Interpretation of Ventilator Alarms (Nursing)

by Rhonda Lawes, PhD, RN

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    00:01 This portion of our video series, I'm going to teach you the minimum basics that every nurse needs to know about the alarms on a ventilator.

    00:08 Alright, one of the best ways to learn these is to also connect with that respiratory therapist.

    00:13 And they're usually really excited about teaching someone who's interested in learning more about pulmonary care.

    00:20 But let me give you what you need to know.

    00:22 See the four on that screen? Yes, those are the minimum basic survival skills, I want you to know about what it means when an alarm goes off.

    00:32 First one, high-pressure.

    00:34 So what is going on? We've got a human connected to a ventilator.

    00:38 Now it's saying high pressure.

    00:40 Well, high pressure is also known as high peak pressure alarm.

    00:44 Now, some of the most serious causes it could be is like pulmonary edema, or even in pneumothorax.

    00:50 This can be a really big deal. But here's let me caution you.

    00:54 When I was a new grad, boy, every alarm, I responded to like it was a code blue.

    00:59 As you gain experience, you'll recognize and you work with different patients, what their kind of rhythm is, and what things that are experiencing.

    01:07 So don't be alarmed if you don't see people flying out of their chairs, every time they hear something.

    01:14 These patients are taking care by experts who know what to expect, they know what else is going on in that patient's body.

    01:20 So while a high pressure alarm absolutely needs to be investigated.

    01:25 And there could be a really serious cause.

    01:28 It may not have to be that someone's in pulmonary edema or pneumothorax.

    01:32 So, talk to the experts. Learn right alongside them with real live patients.

    01:39 Now, here's some other reasons.

    01:40 They could just have excessive secretions.

    01:42 That's not good. But I started with the worst case scenario.

    01:47 Now let's talk about some other reasons that you're going to see the high pressure alarm go off.

    01:51 Excess secretions, we don't want that for anybody.

    01:55 I mean, they got a lot of gunk going in their airways, and it's no big deal.

    01:58 You'll also see this if the patient is biting on the tube.

    02:04 And I've heard a lot of nurses use some ineffective coping strategies with patients when they do that.

    02:09 But keep in mind, you're on a ventilator.

    02:11 You're breathing through what can feel to you like a drinking straw. You feel completely out of control.

    02:19 So sometimes it's a stress response and anxiety response or just a response to what the heck is this in my mouth.

    02:26 Most patients on a ventilator may not be at the period where they have really clear cognitive skills.

    02:32 So, know that biting on the tube is just something that happens regularly with patients Yelling at them to stop biting on the tube never works.

    02:41 So when your high pressure alarm goes off, I want you to run through the possible things that it could be see which one is most likely to be happening in your patient.

    02:50 Coughing is another reason.

    02:52 So patients can cough, kind of when they're on the ventilator.

    02:57 Are you going to see air come out of their mouth? No, because remember, we have bypassed their upper airways and put a tube in there.

    03:05 So, if a patient is still irritated.

    03:07 Things or they still have the actions of coughing, this can also set off their high pressure alarm.

    03:12 Check and make sure the tubing isn't kinked that can also cause an increase in pressure, because air is not flowing freely from the ventilator to the patient.

    03:22 Okay, so let's put this into practice.

    03:24 You're in a critical care unit.

    03:26 You're taking care of a patient on a ventilator High pressure alarms are going off.

    03:30 Well, you know, the worst case scenario would be something like pulmonary edema, or pneumothorax.

    03:35 Those are not most often the common reasons for it.

    03:39 But those you want filed away in your brain to know that they're the most serious.

    03:42 Now, there's four other things I want you to think through first to see if that's the possibility going on.

    03:49 So our patient has four reasons.

    03:51 I'll go in there and see, "Man, does it look like they have excess secretions? Have they needed to be suctioned? Do they appear to be biting on the tube? Are they [cough sound sample] showing you that coughing action like that airway is irritated? Or look at the tubing.

    04:07 Follow the tubing from the patient, to the ventilator, and make sure it's not kinked.

    04:13 If none of those things are happening, then you have to really start asking, wow, is our worst case scenario happening? That's what you want to do when you're responding to a high pressure alarm.

    04:22 Think through all the possibilities. Once you've ruled them out, then think we might have this other issue as a problem.

