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Respiratory Therapy at Thompson Health

This presentation provides an overview of the various oxygen devices used in respiratory therapy and the key guidelines for nursing staff at Thompson Health. Understanding these tools and best practices is crucial for delivering effective patient care.

Servo-U Ventilators

Adult Patient Use

The Servo-U ventilator is designed for use with adult patients only, providing advanced features and capabilities.

Monitoring & Therapies

The Servo-U is capable of delivering non-invasive ventilation therapies.

Portability & Durability

With 1 MRI compatible unit and a 90-minute battery life, the Servo-U is a versatile and robust ventilator for patient transport.

Specialized Care

Respiratory therapists are required to operate the Servo-U, from initial setup to adjustments and withdrawal of care.

Servo-Air Ventilator

Adult Use Only

The Servo-Air ventilator is designed for adult patient use, providing non-invasive or invasive ventilation support.

Respiratory Therapist Required

All major actions on the Servo-Air ventilator must be performed by a trained respiratory therapist to ensure safe and effective operation. RT must be present for transport.

Suitable for ED/ICU

The versatile Servo-Air is well-suited for use in emergency departments and intensive care units, providing advanced ventilation capabilities.

V60 Non-Invasive Ventilation

Adult Use

The V60 ventilator is designed for adult patient use only, not pediatric or neonatal.

ED and ICU Use

This ventilator is primarily used in emergency departments and intensive care units for acute care patients.

Respiratory Therapy

Respiratory therapists are required to transport the patient and perform major actions.

RN may withdraw but must call RT and document in flowsheets

RT must be contacted regarding any changes to settings.

Contraindications

  • Nausea/Vomiting
  • Restraints
  • Trauma

CPAP & BiPAP

Shared Equipment

CPAP and BiPAP machines are shared between the hospital and CCC and can be used anywhere in the building allowing for seamless transitioning of patient care.

Mask Options

These ventilation systems offer both nasal and full-face mask options to accommodate patient comfort and preference.

O2 Support

May bleed in Oâ‚‚ if ordered

Home Devices

•Can match patients home settings

•Patients CAN use home mask

•Patients CAN use home machine after safety check by RT (no humidification may be used)

Small Volume Nebulizer

Versatile Use

Small volume nebulizers can be used anywhere by respiratory therapists (RT) or registered nurses (RN) to deliver aerosolized medications to patients.

High Flow Rate

These nebulizers operate at a flow rate of 8 liters per minute and should be replaced every 3 days to maintain proper function.

Labeling Requirements

Store in bag labeled with date and patient label.

Replace all O2 tubing, mask, and mouthpiece every three days.

Nasal Cannula

Range and Humidification

Nasal cannulas can deliver oxygen flow rates between 1-6 liters per minute. Humidification is recommended when flow exceeds 2 liters per minute to prevent drying of the nasal passages.

Replacement Frequency

Nasal cannulas should be replaced every 3 if humidified

If no humidification is used change weekly (every 7 days) to maintain hygiene and functionality.

Length

Available from 5ft to 25ft

If you know your patient is going to be ambulating please start with the longest cannula. Cut down on waste!

Oxymask

Range

  • The Oxymask has a range of 1L to Flush
  • Never use humidification.
  • 24%-90% FiO2

Sizes

The Oxymask comes in Small and Large sizes to fit a variety of patient needs.

Patient Comfort

The Oxymask is suitable for mouth breathers and claustrophobic patients, and should be changed every 7 days.

Venti Mask

1

Range: 2L-12L

The Venti mask can precisely deliver oxygen at 24%-50% FiO2, making it suitable for a variety of patient needs.

2

Precise Oxygen Administration

The Venti mask is designed to provide controlled and accurate oxygen delivery, ensuring patients receive the appropriate concentration of oxygen for their condition.

3

Recommended for COPD Patients

This mask is particularly well-suited for COPD (Chronic Obstructive Pulmonary Disease) patients, as it should be changed every 7 days for optimal performance and patient comfort.

Aerosol Mask

Range

The aerosol mask has a flow rate range of 8L to 15L, with an FiO2 range of 35% to 100%.

Maintenance

The mask requires sterile water, which must be replaced every 3 days to maintain proper humidity and aerosol generation.

