing in Try to reposition the patient Give pain medicine if ordered If there is chest tightness then give inhaled medicine puffer if ordered The trach tube has fallen out and the patient is having trouble breathing ER
22. lights or vibrators to gain your attention if the alarms sound e Test smoke alarms on a monthly basis by pushing the test button p j i pp Replace batteries in battery operated smoke alarms every six months and whenever the low battery warning sounds Keep a laminated card on your person and in your survival kit that identifies you as deaf or hard of hearing and explains how to communicate with you N Assisting People with Disabilities V Get the person s attention via a visual cue or a gentle touch on their arm before speaking to them V Face the person and make eye contact when speaking to them as they may rely on speechreading V Communicate in close proximity V Speak clearly and naturally V Use gestures to help explain the meaning of what you are trying to communicate to the person V Write a message if there is time and keep a pencil and paper handy Avoid approaching the person from behind Refrain from shouting or speaking unnaturally slowly Do not make loud noises as hearing aids amplify sounds and can create a physical shock to the user Additional Items Emergency Survival Kit E Extra writing pads and pencils for communication H Flashlight whistle or noisemaker H Pre printed key phrases you would use during an emergency E Assistive devices unique to your needs e g hearing aid pager personal amplifier etc H Portable visual notificati
23. neighbours superintendent and property building manager equipment or assistive devices E Laminated copy of your building s they will need evacuation plan and diagram of V Review previous categories in this guide escape routes and location of on how to assist people with specific emergency doors exits on each disabilities and or special needs floor In general avoid attempts to lift support or assist in moving a person down the stairs unless you are familiar with safe techniques E Any other contingency supplies unique to your special needs Travel Considerations e Your Emergency Plan Before travelling visit the Foreign Affairs and International Trade Canada website at www voyage gc ca where you can register and find other helpful travel information Safety tips Discuss your particular accommodation needs with your travel agent Discuss your trip with your doctor to prepare contingency plans in case of illness Obtain necessary travel medical insurance e Carry a copy of the Whether travelling locally or internationally people with disabilities and seniors with special needs should take extra time to research and plan their trip to make their travel experience safe and enjoyable This includes preparing in advance an emergency plan and Ready Go Bag with emergency survival items booklet Bon Voyage But that contains contact information for your destination s Canadian
24. no longer needed and physician has discontinued use caregiver to contact VEP to return Caregiver Signature and Date Page 1 RRT Signature and Date Oximeter Teaching Checklist Patients Clients amp Caregivers Notes Page 2 Troubleshooting Gunooysajgno1 Troubleshooting Troubleshooting Notes College of ii Respiratory herapists of Ontario Troubleshooting Guide Patients Clients amp Caregivers Problems and Solutions When caring for patients on long term ventilation you need to be aware of problems that may arise The problems may be related to what is happening with the patient or what is happening with the ventilator Problems Related to the Patient Whenever there is a problem the first thing you need to do is look at the patient to see if they are having any breathing problems Patients will try to tell you if they are having trouble breathing are in pain or need something Every person is different but common ways of getting your attention include A Clicking their tongues A Making unusual sounds A Triggering an emergency bell or a ventilator alarm If the patient is having trouble breathing they may look Y Short of breath v Pale dusky or blue Y Scared or frightened Consider using a baby monitor alarm so others can hear if there is a problem IMPORTANT If the patient cannot speak or communicate then they are not getting any air
25. partially supported 3 Check that the suction unit is working and ready 4 Check that the pressure settings on the Cough Assist Device are what was ordered Turn on the unit Seal the mask with your hand while you operate the Cough Assist Device Look at the pressure settings on both the IN and EX side Page 5 Pulmonary Clearance Techniques Patients Clients amp Caregivers 5 Make eye contact with the patient Have the patient breathe out fully then place the mask on their face just as they begin to breathe in OR Have the patient breathe in and hold their breath as you place the mask on their face 6 Move the lever to IN side and hold while you call out clearly IN IN IN 7 Quickly switch lever to EX side and call out Cough Cough Cough 8 Remove mask right away 9 Suction if needed Young Children Children need some time to become familiar with the sounds of the device Let them play with the mask and push the buttons so they can hear the sounds When they are comfortable with the sounds let them try one assisted breath Be patient It will take some time for them to be comfortable with the exercise Other Pulmonary Clearance Techniques Chest Physiotherapy Chest physiotherapy is a physical technique of removing secretions with the use of clapping percussion vibrations and or postural drainage Talk to your healthcare professional to learn more about this technique Positive expi
26. reason e g medical name phone number of your condition dosage frequency veterinarian microchipping is and contact information of also recommended prescribing veterinarian Current photo of your service Medical records including animal in case they get lost or vaccinations separated from you Leash harness O Copy of licence if required Muzzle if required Blanket and favourite toy O O O O gt Pet Owners While service animals are accepted at shelters in an emergency family pets are not Hence it is advisable for pet owners to prepare a similar emergency kit for each family pet according to the needs of each different animal e g cat rabbit bird etc In the case of cats include a cat carrier little pan litter scooper and plastic bags It is also recommended for pet owners to have prior arrangements made with family or friends to take care of their animal should evacuating the home be necessary during an emergency For additional information on pets and emergencies please visit the Emergency Management Ontario website at www ontario ca emo e ee Important Considerations Remember The emergency survival kit items listed in this guide are only a suggestion and may or may not apply to every emergency situation and or a person s special needs Therefore you should decide which essential items to include for yourself and your family members During an emergency you may have no electrical power
27. s emergency survival kit to E Latex free gloves to give to anyone providing personal care to you E Any other contingency supplies unique to your special needs your car along with any equipment or assistive devices they will need V Follow instructions posted on special needs equipment and or assistive For Seniors with Diabetes Please refer to previous Other Non Visible Disabilities category devices during an emergency Refrain from shouting or speaking unnaturally slowly Avoid being dismissive of the person s concerns or requests Highrise Safety ee High rise buildings present unique challenges when evacuation is necessary during an emergency Residents should make themselves aware of SS SS 8 Building superintendent s name and phone number Who sits on the Building Safety Committee Who the floor monitors are Who conducts evacuation drills and how often Location of fire extinguishers automated external defibrillator units and oxygen tank v Location of emergency evacuation device s Your Emergency Plan Advise your building manager superintendent of your special needs and or requirements during an emergency Familiarize yourself with your building s evacuation plan Know where all escape routes and location of emergency doors exits are on each floor Know the location of emergency buttons in the building and exits that are wheelchair accessible if applica
28. the Select button cf 3 LEAK COMP ON or LEAK COMP OFF is displayed 4 Turn the Set Value knob until the desired state is displayed 5 Press the Select button P N 10674 Rev H LTV Series Ventilators 42 EXTENDED FEATURES Ventilator Operations NPPV Mode After accessing Extended Features ALARM OP is displayed Turn the Set Value knob until VENT OP is displayed Press the Select button 1 Turn the Set Value knob until the NPPV MODE is displayed C e K sse 2 Press the Select button 3 NPPV MODE ON or NPPV MODE OFF is displayed WS h 4 Turn the Set Value knob until the desired state is displayed d A KS a 5 Press the Select button P N 10674 Rev H LTV Series Ventilators 43 Ventilator Operations Control Unlock When the Easy method is selected unlock the controls by pressing and releasing the Control Lock button When the Hard method is selected unlock the controls by pressing and holding the Control Lock button for 3 seconds After accessing Extended Features ALARM OP is displayed Turn the Set Value knob until VENT OP is displayed Press the Select button 1 Turn the Set Value knob until CTRL UNLOCK is displayed J 2 Press the Select button rt 3 UNLOCK EASY or UNLOCK HARD is displayed BS a 4 Turn the Set Value knob until the desired setting is displayed d A mr 5 Press the Select button P N 10674 Rev H LTV Series Ventilators 44 EXTENDED FEATURES Ventilator Operations La
29. with software version 3 15 or higher installed P N 10674 Rev H LTV Series Ventilators 36 EXTENDED FEATURES Alarm Operations Exit To return to the top of the ALARM OP menu Es We Ris 8 VB wf 2 Press the Select button while EXIT is displayed 1 Turn the Set Value knob until EXIT is displayed P N 10674 Rev H LTV Series Ventilators 37 Ventilator Operations Variable Rise Time The variable Rise Time option is used to select the rise time profile for Pressure Control and Pressure Support breaths The rise time profiles are numbered 1 through 9 where 1 is the fastest rise time and 9 is the slowest rise time After accessing Extended Features ALARM OP is displayed Turn the Set Value knob until VENT OP is displayed Press the Select button and RISE TIME is displayed 1 Press the Select button 2 PROFILE x is displayed where x is the currently set value S i 3 Turn the Set Value knob until the desired Rise Time Profile is displayed Wf 4 Press the Select button P N 10674 Rev H LTV Series Ventilators 38 EXTENDED FEATURES Ventilator Operations Variable Flow Termination The Variable Flow Termination is used to select the percentage of peak flow used for cycling Pressure Support breaths Pressure Support breaths are cycled from inspiration to exhalation when the flow reaches the set percentage of the peak flow or when flow goes below 2 Ipm When Pressure Control Flow Termin
30. 0 1150 Ventilator 5 Turning the Ventilator Off To turn the ventilator off 1 Disconnect the patient from the ventilator De kariy 2 Press and hold the On Standby button for 3 seconds The ventilator ceases operating the audible alarm sounds continuously and the Vent Inop LED is lit 3 Press the Silence Reset button to silence the audible alarm Li e Verify a confirming audible chirp is activated immediately after the alarm is silenced 4 The ventilator continues to charge the internal battery as long as it is connected to an external power source Note The Vent Inop LED will remain lit for a minimum of 5 minutes and does not impact battery life P N 18409 001 Rev A LTV 1200 1150 Ventilator 6 VARIABLE CONTROLS P N 18409 001 Rev A LTV 1200 1150 Ventilator 7 To set a variable control 1 Select the control by pressing the associated button The display for the selected control will be displayed at normal brightness and all other control displays will be dimmed Le ss 2 Change the control value by rotating the Set Value Knob Rotate clockwise to increase and counter clockwise to decrease the value i 3 The new control value goes into effect when the operator Presses the selected button again or Selects another control or Presses the Control Lock button or Waits 5 seconds Cota os BS All controls will then return to their normal brightness P N 18409 001 Rev A LTV 1200 1150 Ventila
31. 000 Quick Reference Guide P N 10674 Rev H TABLE OF CONTENTS Front and Side Panel Reference uunnssnnnnnnnennnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn nennen 1 Front Panel Display and Description 1 Side Panel Descriptions Eed se ie ahta NENNEN Ne ee 3 Turning the Ventilator On and Off uensnneensnsnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn 5 Turning the Ventilator On Turning the Ventilator Off meenanneneneeeenenananenaavaanananannanenaanaaanaanannena naa Ventilator Checkout Tests nnnnrnennannnnnnanananannnannanannnnnnnannnanennnanannnnnannna Alarm Test EE Display TeSt EE COMMON MOST na inre e EE Leak Testi TEE Ment Inop Alarm Test 2 a 2 EE E E ee ATU At SEU Set Defaults irana e n Rn iu BUR AGA ad maad 3 4 E EE E E A TE A EE A A ed Variable Controls uesnssnsnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnrnsnnnnnnnnn nennen Setting Up Modes of Ventilation Setting Up Control Mode Setting Up Assist Control Mode Setting Up SIMV Mode nenn P N 10674 Rev H LTV Series Ventilators iii Setting Up CPAP Mode mrmenenenananenannnanenanannnanenaneaanananaanaanenanaa 23 Setting Up NPPV Mod 242 220 25 Monitored Data c aineen rannani aaa ee naana aaia ANAA KAASE Eaa EATA Kaaa aana EAKA 27 Extended Features aaeanoa aandaa danada aaa anana eataa a aa auaa oada ainiaan aaia 29 Using
32. 2 Project horizontally right to the minute volume 3 Project vertically down to the horizontal axis and read the FIO2 P N 10674 Rev H LTV Series Ventilators 66 ALARMS How to Silence and Reset Alarms To silence an alarm press the Silence Reset button To reset an alarm that has been corrected press the Silence Reset button E again Alarm Cause Solution APNEA XX bpm Occurs when the time since the last breath Reevaluate the start exceeds the set Apnea Interval When patient s condition an Apnea alarm occurs the ventilator will enter Apnea Back up ventilation mode Reevaluate ventilator settings APNEA An Apnea alarm has occurred and cleared Reevaluate the The ventilator is no longer in Apnea Back up mode patient s condition Reevaluate ventilator settings P N 10674 Rev H Alarm BAT EMPTY LTV Series Ventilators Cause Occurs when the ventilator is operating from the internal battery power and the batter charge level is critically low This alarm can be temporarily silenced but cannot be cleared 67 Solution Attach the ventilator to external AC or DC power BATTERY LOW DEFAULTS Occurs when the ventilator is operating from internal battery power and the battery charge level is low Occurs during POST when the ventilator detects an invalid setting stored in non volatile memory Attach the ventilator to external AC or DC power Reevaluate power requirements Pus
33. AC DC Power uununsnnssnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnsnnnnnnnnnnnnnnnnnnerssnnnnnnnnn ernennen 57 Using the AC Adapter enama 57 Using an External DC Power Source 58 Power Displays and Indicators 0annnnnnnnnnnnnnnnnnananannnnnanannnnnnnennnanannnnnna 59 Attaching a Breathing Circuit inannnnnnananananannnnnananannnananannnannnnnnnanannnanns 63 Oxygen Computer Chart nuunsnnesnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnsnnnnnnnnnnnnnnnnnnnnnssnnnnnnnnn nenn 65 PLANING Ee ENEE ENEE EE ee 67 P N 10674 Rev H LTV Series Ventilators iv FRONT AND SIDE PANEL REFERENCE Front Panel Display and Description P N 10674 Rev H LTV Series Ventilators 1 A Mode and Breath Selection Selects ventilation modes Selects breath types B Power Turns ventilator On or to Standby C Variable Control Settings Sets ventilation characteristics such as Tidal Volume and Breath Rate D Display Window Displays Alarm Messages Monitored Data Extended Features menu E Airway Pressure Display Displays real time airway circuit pressure F Patient Effort Indicator LED is lit briefly each time a patient trigger is detected G Power Source Displays power source and charge levels H Variable Alarm Settings Sets variable alarm levels I Alarm Silence Reset Silences audible alarms Clears visual alarms J Set Value Knob Changes variable contro