    04:30 Here's what I want you to think about with a low pressure alarm, if you hear this in a patient that you're caring for.

    04:35 First you need to go in and check the patient.

    04:37 You're going to initially scan the patient and make sure that ET tube does not appear to be displaced.

    04:44 The tubing is connected, right? Those are the first two obvious things we're going to look for.

    04:49 Now, sometime this alarm is also referred to as low tidal volume alarm.

    04:53 So I want to make sure that ET tube is in the right place.

    04:57 And all the tubing is connected.

    05:00 Now, what are the other possibilities that could be happening? Well, we could have someone who has moved that tube.

    05:07 How would I know it? Because I know where the placement of the tube is.

    05:11 I know how far it is in the patient, I've got that marked.

    05:14 And if that has been moved, or if the tube is completely out of the patient, that's going to be a really obvious sign.

    05:21 Might be something like the cuff leaking.

    05:23 Remember, the cuff is at the end of that endotracheal tube.

    05:26 If that has developed a slow leak, you start to hear low pressure alarms.

    05:31 So, when you hear low pressure, the ventilator is telling you, "Hey, it's not taking as much effort for me to push air into this patient, something's wrong." What could it be? Tubes not in the right place.

    05:44 The circuit of the tubing is disconnected.

    05:47 Those are two of the most obvious reasons.

    05:50 The low minute ventilation alarm is a different type of alarm.

    05:54 Now this could happen when you have a decreased respiratory rate.

    05:58 Because low minute ventilation is the ventilators way of telling you, "Hey, they're not getting as much volume in a minute as we had intended, or what the ventilator settings are." One way to get their is to just breathe less often.

    06:13 Right? So they have a decreased respiratory rate.

    06:16 Since they're taking fewer breaths per minute, they have a lower volume.

    06:21 Another option could be decreased tidal volume.

    06:23 They're not taking adequately deep enough breaths.

    06:26 Now, we'll get into ventilator settings.

    06:29 But for now, just think about low minute ventilation means you're not getting as much air in and out in a minute.

    06:35 As we have settings, causes could be respiratory rate is too low for what this patient needs. The tidal volume is decreased.

    06:42 They're taking shallower breaths than we intended.

    06:45 And remember, this alarm setting if it hasn't been adjusted, and there's been a clinical change in the patient that can also be going off.

    06:52 So, when I have a low minute ventilation, I know what can cause it.

    06:57 Not enough press, not deep enough press.

    07:00 But I want to make sure that there haven't been any recent ventilator changes or clinical changes in the patient.

    07:05 That would also give me clues as to why low minute ventilator alarms were going off.

    07:12 The apnea alarm is a different type of alarm too.

    07:16 Now you pretty much know what apnea means.

    07:19 A is without. So this is somebody who is not breathing.

    07:23 You won't really see this unless the patient is in a spontaneous mode like SIMV or on CPAP.

    07:28 Now, SIMV, we're going to break those down a little bit.

    07:32 CPAP is that Continuous Positive Airway Pressure.

    07:35 Now the patient is not initiating a breath and that's why the apnea alarm is going off.

    07:41 There'll be a time limit set. Maybe it's four seconds or whatever the timing is set based on that particular patient, when they go longer than that without initiating a breath.

    07:51 the apnea alarm will go off.

    About the Lecture

    The lecture Interpretation of Ventilator Alarms (Nursing) by Rhonda Lawes, PhD, RN is from the course Mechanical Ventilation (Nursing).

    Included Quiz Questions

    1. Pulmonary edema
    2. Coughing
    3. Kinked tubing
    4. Disconnected tubing
    5. Self-extubation
    1. Disconnected tubing
    2. Self-extubation
    3. Decreased respiratory rate
    4. Coughing
    5. Pneumothorax
    1. Decreased respiratory rate
    2. Decreased tidal volume
    3. Misplaced ET tube
    4. Kinked tubing
    5. Coughing
    1. Check the ventilator tubing for kinks.
    2. Request an order for an x-ray to check tube placement.
    3. Auscultate the client’s lungs to rule out pneumothorax.
    4. Check how many breaths per minute the ventilator is set at.

    Author of lecture Interpretation of Ventilator Alarms (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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