FiO2 Adjustment

The FiO2 can be adjusted using the blue dial on the humidity bottle, allowing for precise control of the oxygen concentration.

Trach Mask

Same set up as aerosol mask with trach mask in place of face mask.


Face Tent

Flow Range

The face tent delivers 8L-15L of oxygen at an FiO2 (fraction of inspired oxygen) between 35%-100%.

Water Requirement

The device requires sterile water which must be replaced every 3 days to maintain proper humidification.

FiO2 Adjustment

The FiO2 can be adjusted using the blue dial on the device to deliver the desired oxygen concentration. Flowmeter adjusts humidification level only.

Trach Care: Cuffed vs. Non-Cuffed Trach

Cuffed Tracheostomy Tubes are used for patients requiring mechanical ventilation or at risk of aspiration. The cuff is inflated to prevent air leakage and aspiration, but requires regular monitoring of cuff pressure to avoid complications.

Non-Cuffed Tracheostomy Tubes are used for patients who can breathe on their own without risk of aspiration. These allow for easier phonation and swallowing, and are generally used for long-term tracheostomy patients.

Tracheostomy Care

Purpose:
To maintain patency, prevent infection, and increase comfort of patient/resident with a tracheostomy.

Equipment:

  • Trach care kit
  • Sterile water or sterile saline
  • Hydrogen peroxide
  • Suction
  • Sterile gloves

Procedure:

  • Suction per procedure
  • Apply sterile gloves
  • Loosen inner cannula
  • Remove inner cannula; place in half-strength peroxide solution (½ hydrogen peroxide / ½ sterile water or saline)
  • Cleanse inner cannula with a test tube brush or pipe cleaner
  • Rinse in sterile water/saline, shake dry, and replace
  • Lock inner cannula (clockwise for plastic, metal lock for metal trach)
  • Document in nurse’s notes:
  • Color and characteristics of secretions
  • Patient/resident tolerance of care

Tracheostomy Dressing Changes

Purpose:
To promote skin integrity and prevent infection of tracheostomy stoma.

Equipment:

  • Disposable trach care kit
  • Sterile water, hydrogen peroxide (½ strength)
  • Date, time, initial opened containers, change every 24 hours

Procedure:

  • Wash hands
  • Use sterile technique
  • Set up trach kit and pour sterile water and peroxide in basins
  • Apply sterile gloves
  • Remove soiled trach dressing with gloved hand
  • Cleanse stoma with ½ strength peroxide
  • Rinse stoma with sterile water using a sterile hand
  • Replace soiled dressing with new lint-free precut dressing
  • Replace trach ties or securing device only when soiled
  • Ask for assistance during changing of dressing/ties if needed
  • Prepare new ties by knotting and cutting slits as described
  • Attach new ties to trach plate and secure with a square knot
  • Keep an extra trach tube at bedside
  • Document on nurses' notes:
  • Wound condition
  • Character of secretion
  • Resident/patient tolerance
  • Tube patency maintained
  • Dispose of soiled dressings properly

Non-Rebreather

Use at 15L

The non-rebreather mask is designed to be used at a high flow rate of 15 liters per minute. It should not be titrated down.

One-Way Valves

The mask has one-way valves that prevent exhaled air from being re-breathed. This ensures a high concentration of oxygen is delivered to the patient.

No Humidification

Unlike some other oxygen delivery devices, the non-rebreather does not provide humidified oxygen. This can make the air feel dry for the patient.

Medium Flow Nasal Cannula

Green Tubing

The medium flow nasal cannula uses green tubing to deliver oxygen at a range of 6-15 liters per minute.

Humidified Oxygen

The oxygen delivered through a medium flow nasal cannula must be humidified to prevent drying of the nasal passages and discomfort for the patient.

Replace Every 3 Days

For hygiene and optimal performance, the medium flow nasal cannula tubing should be replaced every 3 days or as needed.

Heated High Flow Nasal Cannula

1

High Flow Range

The heated high flow nasal cannula can deliver oxygen at a range of 25L-60L, with an FiO2 of 21%-100%.

2

Sizing

•S/M/L nasal prongs

3

Sterile Water and RT Presence

The device requires the use of sterile water and the presence of a respiratory therapist for proper setup and monitoring.

4

Frequent Replacement

The cannula should be replaced every 3 days, making it suitable for use in the emergency department and ICU settings.

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