34. Demonstrate how to stock the portable suction bag for use outside the home Manual Ventilation Caregiver Initials 1 Demonstrate how to properly connect and disconnect an individual from a ventilator 2 Demonstrate when and how to use the manual resuscitation bag 3 Demonstrate how to test the manual resuscitation bag for proper functioning 4 Demonstrate how to properly clean the manual resuscitation bag 5 Demonstrate how to add oxygen when using the manual resuscitation bag Page 6 My Education Checklist and Learning Log Patients Clients amp Caregivers Ventilator Care Caregiver Initials 1 Describe the purpose of a ventilator and when an individual might need one 2 Demonstrate what needs the check out procedure when starting the ventilator at the bedside high and low pressure testing 3 Demonstrate what needs to be turned on and checked when starting the ventilator on the wheelchair 4 Demonstrate how to change the water in the humidifier and describe what kind of water is used in the humidifier 5 Explain what needs to be plugged in when the wheelchair ventilator is not in use 6 Demonstrate how and when to make ventilator setting changes including oxygen 7 Demonstrate how to check the ventilator high and low pressure alarms 8 Describe the kind of situations that make the low pressure alarm sound and what to do for the individual 9 Describe the kind of situations that make the high pressure alar
35. If Pressure ventilation is selected set the Pressure Control for Apnea backup Set the Inspiratory Time for Apnea backup The calculated peak flow Vcalc is displayed in the window while Inspiratory Time is being changed Veale only applies to volume ventilation Set the Pressure Support if desired Set 02 LTV 1200 only Set the Sensitivity to a setting from 1 to 9 10 Setthe High Pres Limit alarm 11 Setthe Low Pressure alarm for Apnea backup 12 Setthe Low Min Vol alarm 13 Adjust the PEEP control P N 18409 001 Rev A LTV 1200 1150 Ventilator 14 SETTING UP MODES OF VENTILATION Setting Up NPPV Mode P N 18409 001 Rev A LTV 1200 1150 Ventilator 15 To set the Ventilator up in NPPV mode Set any desired Extended Features options and 1 Push the Assist Control SIMV CPAP mode button until the NPPV LED flashes Press the button once more to confirm The NPPV LED continues to flash and SET IPAP displays The Pres Support control display is bright and all other controls dim Turn the Set Value knob to adjust the IPAP value shown in Pres Support LED window Press the Pres Support button to confirm SET EPAP will display The PEEP control display is bright and all other controls are dim Turn the Set Value knob to adjust the EPAP value shown in the PEEP LED window Press the PEEP button to confirm The PEEP button push confirms NPPV operation and LED then turns solid Set 02 LTV 1200 only S
36. If this happens manually ventilate using the resuscitation bag A patient with a speaking valve who cannot talk usually means they are not getting any air What do do if the patient is in distress 1 Try to find out what the problem is by asking the patient What is the problem or Are you getting enough air or Do you need to be suctioned 2 Manually ventilate using a resuscitation bag 3 Use oxygen with the resuscitation bag if needed Page 1 Troubleshooting Guide Patients Clients amp Caregivers 4 Ifthe patient has nodded yes to Do you need to be suctioned then suction them immediately 5 Call out for help to anyone who can hear you such as a family member Phone 911 or your regional emergency number for an ambulance 6 Keep on manually ventilating the patient until help arrives 7 Stay with the patient Tell the patient what is happening and that help is on the way 8 Once emergency support has arrived explain the problem to the attendants The following table lists problems and some steps to take to solve them If you at any time do not feel that you are able to correct the problem do not wait to call for help Problem What to do Blocked Airway Y Suction to remove mucous or food Choking on food A Manually ventilate using the resuscitation bag Mucous in the airway v If there is an inner cannula change it Patient is not getting enough A Manually ve
37. L BREATHS VC PC ONLY Key 3 Press the Select button P N 10674 Rev H LTV Series Ventilators 34 EXTENDED FEATURES Alarm Operations High PEEP Alarm This menu item is used to set a high PEEP alarm value When the current PEEP value exceeds the set high PEEP alarm value an audible alarm will be sounded and a flashing HIGH PEEP message will be displayed After accessing Extended Features ALARM OP is displayed Press the Select button and ALARM VOL is displayed Turn the Set Value knob until HIGH PEEP is displayed 1 Press the Select button 2 Turn the Set Value knob until the desired setting is displayed Ki HI PEEP OFF or PEEP xx cmH 0 A A 3 Turn the Set Value knob until the desired setting is displayed k 4 Press the Select button 1 The HIGH PEEP alarm is only available on ventilators with software version 3 15 or higher installed P N 10674 Rev H LTV Series Ventilators 35 Alarm Operations PNT Assist This menu item is used to configure the patient Assist Port output signal to be generated for use with remote alarm systems After accessing Extended Features ALARM OP is displayed Press the Select button and ALARM VOL is displayed Turn the Set Value knob until PNT ASSIST is displayed 1 Press the Select button 2 Turn the Set Value knob until the desired setting is displayed 4 NORMAL or PULSE u 3 Press the Select button The PNT ASSIST option is only available on ventilators
38. Leaks around trach or trach tube cuff Alarm set incorrectly Dirty inlet filter Settings are incorrect Ventilator malfunction Power source has changed from AC to internal or external power source Power source has changed from external to internal Internal battery is discharged If coughing may need puffer or suctioning Give inhaled medicine if ordered Contact the appropriate healthcare provider Change alarm to proper setting Look and feel for any leaks exhalation valve humidifier pressure line and tubing for leaks Drain water Reconnect patient to ventilator Reposition patient and or the trach tube Try to deflate reinflate the cuff Reset alarm to proper setting Replace filter Reset settings Manually ventilate patient and call the equipment provider Ensure ventilator is plugged in and there is power If switching to or from an external battery then press the reset button to cancel the audible and visual alarm Plug in and operate ventilator on AC power for at least three hours If no power is available then manually ventilate Page 7 Troubleshooting Guide Patients Clients amp Caregivers Notes Page 8 Emergency Contacts amp Planning Emergency Contacts and Planning Ontario Emergency Preparedness Guide for People with Disabilities Special Needs Useful Web Resources Huluueld 8 SUEIUOH 42436133W3 Emergency Contact
39. T OP is displayed Press the Select button 1 Turn the Set Value knob until COM SETTING is displayed Le VS 2 Press the Select button ae 3 MONITOR or the currently selected protocol is displayed tt dn 4 Turn the Set Value knob until the desired protocol is displayed a 5 Press the Select button P N 10674 Rev H LTV Series Ventilators 47 Ventilator Operations Set Date After accessing Extended Features ALARM OP is displayed Turn the Set Value knob until VENT OP is displayed Press the Select button bag 1 Turn the Set Value knob until SET DATE is displayed Les Af 2 Press the Select button ut 3 The current date is displayed in the currently selected date format Daile 4 Press the Control Lock button to exit or continue to modify the Date To modify the Date 1 Press the Select button YEAR xxxx is displayed Een W s Turn the Set Value knob until the desired year is displayed Lee Press the Select button MONTH xx is displayed wo Turn the Set Value knob until the desired month is displayed Press the Select button DAY xx is displayed Turn the Set Value knob until the desired day is displayed Press the Select button to accept the new date NOOR WN OOD IDI ei N P N 10674 Rev H LTV Series Ventilators 48 EXTENDED FEATURES Ventilator Operations Set Time After accessing Extended Features ALARM OP is displayed Turn the Set Value knob until VENT OP is displayed Press the Select button
40. acuation order Carry a personal alarm that emits a loud noise to draw attention to your whereabouts If you rely on any life sustaining eguipment apparatus develop an emergency back up plan that will ensure the equipment apparatus works in the event of a power outage Install working smoke alarms on every floor of your home and outside all sleeping areas Test smoke alarms on a monthly basis by pushing the test button Replace smoke alarm batteries every six months and whenever the low battery warning sounds Develop and practise a home fire escape plan or refer to your building s fire safety plan so that everyone in your home knows what to do in the event of a fire Practise your emergency plan with your network at least twice a year If during an emergency your support network cannot assist you for whatever reason ask other individuals around you to help you Remember to inform them of your special needs and how they can best offer any assistance to you eee Important Considerations Tips on Helping a Person with a Disability ASK First if the person needs or wants your help do not just assume that they do Allow the person to identify how best to assist them Do not touch the person their service animal and or their assistive device equipment without their permission Follow instructions posted on special needs equipment and or assistive device during an emergency Avoid attempts to lift support or ass
41. ation is enabled the Variable Flow Termination setting is used for flow termination of Pressure Control breaths as well After accessing Extended Features ALARM OP is displayed Turn the Set Value knob until VENT OP is displayed Press the Select button ki ee 1 Turn the Set Value knob until FLOW TERM is displayed 2 Press the Select button 3 OF PEAK xx is displayed where xx is the current Flow Termination setting en il 4 Turn the Set Value knob until the desired Flow Termination percentage d is displayed A Sg wf 5 Press the Select button fy P N 10674 Rev H LTV Series Ventilators 39 Ventilator Operations Variable Time Termination The Variable Time Termination is used to select maximum inspiratory time for cycling Pressure Support breaths Pressure Support breaths are cycled from inspiration to exhalation if this time is reached before the flow reaches the set percentage of the peak flow When a breath is cycled based on the time setting the Pressure Support display is flashed briefly After accessing Extended Features ALARM OP is displayed Turn the Set Value knob until VENT OP is displayed Press the Select button SS 1 Turn the Set Value knob until TIME TERM is displayed A p 2 Press the Select button Aa 3 TERM x x sec is displayed where xx is the current Time Termination setting 4 Turn the Set Value knob until the desired Time Termination is Ki displayed 4 A 5 Press
42. ator 24 USING AC DC POWER Using the AC Adapter To run the ventilator from an external AC power source 1 Connect the power jack straight or 90 from the AC adapter to the power port pigtail connector on the left side of the ventilator 2 Connect the proper AC power cable 110 or 220 V plug to the AC power adapter 3 Connect the 110 or 220 V power cable to a suitable power source While the ventilator is plugged in the internal battery is continuously charged CAUTION Release Button To avoid damaging the ventilator or the power connector press the release button on the connector before removing it from the ventilator power port pigtail connector P N 18409 001 Rev A LTV 1200 1150 Ventilator 25 Using an External DC Power Source To run the ventilator from an external DC power source 1 Connect the power port of the external DC power adapter cable to the power port pigtail connector on the left side of the ventilator 2 If applicable connect the DC jack to the DC power source P N 18409 001 Rev A LTV 1200 1150 Ventilator 26 POWER DISPLAYS AND INDICATORS Indicators Battery Level The Battery Level indicator shows the level of available internal battery power while running from the internal battery Approximate Battery Time LED Color Battery Level nominal settings Internal battery level is acceptable 45 minutes Internal battery level is low 10 minutes Internal battery l
43. ator Checkout tests To enable the Ventilator Checkout menu 1 Begin with the ventilator in Standby mode off and connected to a valid AC power source e Verify that the External Power and Charge Status LEDs are illuminated 2 Press and hold the Monitor Select button While holding ww the Select button press the On Standby button e REMOVE PTNT alarm message is displayed and an audible alarm is sounded 3 Clear the alarm by pressing the Silence Reset button e Audible alarm is silenced and VENT CHECK is displayed 4 Press the Select button to move to the first test e ur e The first Ventilator Checkout Test ALARM is j displayed P N 10674 Rev H LTV Series Ventilators 7 Alarm Test The alarm Test is used to verify that the audible alarm is working correctly 1 Press the Select button while ALARM is displayed F 2 Verify the audible alarm is sounded e Ifa Patient Assist Call System or Remote Alarm is connected via the ventilator s Patient Assist Port verify the device also activates audible visual as specified by its manufacturer 3 When the alarm has sounded for at least 2 seconds press the F Select button again e The audible alarm is silenced and the next menu item is displayed 4 For ventilators with an audio sound symbol E on the back panel label verify a confirming audible chirp occurs after the alarm is silenced P N 10674 Rev H LTV Series Ventilators 8 Ventilator Checkout Tests
44. ay and Description LTV 1200 shown E P N 18409 001 Rev A LTV 1200 1150 Ventilator B C D E F Ge H l Sg Mode and Breath Selection Selects ventilation modes and selects breath types On Standby Button Turns the ventilator On or to Standby Variable Control Settings Sets and displays each ventilation characteristic Display Window Displays Alarm Messages Monitored Data and Extended Features menus Airway Pressure Display Displays real time airway circuit pressure Patient Effort Indicator LED is lit briefly each time a patient trigger is detected Power Source Displays power source and charge levels Variable Alarm Settings Sets and displays variable alarm levels Alarm Silence Reset Silences audible alarms Clears visual alarms Set Value Knob Changes variable control settings Navigates Extended Features Special Controls Activates special controls such as Manual Breath Low Pressure O Source LTV 1200 only Insp Exp Hold and Control Lock feature PEEP PEEP control setting and display P N 18409 001 Rev A LTV 1200 1150 Ventilator 2 FRONT AND SIDE PANEL REFERENCE Side Panel Descriptions P N 18409 001 Rev A LTV 1200 1150 Ventilator A 22mm Outlet Port Patient Breathing Circuit outlet port B Flow Xducer Flow Transducer high pressure sensing port C Flow Xducer Flow Transducer low pressure sensing port
