Management of the Home Ventilator – Segment 1

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Management of the Home Ventilator – Segment 1

Management of Home Ventilators

Purpose

  • Provide guidelines for home health nurses and other caregivers who care for ventilator dependent clients.
  • Promote safety in management of high tech care in the home setting.
  • Promote self care in the home.

Applies To

  • Registered Nurses
  • Licensed Practical/Vocational Nurses

Guidelines

  • Caregivers who are willing and able to help with client care needs are necessary for discharge to the home setting.
  • Individual manufacturers of home ventilator equipment have handbooks for recommendations on safe use in the home.
  • Prior to discharge the home care team including the home vendor and respiratory therapist participate in establishing the plan.
  • All family and care giving staff must be familiar with ventilator alarms and how to appropriately respond.The client/caregivers are instructed in how to use the manual resuscitation bag.
  • The client/caregivers are instructed in how to use the manual resuscitation bag.
  • A backup electrical or battery source should be available and local utility companies notified of the client home needs.

Equipment/Supplies

  • Ventilator and associated circuits, filters, and tubing.
  • Heated humidifier or cascade.
  • External 12 volt battery and cord.
  • Ambu bag.
  • Disinfectant (as defined in infection control guidelines and policy).
  • Air compressor and tubing for aerosol treatments (see separate procedure).
  • Tracheostomy equipment and supplies.
  • Communication aids.
  • Equipment as needed for bowel, bladder and personal care such as hospital bed, wheelchair, commode and/or bedpan.

 

 

Trach Tubes/Inner Canula Information

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Informational – Trach Tubes/Inner Canula

Humidification via Compressor Station

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Humidification via Compressor Station

Humidification via Condenser

Purpose

  • To provide humidity to the airway as an artificial airway (tracheostomy) bypasses the body’s natural humidification process.

Applies To

  • Registered Nurses
  • Licensed Practical/Vocational Nurses

Equipment/Supplies

  • Condenser
  • Electrical Outlet
  • Corrugated Tubing
  • Plastic Container/Bottle that holds water and connects to condenser
  • Water Trap
  • Trach Collar and distilled or sterile water for inhalation.

 

G-Tube Reinsertion Station

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G-Tube Reinsertion Station

Purpose

  • Maintain gastrostomy tube patency.
  • Prevent skin breakdown around site.

Applies To

  • Registered Nurses
  • Licensed Practical/Vocational Nurses

Equipment/Supplies

  • Bulb syringe.
  • Water in small container.
  • 4 x 4 gauze sponge and dressing supplies, if necessary.
  • Hypoallergenic tape if necessary.
  • Cotton-tipped applicators.
  • Soap and warm water, basin, wash cloth, and towel.
  • Disposable, non-sterile gloves.

 

 

 

G-Tube Feeding Station

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G-Tube Feeding Station

Administration of Enteral Feedings, Gastrostomy or Jejunostomy Tube

 

Gastric feeding by gastrostomy tube is relatively safe to administer provided gastric emptying is normal. Research has shown that aspiration rates are about the same in clients with a gastrostomy tube as with nasogastric tubes (Metheny, 2000).

 

A gastrostomy tube is inserted in surgery. The tube is placed in the stomach and the tube exits in upper left quadrant of the abdomen. An alternative is a percutaneous endoscopic gastrostomy (PEG) tube. This tube also exits through a puncture wound in upper left quadrant of abdomen but is held securely in place by design.

 

A jejunostomy tube is used when clients are at greater risk of aspiration or have delayed gastric emptying. This tube is placed in surgical procedure and advanced into the jejunum.

 

Chest PT Station

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Chest PT Station

Manual Percussion and Vibration

Purpose

  • Loosen and clear secretions retained in the lungs and bronchi.

Applies To

  • Registered Nurses
  • Licensed Practical/Vocational Nurses

Equipment/Supplies

  • One to four pillows, depending on the client’s comfort and posture.
  • Comfortable surface that can be slanted (hospital bed, tilt table or chair).
  • Glass of water.
  • Tissues and paper bag.
  • Emesis basin.
  • Loose towel or single layer of clothing over chest wall.
  • Mechanical vibrator or percussion (optional).

 

Changing of a Tracheostomy Tube

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Changing of Tracheostomy Tube Station

Changing of Tracheostomy Tube Station

Purpose

  • Prevent respiratory infection.
  • Maintain adequate ventilation.
  • Prevent any tracheal damage.

Applies To

  • Registered Nurses
  • Licensed Practical/Vocational Nurses

Equipment/Supplies

  • Tracheostomy care and suctioning supplies (See Tracheostomy Care procedure).
  • Tracheostomy tube.*
  • 5 to 10 ml syringe.
  • Water-soluble lubricant.
  • Stethoscope.
  • Disposable gloves.

* Note: Use sterile tube as ordered by the physician.

Bowel and Digital Stimulation Program

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Bowel Program and Digital Stimulation Station

Bowel Program, Digital Stimulation

Purpose

  • Manually remove stool.

Applies To

  • Registered Nurses
  • Licensed Practical/Vocational Nurses

Equipment/Supplies

  • Disposable gloves.
  • Water-soluble lubricant.
  • Waterproof, absorbent pads.
  • Bedpan.
  • Wash basin.
  • Washcloths, towels, soap.
  • Suppository as ordered by the physician.

 

Administration of a Nebulizer

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Administration of a Nebulizer


Aerosol Nebulizers/Inhalers

Purpose

  • Administer medication and provide humidification to the tracheobronchial tree.
  • Increase alveolar and total ventilation.
  • Facilitate the ability to cough and remove secretions.

Applies To

  • Registered Nurses
  • Licensed Practical/Vocational Nurses

Equipment/Supplies

  • Oxygen source or compressed air.
  • Connective small bore tubing.*
  • Nebulizer cup.*
  • Aerosol medication.
  • Sterile normal saline.
  • Mouthpiece or adapter if client has a tracheostomy.
  • Disposable gloves, as needed.

* Note: You may use a universal Intermittent Positive Pressure Breathing circuit if the client is on a ventilator.

Foley Catheter and Foley Irrigation Station

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Foley Catheter and Foley Irrigation Station

Urinary Catheter Insertion Straight or Indwelling Catheter

Purpose

  • Obtain a sterile urine specimen.
  • Facilitate emptying bladder.
  • Relieve bladder distention.
  • Irrigate bladder.
  • Measure residual urine.
  • Manage bladder incontinence.
  • Provide an accurate measurement of output.

Applies To

  • Registered Nurses
  • Licensed Practical/Vocational Nurses

Equipment/Supplies

  • Catheter insertion kit (verify size and type of catheter required for procedure) or the following individual items:
  • Individual catheter (verify size and type of catheter required for procedure).
  • Sterile gloves.
  • Clean, disposable gloves.
  • Two sterile drapes, one of which is fenestrated.
  • Sterile water soluble lubricant.
  • Antiseptic cleansing solution.
  • Sterile cotton balls.
  • Sterile forceps.
  • 10 ml syringe, pre-filled with normal saline (used with indwelling catheter to inflate the balloon).
  • Sterile drainage bag or leg bag if inserting indwelling catheter.
  • Leg strap or tape if inserting indwelling catheter.
  • Sterile specimen container (if specimen is to be collected).
  • Sterile receptacle or basin.
  • Sterile irrigation kit with sterile bulb syringe and container for irrigation, if irrigation ordered.
  • Sterile normal saline solution.
  • Warm water, soap, washcloth, and towel.
  • Waterproof pad.