45. ble Request that an emergency evacuation chair be installed on the floor you live or work on preferably close to the stairwell if applicable If you live ina highrise building create a buddy system with your neighbours and regularly practise your emergency response plan with them Emergency Evacuation Device Bee SR e If you rely on any life sustaining equipment apparatus develop an emergency back up plan that will ensure the equipment apparatus is operable in the event of a power outage Obtain large printed signs from the building manager that you can place in your window in the event of an emergency indicating that you need assistance Additional Items Emergency Survival Kit m Personal alarm that emits a loud noise to draw attention to your h bouts Assisting People with Disabilities ee H Supply of food items appropriate V Check on neighbours and or to your dietary restrictions co workers with special needs to find out if they need your help during an emergency or evacuation V Listen actively to what the individual with special needs is E Supply of plastic bags for storing saying garbage personal waste V During an emergency evacuation if time permits offer to carry the person s emergency survival kit for them along with any special H Supply of medications and assistive devices appropriate to your disability E Names and contact information of your
46. cessories such as humidifiers or water traps in place To run the Leak Test 1 Cap or otherwise occlude the patient circuit wye 2 Press the Select button while LEAK is displayed e To perform the Leak Test the ventilator closes the exhalation valve sets the flow valve to a near closed state elevates the turbine motor speed and elevates the circuit pressure e Atthe conclusion of the test the display shows LEAK xx x pass or fail where xx x is the measured leak 3 To exit the Leak Test press the Select button again and the next menu item is displayed P N 10674 Rev H LTV Series Ventilators 11 Vent Inop Alarm Test The Vent Inop Alarm Test is used to verify that the Inop Alarm is working correctly To run the Vent Inop Alarm Test 1 Torun the Vent Inop Alarm Test the ventilator must be on running for at least 60 seconds and the Ventilator Checkout menu must be enabled 2 Turn the ventilator off by pressing and holding the On Standby button for bak 0 a minimum of 3 seconds DO NOT press the Silence Reset button 3 Observe the ventilator for 15 seconds e Listen for the alarm tone e Watch the Vent Inop LED 4 For all ventilators verify that both of the following conditions existed e The alarm tone sounded continuously for the full 15 second duration e The Vent Inop LED illuminated continuously for the full 15 second duration 5 Ifa Patient Assist Call System or Remote Alarm is connected via the ventilator s Pati
47. der replace used cylinder with a new one LOW PRES Occurs when the peak inspiratory pressure Examine Patient for a machine or assist breath is less than Circuit for disconnect the Low Pressure setting Reevaluate ventilator settings Reevaluate patient NO CAL DATA Occurs when the ventilator detects invalid Remove ventilator NO CAL or missing calibration records on power up from service perform Calibration procedure POWER LOST Occurs when the ventilator is operating on Evaluate power external power and the voltage drops below the useable level and switches to internal battery operation requirements Attach ventilator to an external AC or DC power source P N 10674 Rev H LTV Series Ventilators 72 Alarms Alarm Cause Solution POWER LOW Occurs when the ventilator is operating on Evaluate power external power and the voltage drops to the requirements low level REMOVE PTNT Occurs when the ventilator is powered up Ensure patient is in the Ventilator Checkout or Ventilator disconnected from Maintenance modes The ventilator is not ventilator and is being delivering gas ventilated by alternative means RESET A RESET alarm occurs if the ventilator May be caused by restarts following a condition other than Internal Battery being shut down by pressing the depletion during On Standby button operation or ESD If the problem reoccurs remove from service and contact your Service Rep or Pulmonetic Syst
48. e company in an emergency Describe the role of the acute care hospital in an emergency or power failure situation Describe the role of Hydro and the Fire Department in an emergency Explain the emergency preparedness plan including the procedure during a power failure Explain what to do if the individual has an obstructed air passage such as how to clear the airway Explain how to identify and manage someone in respiratory distress Describe demonstrate correct actions for each of the following situations Accidental decannulation Mucous Plug Trauma to stoma area Identify and indicate how to contact local emergency resources Identify what information needs to be conveyed to emergency personnel Ensure family is provided with emergency contact list Caregivers are trained in CPR re AH Demonstrate manual ventilation of a tracheostomy Demonstrate how to ventilate should the trach come out and you can t replace it Caregiver Initials Page 9 My Education Checklist and Learning Log Patients Clients amp Caregivers Name Designation Funding and Equipment Supply Caregiver Initials 1 Explain the role of Assistive Devices Program ADP in funding the equipment and supplies 2 Explain the role of the Ventilator Equipment Pool VEP and how to contact them 3 List the equipment provided by the VEP a ae 4 List equipment not provided by the VEP some 5 Explain the role of the home care company a
49. e ventilator restarts following a condition other than being shut down by pressing the On Standby button These alarms are only active in the Spontaneous Breathing Trial SBT mode of ventilation see the LTV 1200 or LTV 1150 Operator s Manual Chapter 9 for more information on each alarm setting Occurs when a transducer autozero test fails LTV 1200 1150 Ventilator 39 Solution May be caused by Internal Battery depletion or ESD If the problem reoccurs remove from service and contact your Service Rep or Pulmonetic Systems Press Silence Reset button twice to reset alarm If problem occurs frequently remove from service and contact your Service Rep or Pulmonetic Systems 40 Cardinal Health Pulmonetic Systems 17400 Medina Rd Suite 100 Minneapolis Minnesota 55447 1341 Customer Care 800 754 1914 763 398 8500 Fax 763 398 8403 www cardinalhealth com viasys CardinalHealth Notes On the CD Y Glossary of Terms v Identification and Preparation Tool Y Preparation for ICU Discharge Y Preparation for Hospital Discharge v Home Ventilation amp Tracheostomy Care for Adults Y Non Invasive Positive Pressure Ventilation for Adults v Home Ventilation and Tracheostomy Care for Paediatrics Y Pulmonary Clearance Techniques v Routine Tasks Y My Education Checklist and Learning Log v Oximeter Teaching Checklist Y Troubleshooting Guide Y Emergency Contacts and Planni
50. ecting the ventilator to an external battery or to an external AC power source P N 18409 001 Rev A LTV 1200 1150 Ventilator 29 ATTACHING A BREATHING CIRCUIT How to attach a Patient Breathing Circuit 1 Connect the main breathing tube to the 22 mm outlet port on the right side of the ventilator 2 Connect the two exhalation flow transducer sense lines to the ports marked Flow Xducer on the right side of the ventilator These are non interchangeable Luer fittings 3 Connect the Exhalation Valve driver line to the port marked Exh Valve on the right side of the ventilator P N 18409 001 Rev A LTV 1200 1150 Ventilator 30 OXYGEN COMPUTER CHART 20 5 OXYGEN INPUT FLOW ipm S o A 290 A0 D 20 20 Ba M Ie Fidz Assumes a 1 2 LE Beton P N 18409 001 Rev A LTV 1200 1150 Ventilator 31 Oxygen Computer Chart To determine O Input Flow 1 Find the desired Fio on the horizontal axis 2 Project up to the minute volume 3 Project horizontally to the left vertical axis and read the oxygen flow To determine O Concentration 1 Find the O input flow on the vertical axis 2 Project horizontally right to the minute volume 3 Project vertically down to the horizontal axis and read the Fio P N 18409 001 Rev A LTV 1200 1150 Ventilator 32 ALARMS How to Silence and Reset Alarms To silence an alarm press the Silence Reset button To reset an alarm that has been cor
51. ed peak flow Vcalc is displayed in the window while Inspiratory Time is being changed Vcalc only applies to volume ventilation Set the Pressure Support if desired NOTE Although Tidal Volume Pressure Set 02 LTV 1000 only Control and Insp Time are dimmed Set the Sensitivity to a setting from 1 to 9 E 2 EEE appropriate levels as the ventilator uses Set the High Pressure Limit alarm these settings for Apnea back up Set the Low Pressure alarm for Apnea backup ventilation Set the Low Minute Volume alarm Set the PEEP control on the exhalation valve P N 10674 Rev H LTV Series Ventilators 24 SETTING UP MODES OF VENTILATION Setting Up NPPV Mode P N 10674 Rev H LTV Series Ventilators 25 To set the Ventilator up in NPPV mode 1 Set the ventilator controls for Control Assist Control SIMV or CPAP mode as described in the preceding section 2 Set the ventilator controls for Volume or Pressure ventilation as described in the preceding section 3 Set all other ventilation parameters as described in the previous section 4 Set the High Pressure Limit alarm 5 Enter Extended Features by pressing and holding the Monitor Select button for 3 seconds 6 Turn the Set Value knob until VENT OP is displayed 7 Press the Monitor Select button 8 Turn the Set Value knob until NPPV Mode is displayed 9 Press the Monitor Select button 10 Turn the Set Value knob until NPPV On is displayed 11 Press Mo
52. ee Phone 1 877 422 1112 Fax 416 422 5943 Email info cpaont org www cpaont org Canadian Red Cross Tel 905 890 1000 Fax 905 890 1008 www redcross ca Centre for Independent Living in Toronto CILT Inc Tel 416 599 2458 TTY 416 599 5077 24hr Newsline 416 599 4898 Fax 416 599 3555 Email cilt cilt ca www cilt ca CNIB Tel 416 486 2500 Toll free Phone 1 800 563 2642 TTY 416 480 8645 Fax 416 480 7700 www cnib ca Learning Disabilities Association of Ontario Tel 416 929 4311 Fax 416 929 3905 www ldao ca Local Emergency Management Contact Multiple Sclerosis Society of Canada Toronto Chapter and Ontario Division Tel 416 922 6065 Toll free Phone 1 866 922 6065 Fax 416 922 7538 www mssociety ca Ontario March of Dimes Tel 416 425 3463 Toll free Phone 1 800 263 3463 Fax 416 425 1920 www dimes on ca Ontario SPCA Ontario Society for the Prevention of Cruelty to Animals Tel 905 898 7122 Toll free Phone 1 888 ONT SPCA 668 7722 Fax 905 853 8643 E mail info ospca on ca www ontariospca ca The Canadian Hearing Society Tel 416 928 2500 Toll free Phone 1 877 347 3427 TTY 416 964 0023 Toll free TTY 1 877 347 3429 Fax 416 928 2523 www chs ca Toronto Rehabilitation Institute Tel 416 597 3422 Fax 416 597 1977 www torontorehab com Accessibility Initiatives Accessibility Directorate of Ontario Tel 416 326 0207 Toll free Phone 1 888 520 5828 TTY 416 326 0148 Toll free TTY
53. ems Only available on ventilators with software version 3 13 or higher installed P N 10674 Rev H LTV Series Ventilators 73 Alarm Cause Solution XDCRFAULT Occurs when a transducer autozero test Press Silence Reset fails button twice to reset alarm If problem occurs frequently remove from service and contact your Service Rep or Pulmonetic Systems P N 10674 Rev H LTV Series Ventilators 74 BulmoneticSystems Innewations Bac s Pulmonetic Systems 17400 Medina Rd Suite 100 Minneapolis Minnesota 55447 1341 Tel 763 398 8500 800 754 1914 Fax 763 398 8400 www Pulmonetic com LTV 1200 1150 Ventilators Duick Reference Guidi Notes LTV 1200 1150 Ventilators Quick Reference Guide CardinalHealth PR TAM Bee A ASSISTANCE Cardinal Health Pulmonetic Systems 17400 Medina Rd Suite 100 Minneapolis Minnesota 55447 1341 Customer Care 800 754 1914 763 398 8500 Fax 763 398 8403 Website www cardinalhealth com viasys P N 18409 001 Rev A LTV 1200 1150 Ventilator ii TABLE OF CONTENTS Table of Contents Front and Side Panel Reference nuesnnssnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn nennen 1 Front Panel Display and Description 1 Side Pahiel Descriptions 3 47 ak een nee eege een 3 Turning the Ventilator On and Off uusnsnnnensnsnnnennnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn 5 Turning the Ventilator On 5 T
54. ent Assist Port verify the device also activates audible visual as specified by its manufacturer 6 Silence the alarm by pressing the Silence Reset button 3 7 For ventilators with an a audio sound symbol on the back panel label verify the following condition existed e A confirming audible chirp occurred after the alarm was silenced P N 10674 Rev H LTV Series Ventilators 12 Ventilator Checkout Tests When the Ventilator Checkout Tests have been completed proceed to Exit for instructions to exit the vent check mode or see below concerning the use of the Set Defaults option Set Defaults The Set Defaults option is used to reset user settable Controls and Extended Features settings to their factory set default values see the LTV 1200 Series Ventilators Operator s Manual for factory set default values To set the default values tee GT Se 1 Turn the Set Values knob until EXIT is displayed and press the Select button J e VENT CHECK is displayed T 2 Turn the Set Values knob until VENT OP is displayed and press the Select button 3 Turn the Set Values knob until DEFAULTS is displayed and press the Select button e SET DEFAULTS is displayed 4 Press the Select button while SET DEFAULTS is displayed e Except for the Language selected and the Date Time settings and format all user settable Controls and Extended Features options are reset to their factory set default values e A DEFAULTS SET alar
55. entilation Invasive http www l tvcoe com The Institute for Rehabilitation Research and Development The Rehabilitation Centre Ottawa Includes Respiratory Protocols for SCl and Neuromuscular Diseases Anatomy and Physiology Clinical Pathway Interventions LVR with bag MI E ventilator and GPB CoughAssist New Generation of MI E Mechanical Insufflation Exsufflation Policy Lung Volume Recruitment with Resuscitation Bag Policy http www irrd ca education The Ventilator Equipment Pool http www ontvep ca The Ministry of Health amp Long Term Care Assistive Devices Program Respiratory Devices Category Administration Manual June 2007 http www health gov on ca english providers pub adp resp manual 20070627 pdf Aaron s Tracheostomy Page A web site that provides information about tracheostomy http www tracheostomy com Page 1 Useful Web Resources Patients Clients amp Caregivers Information on Diseases ALS Society of Canada http www als ca Chronic Obstructive Airway Disease COPD Canadian Lung Association http lung ca diseases maladies copd mpoc e php Cystic Fibrosis http www cysticfibrosis ca Multiple Sclerosis Society of Canada http www mssociety ca en default htm Muscular Dystrophy of Canada http www muscle ca Ontario March of Dimes March of Dimes Canada http www marchofdimes ca dimes Post Polio Health International http www post polio or
56. entilators 17 To set the ventilator up in Control mode 1 2 3 4 5 6 7 8 9 Press the Select button twice to toggle the modes between Assist Control and SIMV CPAP Select the Assist Control mode Press the Select button twice to toggle between Volume and Pressure ventilation Select Volume or Pressure as desired Not available on the LTV 900 Set the Breath Rate If Volume ventilation is selected set the Tidal Volume The calculated peak flow Vcalc is displayed in the window while Tidal Volume is being changed If Pressure ventilation is selected set the Pressure Control Not available on the LTV 900 Set the Inspiratory Time The calculated peak flow Vcalc is displayed in the window while Inspiratory Time is being changed Vcalc only applies to volume ventilation Set O2 LTV 1000 only Set the Sensitivity to Off dash Set the High Pressure Limit alarm 10 Set the Low Pressure alarm 11 Set the Low Minute Volume alarm 12 Set the PEEP control on the exhalation valve P N 10674 Rev H LTV Series Ventilators 18 SETTING UP MODES OF VENTILATION Setting Up Assist Control Mode P N 10674 Rev H LTV Series Ventilators 19 To set the ventilator up in Assist Control mode 1 Press the Select button twice to toggle the modes between Assist Control and SIMV CPAP Select the Assist Control mode 2 Press the Select button twice to toggle between Volume and Pressure ventila
57. et the High Pres Limit alarm P N 18409 001 Rev A LTV 1200 1150 Ventilator 16 MONITORED DATA The monitored data displays may be automatically scrolled or manually scrolled To cycle through the available monitored data automatically from a halted scan press the Monitor Select button left of display window twice Pressing the Select button once while scan is active shall halt scanning and the currently display monitor shall remain in the display window Each time you press the button once the next data item in the list will be displayed To resume scan press the Select button twice within 0 3 seconds The monitored data is displayed in the following order Display Description Displays the Peak Inspiratory Pressure measured during the inspiratory phase PIP is not updated for spontaneous breaths Displays a running average of the airway pressure for the last 60 seconds Displays the pressure in the airway circuit at the end of exhalation Displays the breaths per minute and includes all breath types Displays the exhaled tidal volume as measured at the patient wye Displays the exhaled tidal volume for the last 60 seconds as calculated from the last 8 breaths P N 18409 001 Rev A LTV 1200 1150 Ventilator 17 Display Description LE Displays the ratio between measured inspiratory time and measured exhalation time Both normal and inverse E Ratios are displayed I Ecalc Displays the ratio betwee
58. etween Volume and Pressure ventilation Select Volume or Pressure as desired 3 Set the Breath Rate 4 If Volume ventilation is selected set the Tidal Volume The calculated peak flow Vcalc is displayed in the window while Tidal Volume is being changed 5 If Pressure ventilation is selected set the Pressure Control 6 Set the Inspiratory Time The calculated peak flow Vcalc is displayed in the window while Inspiratory Time is being changed Veale only applies to volume ventilation 7 Set the Pressure Support if desired 8 Set 0 LTV 1200 only 9 Set the Sensitivity to a setting from 1 to 9 10 Set the High Pres Limit alarm 11 Set the Low Pressure alarm Set the Low Min Vol alarm Adjust the PEEP control 12 13 P N 18409 001 Rev A LTV 1200 1150 Ventilator 12 SETTING UP MODES OF VENTILATION Setting Up CPAP Mode P N 18409 001 Rev A LTV 1200 1150 Ventilator 13 To set the ventilator up in CPAP mode 1 Press the Select button twice to toggle the modes between Assist Control and SIMV CPAP Select the SIMV CPAP mode Press the Select button twice to toggle between Volume and Pressure ventilation for Apnea backup Select Volume or Pressure for Apnea backup Set the Breath Rate to Off dashes If Volume ventilation is selected set the Tidal Volume for Apnea backup The calculated peak flow Vcalc is displayed in the window while Tidal Volume is being changed
59. evel is critically low 5 minutes Ventilator is running on AC or External Battery P N 18409 001 Rev A LTV 1200 1150 Ventilator 27 Indicators Charge Status Gong Es When the ventilator is plugged into an External Power source it automatically charges the internal battery LED Color Charge Status Flashing The ventilator is performing pre charge qualification testing of the Amber battery prior to starting the charge process This happens when external power is first applied to the ventilator The qualification process normally takes a few seconds but may take up to an hour on a deeply discharged battery The internal battery is charged to full level The battery has not reached a full charge level and is still charging The ventilator has detected a charge fault or internal battery fault The internal battery cannot be charged Contact a Pulmonetic Systems Certified Service Technician P N 18409 001 Rev A LTV 1200 1150 Ventilator 28 POWER DISPLAYS AND INDICATORS Indicators External Power The External Power indicator shows the level of external power while the ventilator is operating from an external power source When the ventilator is running from the internal battery the External Power indicator is off When running from external power the indicator shows the following levels External Power level is acceptable External Power level is low External power may be provided by conn
60. f Terms Appendix B Quick Reference Guide to LTV 900 950 amp 1000 Series Ventilators Appendix C Quick Reference Guide to LTV 1200 1150 Series Ventilators Healthcare Professionals Al c 9 U o gt EK ov c e JU ei A Appendices zu i ha FEN e aii a a it a gt a eobeiiccsbussiaccire Fa mare DU a er m H Notes Orem heh Mi ie EA 1 a D gt ontario sages BEE Su Desen Please read inaructions prior in compistion Press hard you are compisting muftipie Copien Authorization dee LJ CH mm Zeg resch ew or 0011 gen Crier Cabal Suppor Progam OUE Ammiano ke Cer of Seen nate ICH a OTT Emise ka fat ern re Coen be Eu Se Ta le EE ge A E Lt AT te et hen ts at een aber in i en ph el MO nnd Kuid pat kr Ee Gees of mea pesaka Frae fa giereg AD ame Bee Kai ircherreadicee ze Dog berm ja krai Correct arai cent bo tab banat ei Ery raar wheel Dhan ru vg Be AOF meal elt te Teens Ee Ge dd Da baren e E Mroe r of baat ba Ra A eget i ia come ta gen al vait rame ef aari e age gehn Kawai Daaa Branch LEE ingaranan EE ba Ses RDO e a A ETTE ETC beid en Pl fei Pa eed fo he make per ba aed LTV Series Ventilators LTV 900 950 and 1000 Quick Reference Guide P N 10674 Rev H Notes Pulmonetic systems Innovations For Life LTV Series Ventilators LTV 900 950 and 1
61. g and how they might need your help V If they speak in a foreign language your special needs lists all that you do not understand try to i medications you are taking any food communicate using gestures i drug allergies you might have your treating physician s name and contact information and your next of kin H Copy of your travel medical insurance and other important travel documents HA personal alarm that emits a loud V During an emergency evacuation if time permits offer to carry the person s emergency survival kit for them along with any special equipment or assistive devices they wilneed noise to draw attention to your V Review previous categories in this guide on how to assist people with whereabouts E Small container that can store or disintegrate syringes or needles Do not let the person be separated safely if applicable from their wheelchair or mobility aids E Anti nausea and anti diarrhea pills specific disabilities or special needs and pain medication E Sunblock E Insect repellent E Dictionary to help you communicate in a foreign language E Any other contingency supplies unique to your disability or special needs For More Information eee Specific Disabilities and Special Needs Canadian Diabetes Association Tel 416 363 3373 Toll free Phone 1 800 226 8464 Fax 416 408 7117 www diabetes ca Canadian Paraplegic Association Ontario Tel 416 422 5644 Toll fr
62. ge 1 Pulmonary Clearance Techniques Patients Clients amp Caregivers Breath Stacking Breath stacking is a breathing exercise that can help people who have breathing problems due to muscle weakness or poor chest movement You will need 2 manual resuscitation bags You need one in case of emergencies where you need to use it to manually ventilate The second one will be changed to become your Breath Stacking Bag The bag used for breath stacking prevents the person from breathing out The bag used for breath stacking should be clearly marked Not for resuscitation Making a Breath Stacking Bag Manual resuscitator bag One way valve Extension tube Either a mask or mouthpiece LANAA Nose clips How is breath stacking done 1 Have the person sit comfortably They can lean back a bit but they should not be slouching 2 Put on nose clips Look at the person being bagged and try to squeeze the bag as the person breathes in Have the person take a deep breath in Have them place their lips around the mouthpiece or hold the mask on their face Have the person breathe in the air as the bag is squeezed Ask them to try to to keep breathing in more air as the bag is squeezed a second time a Di Sr Za They should fill their lungs as full as possible and feel a stretch across the front of their chest 9 Have them hold the air in as long as possible before letting it go out Use the air they are breathing out to cough 10
63. gs Inspect Patient Circuit for occlusions or kinks Reevaluate patient HW Fault Occurs when the ventilator detects a problem with the ventilator hardware If alarm reoccurs contact your Service Rep or Pulmonetic Systems P N 18409 001 Rev A LTV 1200 1150 Ventilator 36 Alarms Alarm Cause Solution INOP A ventilator INOP occurs when If an INOP alarm occurs e _ The ventilator is switched from On to during operation Vert ine Standby remove ventilator from Bu e _ The ventilator detects any condition service and contact that is deemed to make the ventilator your Service Rep unsafe LOCKED The LOCKED message is displayed when Press the Control a button is pressed while the controls are Lock button locked No audible alarm is given If locked alert continues press and hold the Control Lock button for three seconds LOW MIN VOL Occurs when the exhaled minute volume Examine Exhalation is less than the set Low Minute Volume Valve body for disconnects Reevaluate patient P N 18409 001 Rev A LTV 1200 1150 Ventilator 37 Alarm Cause Solution LOW O PRES Occurs when the average oxygen inlet Increase Oz inlet LTV 1200 only pressure is less than the minimum pressure acceptable inlet pressure of 35 PSIG If using O2 cylinder replace used cylinder with a new one LOW PEEP Occurs when the patient circuit Positive Reevaluate ventilator End Expiratory Pressure PEEP is less settings tha
64. h the Silence Reset button twice to reset alarm Reevaluate ventilator settings DEFAULTS SET Occurs when the ventilator is first powered up after the SET DEFAULTS option has been used to reset all controls and extended features settings to their factory set default values Push the Silence Reset button twice to reset alarm Reevaluate ventilator settings P N 10674 Rev H LTV Series Ventilators 68 Alarms Alarm Cause Solution DISC SENSE Occurs when the ventilator detects one of Check Patient Circuit the following conditions assembly for e The patient circuit or proximal disconnects pressure sense line has become Check pressure disconnected sensing lines for e The low side exhalation flow occlusions transducer sense line has become disconnected e The proximal pressure sense line is pinched or occluded HIGH O PRES Occurs when the average oxygen inlet Reduce O inlet pressure exceeds the acceptable limit for pressure the type of oxygen source P N 10674 Rev H LTV Series Ventilators 69 Alarm Cause Solution HIGH PEEP Occurs when the ventilator detects one of Reevaluate ventilator the following conditions settings e The patient circuit positive end Disassemble clean expiratory pressure PEEP exceeds and reassemble the the High PEEP alarm setting Patient Circuit D Patient Circuit Exhalation valve Exhalation Valve and and or PEEP valve occluded PEEP Valve HIGH PRES Occur
65. ion eeeeeeeoe 22 Introduction es e Emergencies can occur suddenly and without any advance warning Although Ontario has effective emergency management legislation and programs individuals and families play a vital role in preparing for times of crisis when emergency services and other government resources may be strained It is important that individuals and families prepare to be self reliant for at least three 3 days immediately after or during an emergency This guide provides special emergency preparedness considerations and advice for the estimated 1 5 million Ontarians with disabilities and or special needs including seniors with special needs Prepare Now Emergency preparedness includes developing and practising a family emergency response plan and the preparation of an emergency survival kit For those living with a physical visual auditory and or other non visible disability emergency preparedness should also involve incorporating special accommodations into their family emergency response plan To best prepare for an emergency according to one s special needs please refer to the appropriate category in this guide for a list of suggested emergency survival kit items and contingency planning considerations For more information on emergency management arrangements in your area contact your municipal Emergency Management Coordinator through your local government office Using this Guide This guide cover
66. ist in moving someone unless you are familiar with safe techniques Never administer any food or liquids to an unconscious or unresponsive person Be aware that some people who have disabilities may request that you use latex free gloves to reduce spread of viral infection to them Ask the person with special needs if areas of their body have reduced sensation and if they need you to check those areas for injuries after a disaster Mobility ee Mobility limitations may make it difficult for a person to use stairs or to move quickly over long distances These can include reliance on mobility devices such as a wheelchair scooter walker crutches or a walking cane In addition people with a heart condition or various respiratory difficulties can experience certain levels of mobility limitations Your Emergency Plan e Ask your network This will help your to practise moving network become more your special needs comfortable handling or equipment during using your special your emergency needs equipment during practice plan an emergency e If you use a wheelchair or scooter request that an emergency evacuation chair be stored near a stairwell on the same floor that you work or live on so that your network can readily use it to help you safely evacuate the building In your instruction list for your network identify areas of your body that have reduced sensation so these areas can be checked for injuries
67. ition or special medical need you may want to consider owning and wearing a MedicAlert bracelet or identification as part of your emergency preparedness plan For more information visit www medicalert ca Important Considerations eee Remember Regularly check expiration dates on all medications bottled water and canned packaged food in your emergency survival kit It is best to replace food and bottled water at least once a year Prepare a contact information list of all your emergency contact persons and provide a copy to your designated network at work and or home Also keep a copy in your survival kit on your person at home at your workplace and in your car if applicable Provide written instructions for your network on how best to assist you and your service animal if applicable during an emergency Label all of your special needs equipment and attach laminated instruction cards on how to use retrieve and or move each assistive device during an emergency Since your medications assistive devices etc may change over time it is advisable for you to regularly assess your needs and incorporate any changes to your emergency survival kit supplies and your family emergency plan If your personal needs require regular attendant care and or life sustaining apparatus arrange with your network to check on you immediately if an emergency occurs or if local officials issue an ev
68. l settings Navigates Extended Features menu K Special Controls Activates special controls such as Manual Breath Low Pressure O Source Insp Exp Hold or Control Lock feature P N 10674 Rev H LTV Series Ventilators 2 FRONT AND SIDE PANEL REFERENCE Side Panel Descriptions Lah Side Kariler Versione P N 10674 Rev H LTV Series Ventilators A 22mm Outlet Port Patient Breathing Circuit outlet port B Flow Xducer Flow Transducer high pressure sensing port C Flow Xducer Flow Transducer low pressure sensing port D Exh Valve Exhalation Valve drive line port E Alarm Sounder Port F Cooling Fan G DC Input External DC power port earlier version or DC power port pigtail connector current version H Patient Assist Patient Assist Call jack l Comm Port Communications port J Oy Inlet Oxygen Inlet fitting K Filter Air Inlet P N 10674 Rev H LTV Series Ventilators TURNING THE VENTILATOR ON AND OFF Turning the Ventilator On To turn the LTV ventilator on 1 Connect the ventilator to an external power source e The AC power adapter may be used or the ventilator may be connected to an external battery e If you do not connect the ventilator to an external power source it will operate from the internal battery Ow Reif 2 Press and release the On Standby button The ventilator will commence operation e The On Standby LED is lit and the Powe
69. lect button 3 PIP LED ON or PIP LED OFF is displayed Bone 4 Turn the Set Value knob until the desired setting is displayed I J wer 5 Press the Select button P N 10674 Rev H LTV Series Ventilators 51 Ventilator Operations Model Number Serial Number After accessing Extended Features ALARM OP is displayed Turn the Set Value knob until VENT OP is displayed Press the Select button To view the LTV model number Turn the Set Value knob until LTV XXXX is displayed where XXXX is Ci the model of the ventilator vl To view the LTV serial number 1 Press the Select button while LTV XXXX is displayed F e The serial number is displayed on the left side of the display area as XXXXXX where XXXXXX is the serial number of the ventilator 2 Press the Select button to return to the model number option To view LTM compatibility 1 Press the Select button while LTV XXXX is displayed F e LTM will be displayed if software and internal hardware in the LTV Ventilator are LTM compatible 2 Press the Select button to return to the model number ome D DH P N 10674 Rev H LTV Series Ventilators 52 EXTENDED FEATURES Ventilator Operations Valve Home Position After accessing Extended Features ALARM OP is displayed Turn the Set Value knob until VENT OP is displayed Press the Select button To view the valve home position Turn the Set Value knob until Vhome XXX is displayed where XXX is the d
70. lities ACSD or Ontario Disability Support Program ODSP insurance or various service clubs to ask for help Sometimes they can help with funding Consider where you could go if there was a prolonged power outage List friends family hospital or fire station address here Page 7 Emergency Contacts and Planning Patients Clients amp Caregivers Family Friend Street Address City Contact Person Cell Phone Out of Town Family Friend Street Address City Contact Person Cell Phone Postal Code Home Phone Postal Code Home Phone Page 8 Emergency Contacts and Planning Patients Clients amp Caregivers Long term Emergency Refuge If the power outage is long term you will have to leave your home and stay somewhere else for a while Make plans on where you will go if this happens Street Address City Postal Code Contact Person Home Phone Cell Phone How will get there Have a transportation plan ready in case you need to leave home quickly Contact Person Home Phone Cell Phone Travel Bag Checklist In an emergency you will have to leave your home quickly Have a travel bag packed with everything you would need to take with you in an emergency The contents of your travel bag should include LI Spare trach tubes current trach tube size and another one that is one size smaller Q Ventilator settings LI Spare ventilator circuit and HME LJ Your Con
71. location of emergency buttons Many seniors buildings have emergency buttons located in bedrooms and washrooms that have a direct link to 911 or the building s superintendent If asked to evacuate bring with you any equipment or assistive devices you may need immediately e Always wear your MedicAlert identification Additional Items Emergency Survival Kit E Supply of food items appropriate to your disability or dietary restrictions E Assistive devices needed such as canes walkers lightweight manual wheelchair hearing aids breathing apparatus blood glucose monitoring device etc Assisting People with Disabilities V Check on neighbours who are seniors with special needs to find out if they need your help during an emergency or evacuation te E Prescription eyewear and footwear V Allow the person to describe what if required help they need and how it can be E Extra supply of medications and provided to them vitamin supplements W Be pattant IS H Personal disability related list of all your needed medical supplies and special equipment H Copies of all medication prescriptions V ifthe person appears anxious or agitated speak calmly and provide assurance that you are there to help V If evacuation is necessary offer a ride to seniors who do not have E Extra dentures if required and access to a vehicle cleaner V If time permits offer to carry the person
72. m sound and what to do for the individual 10 Describe the kind of situations that make the power switch over alarm sound and what to do for the individual 11 Describe the kind of situations that make the ventilator inoperative alarm sound and what to do for the individual 12 Describe all ventilator alarms including high and low pressure alarms 13 Describe what to do when there is a ventilator IN OP alarm 14 Demonstrate how to assemble and disassemble the ventilator circuit Page 7 My Education Checklist and Learning Log Patients Clients amp Caregivers 15 16 17 18 19 20 21 22 23 Demonstrate changing the ventilator circuit and checking the ventilator after changing the circuit Describe how to use a PEEP valve if applicable Demonstrate how to assemble and disassemble the PEEP valve if applicable Demonstrate how to clean the ventilator circuit Describe how and when to clean the ventilator circuit and change the filters Demonstrate how to check the external and internal battery Discuss how long a battery should last Discuss how often to check and discharge the battery Demonstrate how to charge and discharge the battery Page 8 My Education Checklist and Learning Log Patients Clients amp Caregivers Emergency Management Mu 10 11 12 13 14 Describe the emergency plan i e when to call 911 D s eg Describe the role of the home car
73. m will be generated the next time the ventilator is powered up in normal ventilation mode see Alarms DEFAULTS SET for additional information P N 10674 Rev H LTV Series Ventilators 13 Exit To return to any of the VENT CHECK tests turn the Set Value knob until the desired test is displayed To Exit 1 Press the Select button while EXIT is displayed and VENT CHECK is displayed K 2 Turn the Set Value knob until EXIT is displayed again kJ ef 3 Press the Select button nial The Ventilator performs a Self Test POST and resumes normal operation P N 10674 Rev H LTV Series Ventilators 14 VARIABLE CONTROLS P N 10674 Rev H LTV Series Ventilators 15 To set a variable control 1 Select the control by pressing the associated button The display for the selected control will be displayed at normal brightness and all other control displays will be dimmed 2 Change the control value by rotating the Set Value Knob Rotate clockwise to increase and counter clockwise to decrease the value nc 3 The new control value goes into effect when the operator e Presses the selected button again or e Selects another control or e Presses the Control Lock button or e Waits 5 seconds Cots La LA All controls will then return to their normal brightness P N 10674 Rev H LTV Series Ventilators 16 SETTING UP MODES OF VENTILATION Setting Up Control Mode P N 10674 Rev H LTV Series V
74. mate Battery Time LED Color Battery Level nominal settings Internal battery level is acceptable 45 minutes Internal battery level is low 10 minutes Internal battery level is critically low 5 minutes Ventilator is running on AC or External Battery P N 10674 Rev H LTV Series Ventilators 59 Indicators Charge Status Cong Es When the ventilator is plugged into an External Power source it automatically charges the internal battery LED Color Charge Status Flashing The ventilator is performing pre charge qualification testing of the Amber battery prior to starting the charge process This happens when external power is first applied to the ventilator The qualification process normally takes a few seconds but may take up to an hour on a deeply discharged battery The internal battery is charged to full level The battery has not reached a full charge level and is still charging The ventilator has detected a charge fault or internal battery fault The internal battery cannot be charged Contact your Pulmonetic Systems Certified Service Technician P N 10674 Rev H LTV Series Ventilators 60 POWER DISPLAYS AND INDICATORS Indicators External Power The External Power indicator shows the level of external power while the ventilator is operating from an external power source When the ventilator is running from the internal battery the External Power indicator is off When ru
75. meters are displayed P N 10674 Rev H LTV Series Ventilators 56 USING AC DC POWER Using the AC Adapter To run the ventilator from an external AC power source 1 Connect the power jack straight or 90 from the AC adapter to the power port earlier version ventilators or power port pigtail connector current version ventilators on the left side of the ventilator 2 Connect the proper AC power cable 110 or 220 V plug to the AC power adapter 3 Connect the 110 or 220 V power cable to a suitable power source While the ventilator is plugged in the internal battery is continuously charged CAUTION Release Button To avoid damaging the ventilator or the power connector press the release button on the connector before removing it from the ventilator power port pigtail connector P N 10674 Rev H LTV Series Ventilators 57 Using an External DC Power Source To run the ventilator from an external DC power source 1 Connect the power port of the external DC power adapter cable to the power port on the left side of the ventilator earlier version ventilators or the power port pigtail connector current version ventilators 2 Connect the DC jack to the DC power source P N 10674 Rev H LTV Series Ventilators 58 POWER DISPLAYS AND INDICATORS Indicators Battery Level The Battery Level indicator shows the level of available internal battery power while running from the internal battery Approxi
76. n the Low PEEP alarm setting Disassemble clean and reassemble the Patient Circuit Exhalation Valve and PEEP Valve LOW PRES Occurs when the peak inspiratory pressure Examine Patient for a machine or assist breath is less than Circuit for disconnect the Low Pressure setting Reevaluate ventilator settings Reevaluate patient NO CAL DATA Occurs when the ventilator detects invalid Remove ventilator NO CAL or missing calibration records on power up from service perform Calibration procedure P N 18409 001 Rev A LTV 1200 1150 Ventilator 38 Alarms Alarm POWER LOST POWER LOW Cause Occurs when the ventilator is operating on external power and the voltage drops below the useable level and switches to internal battery operation Occurs when the ventilator is operating on external power and the voltage drops to the low level Solution Evaluate power requirements Attach ventilator to an external AC or DC power source Evaluate power requirements REMOVE PTNT Occurs when the ventilator is powered up in the Ventilator Checkout or Ventilator Maintenance modes The ventilator is not delivering gas Ensure patient is disconnected from ventilator and is being ventilated by alternative means P N 18409 001 Rev A Alarm RESET SBT lt f SBT gt f SBT lt f Mt SBT gt f Mt SBT OFF XDCR FAULT P N 18409 001 Rev A LTV 1200 1150 Ventilator Cause A RESET alarm occurs if th
77. n the set Breath Rate and Inspiratory Time The display is updated in real time while the Breath Rate setting is being changed Is based on the Tidal Volume and Inspiratory Time settings Displayed when selected and whenever Tidal Volume or Inspiratory Time is selected for change Displays the time remaining until the number of minutes preset in the SBT OP MINUTES menu have elapsed Only displayed in the SBT mode of ventilation f Vt is computed every time the Total Breath Rate f or Total Minute Volume VE is calculated Only displayed when SBT mode is selected P N 18409 001 Rev A LTV 1200 1150 Ventilator 18 EXTENDED FEATURES Navigating the Extended Features Menus To enter the Extended Features menu in normal ventilation mode press and hold the Monitor Select button for three seconds F Een Se To view the next item in a menu turn the Set Value knob CH clockwise v To view the previous item turn the Set Value knob counterclockwise K sse To enter a menu item or select a setting press the Select button To exit a menu turn the Set Value knob until the EXIT option is displayed then press the Select button or press Control Lock P N 18409 001 Rev A LTV 1200 1150 Ventilator Fie Trma Fam Term Tire Teen PC Fim Term Lined Comp CH Gars LTV 12008 sf Flos GT 10 Gini Lindos Digi ees Sofa Wean SAF Get EN Ei Tee
78. nce with all escape routes and locations of emergency doors exits on each floor of any building where you work live and or visit Assisting People with Disabilities V Always ask first if you can be of any assistance to them V For people who are deaf blind use your finger to draw an X on their back to let them know you are there to help during an emergency V To communicate with a deaf blind person try tracing letters with your finger on the palm of their hand V To guide the person offer them your arm instead of taking theirs and walk at their pace Keep half a step ahead of them V If the person has a service dog ask them where you should walk to avoid distracting the animal V Provide advance warning of upcoming stairs curbs major obstacles or changes in direction V Watch for overhangs or protrusions the person could walk into Additional Items Emergency Survival Kit Extra white cane preferably a cane that is longer in length Talking or braille clock E Large print timepiece with extra batteries E Extra vision aids such as an electronic travel aid monocular binocular or magnifier E Extra pair of prescription glasses if you wear them m Any reading devices assistive technology to access information portable CCTV devices E Any other contingency supplies unique to your special needs Do not assume the person cannot see you or that they need your help Never grab or to
79. nd how and when to contact them 6 Listthe supplies that come from the home care company how to place an order and explain funding 7 List the supplies not covered by ADP that the individual is responsible for 8 Describe how to safely store equipment Ot 9 Describe when to discard equipment please refer to guidelines in the Ventilation amp Tracheostomy Care section Healthcare Provider S PE Signature Initials Page 10 My Education Checklist and Learning Log Patients Clients amp Caregivers Best Time for Education Sessions Check off morning M afternoon A or evening E in the chart below for the best time for our education sessions Caregiver Relationship to Tu Th Patient Additional Comments Page 11 My Education Checklist and Learning Log Patients Clients amp Caregivers I understand that although may complete this education checklist am not being certified to do any of the acts described Any actions that take following this training will be done under the direction and responsibility of the patient or their authorized agent Caregiver Signature Date Facility Name Address Instructor Signature Date Facility Name Address Page 12 College of Respiratory herapists of Ontario Oximeter Teaching Checklist Patients Clients amp Caregivers This is a checklist for the healthcare professional to use when reviewing the oximetry equipmen
80. ng v Useful Web Resources v Emergency Preparedness Guide for People with Disabilities Special Needs v Assistive Devices Program Equipment Supply Authorization Form v Quick Reference Guide to LTV 900 950 amp 1000 Series Ventilators v Quick Reference Guide to LTV 1200 1150 Series Ventilators q5 adinosay 7 Partners re Funding provided by Force College of Respiratory Therapists of Ontario 180 Dundas Street West Suite 2103 Toronto Ontario M5G 1Z8 Tel 416 591 7800 Fax 416 591 7890 Toll free 1 800 261 0528 Email questions crto on ca Web site www crto on ca
81. nguage Selection After accessing Extended Features ALARM OP is displayed Turn the Set Value knob until VENT OP is displayed Press the Select button 1 Turn the Set Value knob until LANGUAGE is displayed 3 ENGLISH or the currently selected language is displayed 2 Press the Select button 4 Turn the Set Value knob until the desired language is displayed 5 Press the Select button P N 10674 Rev H LTV Series Ventilators Ventilator Operations Software Versions After accessing Extended Features ALARM OP is displayed Turn the Set Value knob until VENT OP is displayed Press the Select button Turn the Set Value knob until VER xx xx xx is displayed where XX XX XX is the current software version Usage Meter After accessing Extended Features ALARM OP is displayed Turn the Set Value knob until VENT OP is displayed Press the Select button Turn the Set Value knob until USAGE xxxxx x is displayed where XXXXX X is the current number of hours the ventilator has been in operation P N 10674 Rev H LTV Series Ventilators P D Bes i O gt Fa ep C EXTENDED FEATURES Ventilator Operations Communications Setting The ventilator may be connected to printer a graphics monitor or a modem The Communications Setting option is used to select the communications protocol for data transmission After accessing Extended Features ALARM OP is displayed Turn the Set Value knob until VEN
82. nitor Select button 12 The NPPV LED will be illuminated 13 Exit the Extended Features menus by turning the Set Value knob until Exit is displayed and pressing Select button until monitored data is displayed in the window P N 10674 Rev H LTV Series Ventilators 26 MONITORED DATA The monitored data displays may be automatically scrolled or manually scrolled To cycle through the available monitored data automatically from a halted scan press the Monitor Select button twice Pressing the Select button once while scan is active shall halt scanning and the currently display monitor shall remain in the display window Each time you press the button once the next data item in the list will be displayed To resume scan press the scan button twice The monitored data is displayed in the following order Display Description Displays the Peak Inspiratory Pressure measured during the inspiratory phase PIP is not updated for spontaneous breaths Displays a running average of the airway pressure for the last 60 seconds Displays the pressure in the airway circuit at the end of exhalation Displays the breaths per minute and includes all breath types Displays the exhaled tidal volume as measured at the patient wye P N 10674 Rev H LTV Series Ventilators 27 Display Description Displays the exhaled tidal volume for the last 60 seconds as calculated from the last 8 breaths Displays the ratio between mea
83. nning from external power the indicator shows the following levels External Power level is acceptable External Power level is low External power may be provided by connecting the ventilator to an external battery or to an external AC power source P N 10674 Rev H LTV Series Ventilators 61 This page intentionally left blank P N 10674 Rev H LTV Series Ventilators 62 ATTACHING A BREATHING CIRCUIT How to attach a patient breathing circuit 1 Connect the main breathing tube to the 22 mm outlet port on the right side of the ventilator 2 Connect the two exhalation flow transducer sense lines to the ports marked Flow Xducer on the right side of the ventilator These are non interchangeable Luer fittings 3 Connect the Exhalation Valve driver line to the port marked Exh Valve on the right side of the ventilator P N 10674 Rev H LTV Series Ventilators 63 This page intentionally left blank P N 10674 Rev H LTV Series Ventilators 64 OXYGEN COMPUTER CHART OXYGEN INPUT FLOW pen 1 290 A0 JA B 70 A 30 1 0 Fiz Assumes a 1 2 LE Beton P N 10674 Rev H LTV Series Ventilators 65 Oxygen Computer Chart To determine O2 Input Flow 1 Find the desired FIO on the horizontal axis 2 Project up to the minute volume 3 Project horizontally to the left vertical axis and read the oxygen flow To determine O Concentration 1 Find the O input flow on the vertical axis
84. ntilate using the resuscitation bag air v SEES ee Ki AN Suction to remove anything that may be blocking the airway Tighten all ventilator tubing connections Check that there is no leak in the system Make sure the humidifier hose is connected Make sure the ventilator settings are set correctly Check to see ifthere is a trach tube cuff leak If oxygen is being used check that the oxygen supply is set up correctly If patient is short of breath right after activity allow them to settle or rest a little to see if there is improvement The patient may need their bronchodilator puffer if it is part ofthe care plan then give the dose now If you have an oximeter check the reading If there is a cuffed trach tube make sure the cuff is properly inflated Page 2 Troubleshooting Guide Patients Clients amp Caregivers Problem What to do Problem with the Trach Tube v A v A lt Make sure the ventilator tubing is not pulling on the trach tube Reposition the patient so the tube is not being pulled on Reposition the head and neck If on the ventilator and you hear air coming from around the trach you may have a trach tube cuff leak Check that the inner cannula is not blocked and is locked in place Check that the trach ties are tied securely but not too tight May need a trach tube change Possible infection Stoma is red swollen or painful to touch Mucous is
85. office and Emergency Operations Centre You can order it free of charge at Www voyage gc ca Divide your medications and medical supplies between your carry on and check in baggage keeping them in their original labelled containers Bring copies of your prescriptions with you Always wear your MedicAlert bracelet F LU i ul Inform your travel companion s on how to assist you in an emergency If travelling alone establish a network e g hotel staff that can assist you during an emergency If you have difficulty using stairs reguest a room on a lower floor Review the hotel emergency exit plan If needing to evacuate bring your emergency Ready Go Bag and any assistive devices you may need 4 a He Additional Items Emergency Survival Kit E Supply of food items appropriate to your dietary restrictions m Supply of medications assistive devices appropriate to your disability e g Glucagen injection if you manage your diabetes with insulin and you are travelling to a remote location that Assisting People with Disabilities V Check on fellow travellers with visible disabilities or special needs to find out if they need your help during an emergency or evacuation does not have ambulance service E Laminated personal information card that you keep on your person at all times when travelling Card identifies V Listen actively to what the individual with special needs is sayin
86. on devices that allow you to know if a person is knocking on the door ringing the doorbell or calling on the telephone H Extra batteries for assistive devices E A CommuniCard produced by The Canadian Hearing Society that explains your hearing loss and also helps identify how rescuers or assisters can communicate with you during an emergency E Any other contingency supplies unique to your special needs Note Typically people who are deafened or hard of hearing will need information presented in a text format Non Visible Disabilities eee Your Emergency Plan e Prepare an easy to understand list of instructions or information for yourself that you think you may need in an emergency e Keep an emergency contact list on your person of key people that are aware of your special needs Non visible disabilities can include communication cognitive sensory mental health learning or intellectual disabilities in which an individual s ability to respond to an emergency is restricted They can also range from allergies epilepsy hemophilia diabetes thyroid condition multiple sclerosis pulmonary or heart disease and or dependency on dialysis sanitary or urinary supplies Individuals with non visible disabilities may have difficulty performing some tasks without appearing to have a disability e Inform your designated support network of where you store your medication e Keep a pencil and paper or por
87. or patients with chronic airway secretion encumbrance Chest 2004 126 774 780 Resources Ottawa Rehabilitation Center www rehab on ca Page 7 Pulmonary Clearance Techniques Patients Clients amp Caregivers Notes Page 8 Education Checklists Routine Tasks What to do and when to do it My Education Checklist and O O Learning Log Oximeter Teaching Checklist SISIDSU uonenpa Education Checklists Notes Education Checklists College of Respiratory herapists of Ontario Routine Tasks Patients Clients amp Caregivers Task Weekly Monthly Stoma care Trach care Clean reusable inner cannula or replace disposable inner cannula Clean speaking valves Clean suction canister warm soapy water Change HME if it is used all the time Ventilator plugged in Test ventilator alarms Check ventilator settings Test the ventilator circuit Test the manual resuscitator bag if used often a o Make sterile distilled water Every 2 3 days rn i oa Test the manual resuscitator bag if not used frequently Clean suction canister in vinegar and water es y Change HME if being used only at night time EE Wipe down suction machine E EC Change suction tubing i a Clean and test manual resuscitation bag LT x Clean ventilator circuit E Clean puffer chamber Ome Clean humidifier i E Unplug ventilator and wipe with a damp cloth LA Check
88. r On Self Tests POST are run During POST e The front panel displays are illuminated D Verify the audible alarm is activated for 1 second only on ventilators with a a symbol on the back panel label e Verify a confirming audible chirp is activated only on ventilators with a symbol on the back panel label 3 Once POST is successfully completed the ventilator begins operating using the stored control settings P N 10674 Rev H LTV Series Ventilators 5 Turning the Ventilator Off To turn the LTV ventilator off Disconnect the patient from the ventilator Ow Surv Press and hold the On Standby button for 3 seconds The ventilator ceases operating the audible alarm sounds continuously and the Vent Inop LED is lit Press the Silence Reset button to silence the audible alarm S e Verify a confirming audible chirp is activated immediately after the alarm is silenced only on ventilators with a symbol on the back panel label The ventilator continues to charge the internal battery as long as it is connected to an external power source Note The Vent Inop LED will remain lit for a minimum of 5 minutes and does not affect battery life P N 10674 Rev H LTV Series Ventilators 6 VENTILATOR CHECKOUT TESTS WARNING Disconnect the patient from the ventilator prior to running the Ventilator Checkout tests and ventilate the patient using an alternative method The ventilator does not deliver gas during the Ventil
89. r saturation and Heart Rate HR 7 Describe when and how often to change probe every 4 hours and as needed PRN 8 Systematic troubleshooting refer to user guide a i 9 Explain the battery power requirements rr 10 Explain the routine monitor maintenance a E Suctioning Caregiver Initials 1 Explain why an individual might need suctioning a a 2 Identify the appropriate interventions for secretions that are dry and thick yellow or green blood tinged 3 Explain the purpose of suctioning KM E 4 Identify the characteristics of secretions colour consistency amount and odour and why it is important 5 Demonstrate how to correctly set up the suction equipment 6 Explain why it is important to use two gloves when suctioning 7 Demonstrate clean suctioning technique including asking the individual for direction before and during suctioning Page 5 My Education Checklist and Learning Log Patients Clients amp Caregivers 8 Explain why suctioning should be done only when needed trying to avoid over suctioning or frequent suctioning 9 Explain what to do if blood is suctioned from the trachea and explain what difference it might make if the individual takes blood thinners 10 Explain how to troubleshoot the suction unit a 11 Describe correct disposal of dirty suction equipment including suction catheters and gloves 12 Demonstrate how to Tip suction Tube suction Deep suction 13
90. ration E The Canadian Hearing Society H Toronto Rehabilitation Institute Special appreciation is also extended to all the people that volunteered their time to pose for the pictures throughout this guide Emergency Management Ontario Accessibility Directorate of Ontario Ministry of Community Safety Ministry of Community and Correctional Services and Social Services www ontario ca emo WWW MCSS gov on ca Since not every emergency situation is similar or predictable every person should rely on and use their best judgement when offering assistance to others in an emergency without putting their own or other people s safety at risk Queen s Printer for Ontario 2007 All material created in this guide is protected by Crown Copyright which is held by the Queen s Printer for Ontario No materials can be reproduced or copied in part or in whole without the expressed written permission of the Ministry of Community Safety and Correctional Services eee Contents Introduction eero see snd E vees kees EE 2 Emergency Survival Kit Checklist 3 Service Animal Emergency Kit Checklist 4 Important Considerations eeeeeeos 5 Categories CET 8 g VISION 24 4664 696644 aas EHS EE EE E 10 A HESFING W EE EE 12 g Non Visible Disabilities 14 II Seniors with Special Needs 16 Highrise Safety ee eeeeeoeo 18 Pg Travel Considerations e 20 For More Informat
91. ratory pressure devices PEP The PEP device is a small hand held device where you breathe out against a pressure Page 6 Pulmonary Clearance Techniques Patients Clients amp Caregivers Clinical References Miske LJ Hickey EM Kolb SM Weiner DJ Panitch HB Use of the mechanical in exsufflator in pediatric patients with neuromuscular disease and impaired cough Chest 2004 125 1406 1412 Finder J Overview of airway clearance technologies July 2006 Available at http www rtmagazine com issues articles 2006 07 06 asp Accessed August 12 2007 Bach JR Mechanical insufflation exsufflation has it come of age A commentary Eur Respir J 2003 21 385 386 Finder JD Birnkrant D Farber CJ et al Respiratory care of the patient with Duchenne muscular dystrophy ATS consensus statement Am J Respir Crit Care Med 2004 170 456 465 Chatwin M Ross E Hart N Nickol AH Polkey MI Simonds AK Cough augmentation with mechanical insufflation exsufflation in patients with neuromuscular weakness Eur Respir J 2003 21 502 508 Tzeng AC Bach JR Prevention of pulmonary morbidity for patients with neuromuscular disease Chest 2000 118 1390 1396 McCool DF Rosen MJ Nonpharmocologic airway clearance therapies AACP evidence based clinical practice guidelines Chest 2006 129 250 259 Winck JC Goncalves MR Lourenco C Viana P Almeida J Bach JR Effects of mechanical insufflation exsufflation on respiratory parameters f
92. rected press the Silence Reset button Ki again Alarm Cause Solution APNEA XX bpm Occurs when the time since the last breath Reevaluate the start exceeds the set Apnea Interval When patient s condition an Apnea alarm occurs the ventilator will enter Apnea Back up ventilation mode Reevaluate ventilator settings APNEA An Apnea alarm has occurred and cleared Reevaluate the The ventilator is no longer in Apnea Back up mode patient s condition Reevaluate ventilator settings P N 18409 001 Rev A LTV 1200 1150 Ventilator 33 Alarm Cause Solution BAT EMPTY Occurs when the ventilator is operating Attach the ventilator to from the internal battery power and the external AC or DC batter charge level is critically low This power alarm can be temporarily silenced but cannot be cleared BAT LOW Occurs when the ventilator is operating Attach the ventilator to from internal battery power and the battery external AC or DC charge level is low power Reevaluate power requirements DEFAULTS Occurs during POST when the ventilator Push the detects an invalid setting stored in non volatile memory Silence Reset button twice to reset alarm Reevaluate ventilator settings DEFAULTS SET Occurs when the ventilator is first powered up after the SET DEFAULTS option has been used to reset all controls and extended features settings to their factory set default values Push the Silence Reset button
93. riginally made available Ontario Emergency Preparedness Guide for People with Disabilities Special Needs www ontario ca emo Acknowledgements ee This Emergency Preparedness Guide for People with Disabilities and or Special Needs was prepared by the Government of Ontario s Emergency Management Ontario in partnership with the Accessibility Directorate of Ontario In order to produce a guide that promotes the values and protects the integrity independence and safety of all Ontarians the following organizations were consulted for their subject matter expertise and special insights for which we are most appreciative m Canadian Diabetes Association H Canadian MedicAlert Foundation m Canadian Paraplegic Association Ontario m Canadian Red Cross E Centre for Independent Living in Toronto CILT Inc E CNIB H Foreign Affairs and International Trade Canada E Learning Disabilities Association of Ontario H Ministry of Community and Social Services Emergency Management Unit H Ministry of Government Services H Multiple Sclerosis Society of Canada Toronto Chapter and Ontario Division m National USA Organization on Disability Headquarters E Office of the Fire Marshal Ontario Head Office E Ontario March of Dimes Provincial Office H Ontario Seniors Secretariat H Ontario SPCA Ontario Society for the Prevention of Cruelty to Animals m SOS Emergency Response Technologies E St Demetrius Development Corpo
94. s amp Planning Emergency Contacts amp Planning Notes College of Respiratory herapists of Ontario JANA i SS L u Se fr a ap OII LAaACL din Emergency Contacts and Planning Patients Clients amp Caregivers All About You Your Contact Information First Name Middle Name Last Family Name Street Address City Home Phone Fax Date of Birth Allergies Your Ventilator Settings Postal Code _ Cell Phone Email These settings have been determined by your doctor and healthcare professionals team Do not change the settings without first talking with your doctor and healthcare professionals Make Mode Volume Low Minute Volume Model Breath Rate Pressure IMPORTANT You need to have a complete list of your ventilator settings even those settings that do not appear on the front panel of the ventilator Page 1 Emergency Contacts and Planning Patients Clients amp Caregivers If you use a speaking valve first deflate the cuff Then change the ventilator settings to Volume Breath Rate Inspiratory Time I E ratio Breath Effort sensitivity Low Alarm High Alarm Keep track of ventilator setting changes Ventilator Setting Change Reason for Change Date Changed Your Trach Tube Make Model Type Serial Size Ordering information Page 2 Emergency
95. s amp batteries Battery operated radio amp batteries or crank radio LI Spare batteries L Candles and matches lighter L Important papers identification L Clothing and footwear L Blankets or sleeping bags LJ Toilet paper and other personal items LI Telephone that can work during a power disruption Q Extra car keys and cash O D DO D D O D O Page 10 Emergency Contacts and Planning Patients Clients amp Caregivers LJ Whistle to attract attention if needed LI Playing cards LJ First aid kit L Backpack or duffle bag This Guide may found at the web site www emergencymanagementontario ca Make sure that your supplies do not become too old to use For example keep your medicine up to date Buy bottled water and food with a long expiry date You should also check your flashlight s and replace the batteries from time to time Page 11 Emergency Contacts and Planning Patients Clients amp Caregivers Notes Page 12 College of Respiratory herapists of Ontario The following document titled Emergency Preparedness Guide for People with Disabilities Special Needs has been provided by Emergency Management Ontario The following acknowledges the original copyright claimed by the Queen s Printer of Ontario Queen s Printer for Ontario 2007 Reproduced with permission The document is being reproduced here with permission from Emergency Management Ontario in the form o
96. s topics relevant to the emergency preparedness needs of people with visible and or non visible disabilities and seniors with special needs e Disabilities special needs are identified as separate categories according to colour and a symbol shown on the top right hand corner of each page e Each category provides information on how individuals should prepare for an emergency given their special needs how the public can best assist a person with a disability and additional suggested survival kit items e The last page is an additional contact information resource for the reader e Copies of this guide are available in both English and French and in alternative formats upon request Please contact Emergency Management Ontario Accessibility Directorate of Ontario General Tel 416 314 3723 General Tel 416 326 0207 Toll free Phone 1 877 314 3723 Toll free Phone 1 888 520 5828 TTY 416 326 0148 Toll free TTY 1 888 335 6611 eee Emergency Survival Kit Checklist This Emergency Survival Kit checklist outlines the basic items every individual should keep in an easy to reach place to help them be self reliant for at least three 3 days immediately after or during an emergency Since emergency supply requirements vary for individuals with different disabilities please refer to the appropriate category in this guide for additional suggested survival kit items Prepare Now Emergency Survival Checklist Learn How Flashlight and ba
97. s when the circuit pressure exceeds Reevaluate ventilator the set High Pressure Limit setting settings Inspect Patient Circuit for occlusions or kinks Reevaluate patient HW Fault Occurs when the ventilator detects a If alarm reoccurs problem with the ventilator hardware contact your Service Rep or Pulmonetic Systems 3 The HIGH PEEP alarm is only available on ventilators with software version 3 15 or higher installed P N 10674 Rev H LTV Series Ventilators 70 Alarms Alarm Cause Solution INOP A ventilator INOP occurs when If an INOP alarm e The ventilator is switched from On to occurs during Yih Standby operation remove Ed e The ventilator detects any condition ventilator from service that is deemed to make the ventilator and contact your unsafe Service Rep LOCKED The LOCKED message is displayed when Press the Control Lock a button is pressed while the controls are button locked No audible alarm is given If locked alert continues press and hold the Control Lock button for three seconds LOW MIN VOL Occurs when the exhaled minute volume is Examine Exhalation less than the set Low Minute Volume Valve body for disconnects Reevaluate patient P N 10674 Rev H LTV Series Ventilators 71 Alarm Cause Solution LOW 0 PRES Occurs when the average oxygen inlet Increase Oz inlet pressure is less than the minimum pressure acceptable inlet pressure of 35 PSIG If using O2 cylin
98. sired setting is displayed and push the Select button e When SBT ON is selected the Spontaneous Breathing Trial ventilation mode is turned on using the current SBT menu settings If the SBT menu settings were not previously reset the factory set default settings will be used All SBT menu settings are to be reviewed for applicability and or set as necessary prior to selecting the SBT ON menu option e When the Spontaneous Breathing Trial ventilation mode is active and SBT OFF is selected the Spontaneous Breathing Trial ventilation mode is terminated and ventilation returns to the previously set modes settings P N 18409 001 Rev A LTV 1200 1150 Ventilator 22 SBT Spontaneous Breathing Trial 2 SBT Menu Options SBT OP SBT START PRES SUPPORT PEEP SBT FIO2 LTV 1200 only MINUTES HIGH f Vt LOW ft SBT HIGH f SBT LOW f DISPLAY f Vt EXIT Turn the Set Value knob until desired SBT menu option is displayed push the Select button and the value setting is displayed Turn the Set Value knob until the desired setting is displayed push the Select button and the desired value is set P N 18409 001 Rev A LTV 1200 1150 Ventilator 23 EXTENDED FEATURES Exiting Extended Features To return to Monitored Parameters 1 Turn the Set Value knob until EXIT is displayed 2 Press the Select button 3 Repeat Steps 1 and 2 until the Monitored Parameters are displayed P N 18409 001 Rev A LTV 1200 1150 Ventil
99. sured inspiratory time and measured exhalation time Both normal and inverse E Ratios are displayed Is based on the Tidal Volume and Inspiratory Time settings Displayed when selected and whenever Tidal Volume or Inspiratory Time is selected for change P N 10674 Rev H LTV Series Ventilators 28 EXTENDED FEATURES Navigating the Extended Features Menus To enter the Extended Features menu in normal ventilation mode press and hold the Monitor Select button for three seconds To view the next item in a menu turn the Set Value knob CH clockwise ey To view the previous item turn the Set Value knob counterclockwise To enter a menu item or select a setting press the F Select button To exit a menu turn the Set Value knob until the EXIT option is displayed then press the Select button or press Control Lock P N 10674 Rev H LTV Series Ventilators 29 Aigo Tree Fipa Terre Tree Zem PC Flow Term Laik Comp HPPY Mode EEMAL Linde Language VER sr e 11 P N 10674 Rev H LTV Series Ventilators 30 EXTENDED FEATURES Alarm Operations Alarm Volume After accessing Extended Features ALARM OP is displayed Press the Select button and ALARM VOL is displayed Press the Select button 2 VOL xx dBA is displayed where xx is the currently set volume 3 Turn the Set Value knob until the desired setting is displayed EN V 4 Press the Select button beid P N 10674 Rev
100. t with the caregiver Verify receipt of the equipment probes the reference manual and user guide 1 Ensure all probes and cables are working by testing them on either yourself or patient Ensure caregiver performs the same test on the child 2 Review and explain parameters LI Spo2 LJ Heart rate L Waveform L Perfusion Index 3 Review and explain alarms must be ordered by physician LJ Low Saturation L High Saturation if a patient is not on oxygen this can be turned off as ordered by physician Low Heart Rate High Heart Rate Explain that adjusting alarms must have a physician s order Demonstrate how to adjust alarms in case physician orders it to be made at home LI OOO Review and explain Power indicator light Battery indicator four shaded segments fully charged Heart rate volume a a Q Alarm volume LI Backlight LJ Lock function LJ Alarm silence button one for two min silence three quick will silence indefinitely press once to reset to normal function Review battery power U Needs 3 5 hours to completely charge internal battery L Battery life 24 hours if completely charged if backlight is on the internal battery lasts 12 hours Troubleshooting LJ Review the troubleshooting guide in the technical reference manual page 3 1 Contact information to tell family caregiver L Contact Ventilator Equipment Pool VEP LI Explain to the caregiver when equipment is
101. table electronic recording device handy to write down or record any new instructions provided to you in an emergency Consider owning and wearing a MedicAlert bracelet or identification because it will help notify emergency responders about your non visible disabilities For more information visit www medicalert ca Request a panic push button to be installed in the building you work and or live in so that in the event of an emergency you can notify others of your whereabouts and that you need special assistance People with Multiple Sclerosis Symptoms are often made worse by heat and humidity Be prepared to keep cool and dry People with Diabetes Keep frozen water bottles or ice packs in your freezer Have an insulated bag or cooled thermos ready to store your insulin should there be a power outage or you need to evacuate Assisting People with Disabilities V Allow the person to describe what help they need from you V Find effective means of communication e g provide drawn or written instructions When giving directions use landmarks instead of terms go left or turn right V Be patient flexible and maintain eye contact when speaking to the person V Repeat instructions if needed V Ask the person about their medication and if they need any help taking it Never offer medicines not prescribed by their physician V Keep people with multiple sclerosis
102. tact List Healthcare team names and phone numbers Personal support network names and phone numbers MER phone number Equipment supplier name and phone number Oxygen supplier name and phone number List of medicines and inhalers puffers Resuscitation bag and mask Portable suction unit and supplies D C Battery LOODU Page 9 Emergency Contacts and Planning Patients Clients amp Caregivers Fire Precautions Fire Extinguishers V Have two fire extinguishers in the home Y Your fire extinguishers need to be checked once a year Smoke Detectors Y Have one smoke detector on every level in your home v Change the batteries in your smoke detectors twice a year Many people change their smoke alarm batteries twice a year when they change their clocks in the spring and the fall Write the date you changed the batteries on the smoke detector vV Posta No Smoking Flame sign if oxygen is in use Emergency Supplies An emergency situation may occur that reguires you to stay in your home for a long period of time So itis wise to have some emergency supplies Have enough supplies for a week According to the Emergency Preparedness Guide for People with Disabilities Special Needs from Emergency Management Ontario Here is what they suggest Respiratory travel bag Enough medications MedicAlert bracelet or identification Bottled water Food non perishable Manual can opener Flashlight
103. the Select button P N 10674 Rev H LTV Series Ventilators 40 EXTENDED FEATURES Ventilator Operations Pressure Control Flow Termination The Pressure Control Flow Termination option is used to enable or disable flow termination for Pressure Control breaths When this option is on Pressure Control breaths are cycled at the set percentage of peak flow if it is reached before the set Inspiratory Time elapses The percentage of peak flow is set in the Variable Flow Termination option After accessing Extended Features ALARM OP is displayed Turn the Set Value knob until VENT OP is displayed Press the Select button 1 Turn the Set Value knob until PC FLOW TERM is displayed 2 Press the Select button 3 PC FLOW ON or PC FLOW OFF is displayed krt 4 Turn the Set Value knob until the desired state is displayed 5 Press the Select button sc P N 10674 Rev H LTV Series Ventilators 41 Ventilator Operations Leak Compensation Use the Leak Compensation option to enable or disable tracking of the Baseline Flow to improve triggering when a circuit leak is present When Leak Compensation is on the system is gradually adjusted to maintain set sensitivity if the leak is stable and there is no auto cycling After accessing Extended Features ALARM OP is displayed Turn the Set Value knob until VENT OP is displayed Press the Select button 1 Turn the Set Value knob until LEAK COMP is displayed VS 2 Press
104. ting the information below will help you to develop a good plan What to do if there is a power failure Use your external D C battery given to you by the Ventilator Equipment Pool VEP for emergency use A full charged battery should last 5 12 hours Y Go somewhere where there is power Somewhere close to your home This could be a hospital a hotel a fire or ambulance hall These places usually have power even during a power outage v Call family or friends to see if their power is out If they still have power you could go there Make sure there is at least one person on your contact list that lives close by and understands your needs v Plan on how you might escape from your home Getting out of your home quickly and safely can be difficult so you need a plan For example if you live in a high rise apartment it may not have adequate back up power for a long power outage It may not be easy to get out of the building when the elevators are not working So you need to have a plan You need two external D C batteries if you want to be mobile with your ventilator One battery to use when you are mobile and the other battery in case of a power failure The backup battery from the VEP is not to be used with your wheelchair You need to buy another D C external battery if you want to use your ventilator while you are mobile If you are having trouble paying for a second battery consider going to Assistance for Children with Sever Disabi
105. tion Select Volume or Pressure as desired Not available on the LTV 900 3 Set the Breath Rate 4 If Volume ventilation is selected set the Tidal Volume The calculated peak flow Vealc is displayed in the window while Tidal Volume is being changed 5 If Pressure ventilation is selected set the Pressure Control Not available on the LTV 900 6 Set the Inspiratory Time The calculated peak flow Vcalc is displayed in the window while Inspiratory Time is being changed Vcalc only applies to volume ventilation 7 Set 02 LTV 1000 only 8 Set the Sensitivity to a setting from 1 to 9 9 Set the High Pressure Limit alarm Set the Low Minute Volume alarm 0 Set the Low Pressure alarm 1 2 Setthe PEEP control on the exhalation valve 1 1 1 P N 10674 Rev H LTV Series Ventilators 20 SETTING UP MODES OF VENTILATION Setting Up SIMV Mode P N 10674 Rev H LTV Series Ventilators 21 To set the Ventilator up in SIMV mode 1 2 3 4 5 6 Press the Select button twice to toggle the modes between Assist Control and SIMV CPAP Select the SIMV CPAP mode Press the Select button to toggle between Volume and Pressure ventilation Select Volume or Pressure as desired Not available on the LTV 900 Set the Breath Rate If Volume ventilation is selected set the Tidal Volume The calculated peak flow Vcalc is displayed in the window while Tidal Volume is being changed
106. tor 8 SETTING UP MODES OF VENTILATION Setting Up Assist Control Mode P N 18409 001 Rev A LTV 1200 1150 Ventilator 9 Setting Up the Ventilator in Assist Control Mode 1 Press the Select button twice to toggle the modes between Assist Control and SIMV CPAP Select the Assist Control mode 2 Press the Select button twice to toggle between Volume and Pressure ventilation Select Volume or Pressure as desired 3 Set the Breath Rate 4 If Volume ventilation is selected set the Tidal Volume The calculated peak flow Vealc is displayed in the window while Tidal Volume is being changed 5 If Pressure ventilation is selected set the Pressure Control 6 Set the Inspiratory Time The calculated peak flow Vcalc is displayed in the window while Inspiratory Time is being changed Veale only applies to volume ventilation Set O2 LTV 1200 only Set the Sensitivity to a setting from 1 to 9 Set the High Pres Limit alarm 0 Set the Low Pressure alarm 1 2 O oO SI Set the Low Min Vol alarm 1 1 12 Adjust the PEEP control P N 18409 001 Rev A LTV 1200 1150 Ventilator 10 SETTING UP MODES OF VENTILATION Setting Up SIMV Mode P N 18409 001 Rev A LTV 1200 1150 Ventilator 11 To set the Ventilator up in SIMV mode 1 Press the Select button twice to toggle the modes between Assist Control and SIMV CPAP Select the SIMV CPAP mode 2 Press the Select button to toggle b
107. tteries Radio and batteries or crank radio Spare batteries for radio flashlight assistive devices etc Manual can opener Clothing and footwear Blankets or sleeping bags Toilet paper and other WO O O O O O O First aid kit personal items O Telephone that can work during O Medication a power disruption O MedicAlert bracelet or O Candles and matches lighter identification O Extra car keys and cash O Backpack duffle bag O Important papers identification Whistle to attract attention O Non perishable food and bottled if needed Playing cards Service Animal Emergency Kit Checklist eee This Service Animal Emergency Kit checklist outlines the basic items every person with a service animal should have prepared in advance to keep their service animals comfortable during the stress of an emergency situation It is advisable to keep all items in a transportable bag that is easy to access should evacuating the home become necessary Also remember to check the kit twice a year an easy way to remember is to do it when you check your smoke alarms bi annually to ensure freshness of food water and medication and to restock any supplies you may have borrowed from the kit Service Animal Emergency Kit Checklist Minimum 3 day supply of bottled water and pet food Portable water and food bowls Plastic bags Paper towels and can opener Up to date ID tag with your Medications with a list phone number and the identifying
108. twice to reset alarm Reevaluate ventilator settings P N 18409 001 Rev A LTV 1200 1150 Ventilator 34 Alarms Alarm Cause DISC SENSE Occurs when the ventilator detects one of the following conditions e The patient circuit or proximal pressure sense line has become disconnected Solution Check Patient Circuit assembly for disconnects Check pressure sensing lines for e The low side exhalation flow occlusions transducer sense line has become disconnected e The proximal pressure sense line is pinched or occluded HIGH f Occurs when the Total Breath Rate f Check Patient Circuit exceeds the high breath rate and time period alarm values HIGH O PRES Occurs when the average oxygen inlet assembly for leaks Check HIGH f alarm values Reduce O inlet LTV 1200 only pressure exceeds the acceptable limit for pressure the type of oxygen source P N 18409 001 Rev A LTV 1200 1150 Ventilator 35 Alarm Cause Solution HIGH PEEP Occurs when the ventilator detects one of Reevaluate ventilator the following conditions settings e The patient circuit positive end Disassemble clean expiratory pressure PEEP exceeds and reassemble the the High PEEP alarm setting Patient Circuit D Patient Circuit Exhalation valve Exhalation Valve and and or PEEP valve occluded PEEP Valve HIGH PRES Occurs when the circuit pressure exceeds Reevaluate ventilator the set High Pressure Limit setting settin
109. uch a person with vision loss Do not touch make eye contact or distract the person s service dog as this can seriously endanger the owner Do not shout at a person with vision loss Speak clearly and provide specific and precise directions Avoid the term over there Instead describe locating positions such as to your right left straight ahead behind you or by relaying clock face positions For example 12 o clock Hearing eee A person can be deaf deafened or hard of hearing The distinction between these terms is based on the individual s language and means of communicating rather than the degree of hearing loss In an emergency the method in which emergency warnings are issued becomes critical to how a person with hearing loss is able to respond and follow instructions to safety Your Emergency Plan e If your network is e Obtain a pager that unavailable during an emergency seek the assistance of others to whom you can communicate your hearing loss by spoken language moving your lips without making a sound pointing to your ear using a gesture or if applicable pointing to your hearing aid Keep a pencil and paper handy for written communication A a A A n i il A is connected to an emergency paging system at your workplace and or the building that you live in Install a smoke detection system that includes smoke alarms and accessory flashing strobe
110. urning the Ventilator Off 2 u0042244244404nanannnnnnnnnnnnnannannnnnnnnnnannnnnnnnnnnsnnnnnnn 6 Variable Controls unnesnssnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnrnsnnnnnnnnn nennen 7 SETTING UP MODES OF VENTILATION annnnnnnanannnanenananannnnnananannnannnnna 9 Setting Up Assist Control Mode nn 9 Setting Up SIMV Mode nenn 11 Setting UB CPAP Mode 3 2 224 222020 ee akt data ge 13 Setting Up NPPV Mode 2 sense V e via enden ENEE nern 15 Monitored Data 2 s 4 anne de Kuimet niu T aa ammu 17 Extended Features u2 u aa euren ete kududa naad Segel 19 SBT Spontaneous Breathing Trail 21 P N 18409 001 Rev A LTV 1200 1150 Ventilator iii Using AC DC Power nensnunnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnsnnnnnnnnnnnnnsnnnnnnnsn nennen 25 Using the AG Ad pter uns een easton tous herd ielsniehnen 25 Using an External DC Power Source nn nesrtrn nent 26 Power Displays and Indicators nannvnnnnnnnnnnnnnnnnanannnnnananananannnnanannnnnna 27 Attaching a Breathing Circuit uurreesnnnennnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn nenne nenn 30 Oxygen Computer Chart unessnnnsnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnsnnnnnnnnnnnnnnnnnnnnnnn nennen 31 LEO 33 P N 18409 001 Rev A LTV 1200 1150 Ventilator iv FRONT AND SIDE PANEL REFERENCE Front Panel Displ
111. velopment The Rehabilitation Centre Ottawa Respiratory Protocols for Spinal Cord Injuries and Neuromuscular Disease http www irrd ca education default as The Toronto East General Hospital Progressive Weaning Centre Provincial Centre of Excellence http www tegh on ca bins content page asp cid 3 2850 amp lang 1 amp pre view Page 5 Useful Web Resources Patients Clients amp Caregivers West Park Healthcare Centre Long Term Ventilation Centre of Excellence On line e learning modules http www ltvcoe com index html Chronic Ventilation Strategy Task Force Final Report June 30 2006 http www health gov on ca english providers program critical care docs report cvtg pdf Page 6 Useful Web Resources Patients Clients amp Caregivers Vendors The Porta Lung http portalung com index htm Breathing Pacemakers Avery Biomedical http www averylabs com index html Diaphragm Pacing System Synapse Biomedical http www synapsebiomedical com products neurx shtml Cough Assist Device http www coughassist com Respironics http www healthcare philips com main homehealth index wpd Resmed Corporation http www resmed com en en Fisher amp Paykel HealthCare http www fphcare com Carestream Medical http www carestream com Draegar Medical Canada http www draeger com CA en US Quadromed Inc http www quadromed com en index html Passy Muir Tracheostomy and Speaking Valves http
112. w rtso ca The BC Association for Individualized Technology and Supports for People with Disabilities Home of the Provincial Respiratory Outreach Program PROP http www beits org default htm The Canadian Lung Association http www lung ca The Ontario Lung Association http www on lung ca Page 4 Useful Web Resources Patients Clients amp Caregivers Home Long Term Ventilation Education AARC Clinical Practice Guideline Long Term Invasive Mechanical Ventilation in the Home 2007 Revision amp Update http www rcjournal com cpgs pdf 08 07 1056 pdf AARC Clinical Practice Guideline Providing Patient and Caregiver Training http www rcjournal com cpgs pcgtcpg html AARC Clinical Practice Guideline Training the Health Care Professional for the Role of Patient and Caregiver Education http www rcjournal com cpgs thcpcpg html AARC Clinical Practice Guideline Pulse Oximetry http www rcjournal com cpgs pulsecpg html Battery University is an on line resource that provides practical battery knowledge http www batteryuniversity com Emergency Management Ontario Emergency Preparedness Guide for People with Disabilities Special Needs http www emergencymanagementontario ca stellent idcplg webdav Contribution 20Fold ers emo documents Disability 20Guide_ Eng od http www getprepared ca IVUN Home Ventilator Guide http www ventusers org edu HomeVentGuide pdf The Institute for Rehabilitation Research and De
113. www passy muir com Bivona Tracheostomy Tubes http www smiths medical com catalog bivona tracheostomy tubes Page 7 Useful Web Resources Patients Clients amp Caregivers Shiley Tracheostomy Tubes http www nellcor com prod list aspx S1 AIR amp S2 TTA Instrumentation Industries Inc http www iiimedical com Intersurgical Complete Respiratory Systems http www intersurgical com Hans Rudolph Inc http www rudolphkc com DeVilbiss Healthcare http www devilbisshealthcare com Cardinal Health http www cardinalhealth com Covidien http www covidien com Lifetronics http www lifetronics com Advance for Managers of Respiratory Care At a glance charts detailing various interface mask products available http respiratory care manager advanceweb com Sharedresources advanceforMRC Resources DownloadableReso urces MR040108 p64AirwayBG pdf Page 8 Section 4 Appendices Appendix A Assistive Devices Program Equipment Supply Authorization Form Sample sw JO Alesso 5 9 UON gt DNPOAU Appendix B Quick Reference Guide to LTV 900 950 amp 1000 Series Ventilators Appendix C Quick Reference Guide to LTV 1200 1150 Series Ventilators S JEUOISSZJOAA 212DUIJLIH s19A16312 8 DI et D gt e u D N D e gt ot u sadipuaddy Section 4 Appendices Appendix A Assistive Devices Program Equipment Supply Authorization Form Sample Introduction amp Glossary o
114. y Education Checklist and Learning Log Patients Clients amp Caregivers 15 Helper role removes ties cleans neck and stoma positions and holds person for tube change suctions tip or measured secures ties when tube is change 16 Describe and demonstrate the emergency replacement of the trach tube 17 Trach Tube Change Y Demonstrates Helper role on patient Practice 1 Practice 2 Practice 3 Y Demonstrates Main role on patient Practice 1 Practice 2 Practice 3 V Demonstrates Solo trach change competently Practice 1 Practice 2 Practice 3 Speaking Valves and Other Adjuncts Caregiver Initials 1 Describe how a speaking valve works and when to use it 2 Describe how to clean and take care of the speaking valve 3 Explain the importance of cuff deflation before using a speaking valve if applicable 6 Explain the need for a specialty trach tube and how to order one Page 4 My Education Checklist and Learning Log Patients Clients amp Caregivers Oximeter Caregiver Initials 1 Explain what parameters the oximeter measures including the waveform and perfusion index 2 Demonstrate how to get a good saturation and heart rate reading 3 Demonstrate correct application of probe a ae 4 Explain when to use oximeter asleep and or unattended 5 Identify oximeter assessment abilities a ae 6 Demonstrate how to set correct alarm settings low and high settings fo
115. yellow or green There is more mucous You need to suction more often Needs more puffer medicine Has a fever or chills Is not feeling well and is really tired Oximeter reading if you have one is low oe lt S If you have an action plan that the doctor has given you follow that Call the doctor or healthcare professional right away The patient is very anxious LS Instill 2 5 mls of normal saline into trach and apply manual resuscitator or ventilator for a few breaths Use Breath Stacking and Cough Assist techniques to move any mucous up the airway Try to remain calm and tell them what you are doing to solve the problem Have patient do relaxation exercises If necessary give medication as ordered Page 3 Troubleshooting Guide Patients Clients amp Caregivers Problem What to do There is a lot of mucous and it is difficult to suction it all out x V Suction 1 Lubricate the suction catheter with water and try suctioning again Use manual resuscitation bag to deliver 3 5 breaths Change the inner cannula if there is one Suction Repeat steps 1 4 if needed RER Use Pulmonary Clearance Techniques such as Breath Stacking This will help move the mucous up so it can be suctioned out Moving often will help a patient cough up their mucous You can turn the patient every 1 2 hours or have them sit in a chair several times a day If you have learned
116. you insert the mouthpiece or put the mask on Ask them to pretend to blow out candles This will help them to empty their lungs Try to catch them on their next breath in and say take a deep breath and another one and another one Make eye contact with them the whole time Then tell them to cough or breathe out when they exhale Page 4 Pulmonary Clearance Techniques Patients Clients amp Caregivers Cough Assist Device The Cough Assist Device helps you get rid of mucous by trying to create a stronger cough You hold a mask on the face and the machine delivers a slow pressure increase when you breathe in Then it is followed by a rapid suction effect The slow breath in followed by a quick breath out creates a cough DE RESFIRONICS Figure 1 Cough Assist Device http www coughassist com default asp Reproduced with permission of Philips Respironetics You can use either a mask or a mouthpiece with the Cough Assist Device Small children and people with muscle weakness will have trouble keeping a seal on a mouthpiece so will need to use a mask When using a mask you will need a good seal If using a mask be sure you have good head and neck support such as against a head rest on a wheelchair How do give a Cough Assist Treatment 1 You need two people to do the Assisted Cough technique 2 Have the patient sit comfortably with good head and neck support They can be in bed with their head

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